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Abstract：
BACKGROUND: The study determined the proportion of patients with pancreatic adenocarcinoma (PDAC) who had margin-positive disease and no other adverse pathologic findings (APF) using institutional and administrative datasets.
METHODS: Patients with clinical stage I or II PDAC in the National Cancer Database (NCDB 2010-2020) and those who underwent pancreatectomy at the authors\' institution (2010-2021) were identified. Isolated margin positivity (IMP) was defined as a positive surgical margin with no APF (negative nodes, no lymphovascular/perineural invasion).
RESULTS: The study included 225 patients from the authors\' institution and 23,598 patients from the NCDB. The margin-positive rates were 21.8% and 20.3%, and the IMP rates were 0.4% and 0.5%, respectively. In the institutional cohort, 68.4% of the patients had recurrence, and most of the patients (65.6%) had distant recurrences. The median recurrence-free survival (RFS) was 63.3 months for no APF, not reached for IMP, 14.8 months for negative margins & 1 APF, 20.3 months for positive margins & 2 APFs, and 12.9 months with all APF positive. The patients in the NCDB with IMP had a lower median OS than the patients with no APF (20.5 vs 390 months), but a higher median OS than those with margin positivity plus 1 APF (20.5 vs 18.0 months) or all those with APF positivity (20.5 vs 15.4 months). Based on institutional rates of IMP, any margin positivity, neck margin positivity (NMP), and no APF, the fraction of patients who might benefit from neck margin revision was 1 in 100,000, and those likely to benefit from any margin revision was 1 in 18,500. In the NCDB, those estimated to derive potential benefit from margin revision was 1 in 25,000.
CONCLUSIONS: Isolated margin positivity in resected PDAC is rare, and most patients experience distant recurrence. Revision of IMP appears unlikely to confer benefit to most patients.
METHODS: Patients with clinical stage I or II PDAC in the National Cancer Database (NCDB 2010-2020) and those who underwent pancreatectomy at the authors\' institution (2010-2021) were identified. Isolated margin positivity (IMP) was defined as a positive surgical margin with no APF (negative nodes, no lymphovascular/perineural invasion).
RESULTS: The study included 225 patients from the authors\' institution and 23,598 patients from the NCDB. The margin-positive rates were 21.8% and 20.3%, and the IMP rates were 0.4% and 0.5%, respectively. In the institutional cohort, 68.4% of the patients had recurrence, and most of the patients (65.6%) had distant recurrences. The median recurrence-free survival (RFS) was 63.3 months for no APF, not reached for IMP, 14.8 months for negative margins & 1 APF, 20.3 months for positive margins & 2 APFs, and 12.9 months with all APF positive. The patients in the NCDB with IMP had a lower median OS than the patients with no APF (20.5 vs 390 months), but a higher median OS than those with margin positivity plus 1 APF (20.5 vs 18.0 months) or all those with APF positivity (20.5 vs 15.4 months). Based on institutional rates of IMP, any margin positivity, neck margin positivity (NMP), and no APF, the fraction of patients who might benefit from neck margin revision was 1 in 100,000, and those likely to benefit from any margin revision was 1 in 18,500. In the NCDB, those estimated to derive potential benefit from margin revision was 1 in 25,000.
CONCLUSIONS: Isolated margin positivity in resected PDAC is rare, and most patients experience distant recurrence. Revision of IMP appears unlikely to confer benefit to most patients.
摘要：
背景：该研究使用机构和管理数据集确定了胰腺腺癌（PDAC）患者中边缘阳性且无其他不良病理结果（APF）的比例。
方法：确定了国家癌症数据库（NCDB2010-2020）中的临床I期或II期PDAC患者以及作者机构（2010-2021）中接受胰腺切除术的患者。孤立切缘阳性（IMP）定义为无APF的手术切缘阳性（阴性淋巴结，无淋巴管/神经周侵犯)。
结果：该研究包括来自作者机构的225名患者和来自NCDB的23,598名患者。边缘阳性率分别为21.8%和20.3%,IMP率分别为0.4%和0.5%，分别。在机构群体中，68.4%的患者复发,大多数患者（65.6％）有远处复发。无APF的中位无复发生存期（RFS）为63.3个月，没有达到IMP，14.8个月的负利润率和1个APF，20.3个月的正利润率和2个APF，12.9个月，所有APF均为阳性。有IMP的NCDB患者的中位OS低于无APF的患者（20.5vs390个月），但中位OS高于边缘阳性加1个APF的患者(20.5vs18.0个月)或所有APF阳性患者(20.5vs15.4个月)。根据IMP的机构费率，任何利润率积极，颈部边缘阳性（NMP），没有APF,可能从颈部边缘翻修术中获益的患者比例为1/100,000,而可能从任何边缘翻修术中获益的患者比例为1/18,500.在NCDB中，估计从利润率修正中获得潜在收益的人数为25,000人中有1人。
结论：在切除的PDAC中，孤立的边缘阳性是罕见的，大多数患者经历远处复发。IMP的修订似乎不太可能使大多数患者受益。
方法：确定了国家癌症数据库（NCDB2010-2020）中的临床I期或II期PDAC患者以及作者机构（2010-2021）中接受胰腺切除术的患者。孤立切缘阳性（IMP）定义为无APF的手术切缘阳性（阴性淋巴结，无淋巴管/神经周侵犯)。
结果：该研究包括来自作者机构的225名患者和来自NCDB的23,598名患者。边缘阳性率分别为21.8%和20.3%,IMP率分别为0.4%和0.5%，分别。在机构群体中，68.4%的患者复发,大多数患者（65.6％）有远处复发。无APF的中位无复发生存期（RFS）为63.3个月，没有达到IMP，14.8个月的负利润率和1个APF，20.3个月的正利润率和2个APF，12.9个月，所有APF均为阳性。有IMP的NCDB患者的中位OS低于无APF的患者（20.5vs390个月），但中位OS高于边缘阳性加1个APF的患者(20.5vs18.0个月)或所有APF阳性患者(20.5vs15.4个月)。根据IMP的机构费率，任何利润率积极，颈部边缘阳性（NMP），没有APF,可能从颈部边缘翻修术中获益的患者比例为1/100,000,而可能从任何边缘翻修术中获益的患者比例为1/18,500.在NCDB中，估计从利润率修正中获得潜在收益的人数为25,000人中有1人。
结论：在切除的PDAC中，孤立的边缘阳性是罕见的，大多数患者经历远处复发。IMP的修订似乎不太可能使大多数患者受益。
