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Abstract：
The influencing role of resection margin (R) status on long-term outcomes, namely overall (OS) and disease-free survival (DFS), after pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) is not still clear. The aim of this study is to evaluate the prognostic impact of R status after PD and to define tumor characteristics associated with a positive resection margin (R1). All PDs for PDAC performed between 2012 and 2023 were retrospectively enrolled. The effect of R status, patient clinico-demographic features, and tumor features on OS and DFS were assessed. One-hundred and sixty-seven patients who underwent PD for PDAC were included in the study. R0 was achieved in 105 cases (62.8%), while R1 was evidenced in 62 patients (37.1%). R1 was associated with a decreased OS (23 (13-38) months) as compared to R0 (36 (21-53) months) (p = 0.003). Similarly, DFS was shorter in R1 patients (10 (6-25) months) as compared to the R0 cohort (18 (9-70) months) (p = 0.004), with a consequent higher recurrence rate in cases of R1 (74.2% vs. 64.8% in the R0 group; p = 0.04). In the multivariate analysis, R1 and positive lymph nodes (N+) were the only independent influencing factors for OS (OR: 1.6; 95% CI: 1-2.5; p = 0.03 and OR: 1.7; 95% CI: 1-2.8; p = 0.04) and DFS (OR: 1.5; 95% CI: 1-2.1; p = 0.04 and OR: 1.8; 95% CI: 1.1-2.7; p = 0.009). Among 111 patients with N+ disease, R1 was associated with a significantly decreased DFS (10 (8-11) months) as compared to R0N+ patients (16 (11-21) months) (p = 0.05). In conclusion, the achievement of a negative resection margin is associated with survival benefits, particularly in cases of N1 disease. In addition, R0 was recognized as an independent prognostic feature for both OS and DFS. This further outlines the relevant role of radical surgery on long-term outcomes.
摘要：
切除边缘（R）状态对长期结局的影响作用，即总体生存期(OS)和无病生存期(DFS)，胰十二指肠切除术（PD）后胰腺导管腺癌（PDAC）尚不清楚。这项研究的目的是评估PD后R状态的预后影响，并定义与阳性切除边缘（R1）相关的肿瘤特征。回顾性纳入2012年至2023年期间进行的所有PDACPDs。R状态的影响，患者临床人口统计特征，并在OS和DFS上评估肿瘤特征。该研究纳入了一百六十七名因PDAC而接受PD的患者。105例（62.8%）达到R0，而R1在62例患者中得到证实(37.1%)。与R0（36（21-53）个月）相比，R1与OS降低（23（13-38）个月）相关（p=0.003）。同样，与R0组（18（9-70）个月）相比，R1组患者的DFS较短（10（6-25）个月）（p=0.004），在R1病例中，复发率更高(74.2%vs.R0组为64.8%；p=0.04)。在多变量分析中，R1和阳性淋巴结（N）是OS（OR：1.6；95％CI：1-2.5；p=0.03和OR：1.7；95％CI：1-2.8；p=0.04）和DFS（OR：1.5；95％CI：1-2.1；p=0.04和OR：1.8；95％CI：1.1-2.7；p=0.009）的唯一独立影响因素。在111例N+疾病患者中，与R0N+患者(16(11-21)个月)相比,R1与DFS显著降低(10(8-11)个月)相关(p=0.05)。总之,负切除边缘的实现与生存益处相关，特别是在N1疾病的情况下。此外,R0被认为是OS和DFS的独立预后特征。这进一步概述了根治性手术对长期结果的相关作用。
