A margin distance analysis of the impact of adjuvant chemoradiation on survival after pancreatoduodenectomy for pancreatic adenocarcinoma

Lee M. Ocuin, Jennifer L. Miller-Ocuin, Mazen S. Zenati, John A. Vargo, Aatur D. Singhi, Steven A. Burton, Nathan Bahary, Melissa E. Hogg, Herbert J. Zeh, Amer H. Zureikat

Research output: Contribution to journalArticle

Abstract

Background: The role of adjuvant chemoradiotherapy (CRT) following pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma (PDA) remains controversial. Recent data suggest that increased margin clearance (MC: distance between tumor and cut surface) is associated with improved survival after PD, but the role of adjuvant CRT in patients with known MC is undefined. We sought to delineate the impact of adjuvant CRT on survival based on MC following PD. Methods: Patients who underwent PD for PDA between 2002 and 2014 were retrospectively stratified into three groups based on MC: 0 mm, ≤1 mm, and > 1 mm. The impact of CRT on survival in each MC group was determined by univariate and multivariate analysis. Results: Three hundred and ten patients with known MC were analyzed (0 mm =67, ≤1 mm =113, and > 1 mm =130). Increasing MC was independently associated with improved OS (≤1 mm, HR 0.66, 95% CI 0.46-0.96, P=0.03; > 1 mm, HR 0.51, 95% CI 0.35-0.75, P=0.001; compared to 0 mm). Adjuvant CRT was administered to 62 patients (20%). On margin-stratified multivariate analysis, adjuvant CRT was independently associated with increased OS in patients with ≤1 mm margins (HR 0.36; 95% CI 0.18-0.69, P=0.002) but not for 0 mm and > 1 mm margins. Conclusions: This analysis suggests that the benefit of adjuvant CRT may be restricted to patients with ≤1 mm MC after PD for pancreatic cancer.

Original languageEnglish (US)
Pages (from-to)696-704
Number of pages9
JournalJournal of Gastrointestinal Oncology
Volume8
Issue number4
DOIs
StatePublished - Aug 1 2017
Externally publishedYes

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Adjuvant Chemoradiotherapy
Pancreaticoduodenectomy
Adenocarcinoma
Survival
Multivariate Analysis
Chemoradiotherapy
Pancreatic Neoplasms

Keywords

  • Adjuvant
  • Chemoradiotherapy (CRT)
  • Margins
  • Pancreatic adenocarcinoma (PDA)
  • Pancreaticoduodenectomy (PD)

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology

Cite this

A margin distance analysis of the impact of adjuvant chemoradiation on survival after pancreatoduodenectomy for pancreatic adenocarcinoma. / Ocuin, Lee M.; Miller-Ocuin, Jennifer L.; Zenati, Mazen S.; Vargo, John A.; Singhi, Aatur D.; Burton, Steven A.; Bahary, Nathan; Hogg, Melissa E.; Zeh, Herbert J.; Zureikat, Amer H.

In: Journal of Gastrointestinal Oncology, Vol. 8, No. 4, 01.08.2017, p. 696-704.

Research output: Contribution to journalArticle

Ocuin, LM, Miller-Ocuin, JL, Zenati, MS, Vargo, JA, Singhi, AD, Burton, SA, Bahary, N, Hogg, ME, Zeh, HJ & Zureikat, AH 2017, 'A margin distance analysis of the impact of adjuvant chemoradiation on survival after pancreatoduodenectomy for pancreatic adenocarcinoma', Journal of Gastrointestinal Oncology, vol. 8, no. 4, pp. 696-704. https://doi.org/10.21037/jgo.2017.04.02
Ocuin, Lee M. ; Miller-Ocuin, Jennifer L. ; Zenati, Mazen S. ; Vargo, John A. ; Singhi, Aatur D. ; Burton, Steven A. ; Bahary, Nathan ; Hogg, Melissa E. ; Zeh, Herbert J. ; Zureikat, Amer H. / A margin distance analysis of the impact of adjuvant chemoradiation on survival after pancreatoduodenectomy for pancreatic adenocarcinoma. In: Journal of Gastrointestinal Oncology. 2017 ; Vol. 8, No. 4. pp. 696-704.
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abstract = "Background: The role of adjuvant chemoradiotherapy (CRT) following pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma (PDA) remains controversial. Recent data suggest that increased margin clearance (MC: distance between tumor and cut surface) is associated with improved survival after PD, but the role of adjuvant CRT in patients with known MC is undefined. We sought to delineate the impact of adjuvant CRT on survival based on MC following PD. Methods: Patients who underwent PD for PDA between 2002 and 2014 were retrospectively stratified into three groups based on MC: 0 mm, ≤1 mm, and > 1 mm. The impact of CRT on survival in each MC group was determined by univariate and multivariate analysis. Results: Three hundred and ten patients with known MC were analyzed (0 mm =67, ≤1 mm =113, and > 1 mm =130). Increasing MC was independently associated with improved OS (≤1 mm, HR 0.66, 95{\%} CI 0.46-0.96, P=0.03; > 1 mm, HR 0.51, 95{\%} CI 0.35-0.75, P=0.001; compared to 0 mm). Adjuvant CRT was administered to 62 patients (20{\%}). On margin-stratified multivariate analysis, adjuvant CRT was independently associated with increased OS in patients with ≤1 mm margins (HR 0.36; 95{\%} CI 0.18-0.69, P=0.002) but not for 0 mm and > 1 mm margins. Conclusions: This analysis suggests that the benefit of adjuvant CRT may be restricted to patients with ≤1 mm MC after PD for pancreatic cancer.",
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T1 - A margin distance analysis of the impact of adjuvant chemoradiation on survival after pancreatoduodenectomy for pancreatic adenocarcinoma

