背景：本研究的目的是验证2017年国际共识在三个解剖维度（A）的基础上提供的临界可切除胰腺导管腺癌（PDAC）的新定义。生物（B），和条件(C)因素，使用已在我们的机构方案中注册的局部PDAC患者的放化疗后手术(CRTS)的患者数据.方法：在2005年2月至2016年12月纳入CRTS方案的307例经病理诊断为局部PDAC的患者中，我们选择了285例可以在CRT后重新评估的患者。根据国际共识A定义将这285例患者分类如下：R（可切除；n=62），BR-PV（边缘可切除，肠系膜上静脉（SMV）/门静脉（PV）单独受累；n=27），BR-A(边界线可切除,动脉受累；n=50），LA(局部推进;n=146)。根据A，B（CRT前通过计算机断层扫描检查发现的血清CA19-9水平和淋巴结转移），和C因素(性能状态(PS))因素。结果：R（83.9％和98.0％）和BR-PV（85.2％和95.5％）的切除率和R0切除率相似，但在BR-A（70.0和84.8%）和LA（46.6和62.5%）中低得多。通过中位生存时间（月）评估的DSS显示出与手术结果相似的趋势：R，27.3英寸BR-PV，BR-A为18.9，洛杉矶为19.3，分别。CA19-9水平>500U/mL的R患者的DSS明显低于CA19-9水平≤500U/mL的患者，但是BR-PV之间的DSS没有差异，BR-A,和LA患者根据CA19-9水平。关于淋巴结转移，根据每个可切除组，DSS没有显着差异。PS≥2的R患者的DSS明显低于PS0-1患者。结论:基于A的三个维度对BR-PDAC定义的国际共识,B,和C是有用和可行的，因为PDAC患者的预后受解剖因素以及生物学和条件因素的影响，这反过来可能有助于决定治疗策略。
Background: The aim of this study was to validate a new definition of borderline resectable pancreatic ductal adenocarcinoma (PDAC) provided by the 2017 international
consensus on the basis of three dimensions of anatomical (A), biological (B), and conditional (C) factors, using the data of the patients who had been registered for our institutional protocol of chemoradiotherapy followed by surgery (CRTS) for localized patients with PDAC. Methods: Among 307 consecutive patients pathologically diagnosed with localized PDAC who were enrolled in our CRTS protocol from February 2005 to December 2016, we selected 285 patients who could be re-evaluated after CRT. These 285 patients were classified according to international
consensus A definitions as follows: R (resectable; n = 62), BR-PV (borderline resectable, superior mesenteric vein (SMV)/portal vein (PV) involvement alone; n = 27), BR-A (borderline resectable, arterial involvement; n = 50), LA (locally advanced; n = 146). Disease-specific survival (DSS) was analyzed according to A, B (serum CA 19-9 levels and lymph node metastasis diagnosed by computed tomography findings before CRT), and C factors (performance status (PS)) factors. Results: The rates of resection and R0 resection were similar between R (83.9 and 98.0%) and BR-PV (85.2 and 95.5%), but much lower in BR-A (70.0 and 84.8%) and LA (46.6 and 62.5%). DSS evaluated by median survival time (months) showed a similar trend to surgical outcomes: 33.7 in R, 27.3 in BR-PV, 18.9 in BR-A and 19.3 in LA, respectively. DSS in R patients with CA 19-9 levels > 500 U/mL was significantly poorer than in patients with CA 19-9 levels ≤ 500 U/mL, but there were no differences in DSS among BR-PV, BR-A, and LA patients according to CA 19-9 levels. Regarding lymph node metastasis, there was no significant difference in DSS according to each resectability group. DSS in R patients with PS ≥ 2 was significantly worse than in patients with PS 0-1. Conclusions: The international
consensus on the definition of BR-PDAC based on three dimensions of A, B, and C is useful and practicable because prognosis of PDAC patients is influenced by anatomical factors as well as biological and conditional factors, which in turn may help to decide treatment strategy.
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