Pancreatic cancer resectability criteria could be simpler

Last Updated: 2017-07-06

By Reuters Staff

NEW YORK (Reuters Health) – The pancreatic cancer resectability criteria advocated by the National Comprehensive Cancer Network (NCCN) may be more complicated than necessary, Japanese researchers say.

In a July 24 online paper in Surgery, Dr. Suguru Yamada and colleagues at Nagoya University Graduate School of Medicine note that in particular, borderline resectable (BR) pancreatic cancers are of interest as they are at high risk for margin-positive resection.

The team reviewed data on 382 patients who underwent curative resection for pancreatic cancer at their institution between 2001 and 2015, in order to find survival differences among subgroups classified according to novel criteria proposed by the Japan Pancreas Society (JPS).

Although the new system is based on NCCN guidelines, it doesn’t consider neoplasm location or variant arterial anatomy.

Patient groups were defined as resectable, resectable with portal vein invasion, borderline resectable with portal vein invasion, borderline resectable with arterial invasion, and unresectable by locally advanced disease. Corresponding survival was 34.2, 29.7, 17.3, 14.3, and 15.8 months.

The overall survival of the resectable group was significantly greater than that in the borderline resectable with portal vein invasion or borderline resectable with arterial invasion groups. Each survival curve, say the investigators, was clearly separated based on JPS resectability criteria.

After resection, the initial patterns of recurrence were investigated based on the JPS criteria of resectability or on tumor location. When patients were diagnosed preoperatively as borderline resectable with arterial invasion, recurrence rates were high (42.0%). This was also the case in those with unresectable locally advanced disease (44.8%).

When survival was calculated according to tumor location, survival of patients with tumors in the uncinate process or neck of the pancreas was found to be worse than that of patients with tumors in other locations.

When 2012 NCCN criteria were employed, median overall survival for resectable, portal invasion, common hepatic artery and superior mesenteric artery invasion groups, respectively, was 30.5, 20.5, 15.8, and 13.8 months.

Thus, say the investigators, the JPS criteria are simpler and effectively predicted survival differences between the resectable group and the other subgroups. They also suggest that patients who are borderline resectable with portal vein invasion and borderline resectable with arterial invasion can be managed as a single subgroup.

Dr. Yamada did not respond to requests for comments.

SOURCE: http://bit.ly/2tmbcgg

Surgery 2017.