AU - Ocuin, Lee M.

AU - Miller-Ocuin, Jennifer L.

AU - Zenati, Mazen S.

AU - Vargo, John A.

AU - Singhi, Aatur D.

AU - Burton, Steven A.

AU - Bahary, Nathan

AU - Hogg, Melissa E.

AU - Zeh, Herbert J.

AU - Zureikat, Amer H.

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Background: The role of adjuvant chemoradiotherapy (CRT) following pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma (PDA) remains controversial. Recent data suggest that increased margin clearance (MC: distance between tumor and cut surface) is associated with improved survival after PD, but the role of adjuvant CRT in patients with known MC is undefined. We sought to delineate the impact of adjuvant CRT on survival based on MC following PD. Methods: Patients who underwent PD for PDA between 2002 and 2014 were retrospectively stratified into three groups based on MC: 0 mm, ≤1 mm, and > 1 mm. The impact of CRT on survival in each MC group was determined by univariate and multivariate analysis. Results: Three hundred and ten patients with known MC were analyzed (0 mm =67, ≤1 mm =113, and > 1 mm =130). Increasing MC was independently associated with improved OS (≤1 mm, HR 0.66, 95% CI 0.46-0.96, P=0.03; > 1 mm, HR 0.51, 95% CI 0.35-0.75, P=0.001; compared to 0 mm). Adjuvant CRT was administered to 62 patients (20%). On margin-stratified multivariate analysis, adjuvant CRT was independently associated with increased OS in patients with ≤1 mm margins (HR 0.36; 95% CI 0.18-0.69, P=0.002) but not for 0 mm and > 1 mm margins. Conclusions: This analysis suggests that the benefit of adjuvant CRT may be restricted to patients with ≤1 mm MC after PD for pancreatic cancer.

AB - Background: The role of adjuvant chemoradiotherapy (CRT) following pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma (PDA) remains controversial. Recent data suggest that increased margin clearance (MC: distance between tumor and cut surface) is associated with improved survival after PD, but the role of adjuvant CRT in patients with known MC is undefined. We sought to delineate the impact of adjuvant CRT on survival based on MC following PD. Methods: Patients who underwent PD for PDA between 2002 and 2014 were retrospectively stratified into three groups based on MC: 0 mm, ≤1 mm, and > 1 mm. The impact of CRT on survival in each MC group was determined by univariate and multivariate analysis. Results: Three hundred and ten patients with known MC were analyzed (0 mm =67, ≤1 mm =113, and > 1 mm =130). Increasing MC was independently associated with improved OS (≤1 mm, HR 0.66, 95% CI 0.46-0.96, P=0.03; > 1 mm, HR 0.51, 95% CI 0.35-0.75, P=0.001; compared to 0 mm). Adjuvant CRT was administered to 62 patients (20%). On margin-stratified multivariate analysis, adjuvant CRT was independently associated with increased OS in patients with ≤1 mm margins (HR 0.36; 95% CI 0.18-0.69, P=0.002) but not for 0 mm and > 1 mm margins. Conclusions: This analysis suggests that the benefit of adjuvant CRT may be restricted to patients with ≤1 mm MC after PD for pancreatic cancer.

KW - Adjuvant

KW - Chemoradiotherapy (CRT)

KW - Margins

KW - Pancreatic adenocarcinoma (PDA)

KW - Pancreaticoduodenectomy (PD)

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