ASO Author Reflections: Margin-Positive Pancreatic Ductal Adenocarcinoma During Pancreaticoduodenectomy: Additional Resection Does Not Improve Survival

Zheng, Richard; Nauheim, David; Bassig, Jonathan; Chadwick, Matthew; Schultz, Christopher W.; Krampitz, Geoffrey W.; Lavu, Harish; Winter, J.; Yeo, Charles J.; Berger, Adam C.

doi:10.1245/s10434-020-09031-2

Cited by 2 publications

(2 citation statements)

References 5 publications

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“…However, R0 resection was not an independent predictor of survival in the present (p = 0.385), which may be related to the fact that the vast majority of patients in the NAT cohort received postoperative adjuvant therapy. A cohort study of 501 patients undergoing pancreaticoduodenectomy showed that adjuvant therapy improved survival and equalized survival curves for patients with positive and negative margins, regardless of resection status 39 .…”

Section: Discussionmentioning

confidence: 99%

A Neoadjuvant Therapy Compatible Prognostic Staging for Resected Pancreatic Ductal Adenocarcinoma

Zhu

Shen

Wang

et al. 2023

Preprint

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Objective: A refined staging system compatible with upfront surgery (UFS) and neoadjuvant therapy (NAT) for PDAC was developed to revise the prediction ability of the AJCC staging system. Background: The AJCC staging system was developed for patients who have undergone UFS for PDAC, and it has limited prognostic ability for patients receiving NAT. Methods: We analyzed 146 PDAC patients who underwent resection after NAT and 1771 patients who underwent UFS between 2012 and 2021 at the Changhai Hospital. Cox proportional regression analysis was used to identify the clinicopathological features and the Neoadjuvant Therapy Compatible Prognostic (NATCP) staging was designed based on these variables. Validation was performed in the prospective NAT cohort and the SEER database. The staging system was then compared with the AJCC staging system in terms of prognostic accuracy. Results: The multivariate analysis demonstrated that tumor differentiation and number of positive lymph nodes were independently associated with OS in the NAT cohort. The NATCP staging simplified the AJCC stages, incorporated tumor differentiation and restaged the disease according to the survival differences observed in the Kaplan-Meier curves. The median OS for NATCP stages IA, IB, II and III were not reached, 31.7 months, 25.0 months, 15.8 months in the NAT cohort and 30.1 months, 22.8 months, 18.3 months ,14.1 months in the UFS cohort. The NATCP staging demonstrated better accuracy compared with the AJCC staging system and was validated in the validation cohort. Conclusions: The NATCP staging provided better prognostic ability than the current AJCC staging system for resected PDAC regardless of the use of NAT and may facilitate clinical decision-making based on accurate prediction of OS of patients.

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Section: Discussionmentioning

confidence: 99%

A Neoadjuvant Therapy Compatible Prognostic Staging for Resected Pancreatic Ductal Adenocarcinoma

Zhu

Shen

Wang

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

A neoadjuvant therapy compatible prognostic staging for resected pancreatic ductal adenocarcinoma

Zhu,

Shen,

Wang

et al. 2023

BMC Cancer

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Objective To improve prediction, the AJCC staging system was revised to be consistent with upfront surgery (UFS) and neoadjuvant therapy (NAT) for PDAC. Background The AJCC staging system was designed for patients who have had UFS for PDAC, and it has limited predictive power for patients receiving NAT. Methods We examined 146 PDAC patients who had resection after NAT and 1771 who had UFS at Changhai Hospital between 2012 and 2021. The clinicopathological factors were identified using Cox proportional regression analysis, and the Neoadjuvant Therapy Compatible Prognostic (NATCP) staging was developed based on these variables. Validation was carried out in the prospective NAT cohort and the SEER database. The staging approach was compared to the AJCC staging system regarding predictive accuracy. Results The NAT cohort’s multivariate analysis showed that tumor differentiation and the number of positive lymph nodes independently predicted OS. The NATCP staging simplified the AJCC stages, added tumor differentiation, and restaged the disease based on the Kaplan-Meier curve survival differences. The median OS for NATCP stages IA, IB, II, and III was 31.7 months, 25.0 months, and 15.8 months in the NAT cohort and 30.1 months, 22.8 months, 18.3 months, and 14.1 months in the UFS cohort. Compared to the AJCC staging method, the NATCP staging system performed better and was verified in the validation cohort. Conclusions Regardless of the use of NAT, NATCP staging demonstrated greater predictive abilities than the existing AJCC staging approach for resected PDAC and may facilitate clinical decision-making based on accurate prediction of patients’ OS.

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ASO Author Reflections: Margin-Positive Pancreatic Ductal Adenocarcinoma During Pancreaticoduodenectomy: Additional Resection Does Not Improve Survival

Cited by 2 publications

References 5 publications

A Neoadjuvant Therapy Compatible Prognostic Staging for Resected Pancreatic Ductal Adenocarcinoma

A Neoadjuvant Therapy Compatible Prognostic Staging for Resected Pancreatic Ductal Adenocarcinoma

A neoadjuvant therapy compatible prognostic staging for resected pancreatic ductal adenocarcinoma

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