Validation of a prediction rule to maximize curative (R0) resection of early-stage pancreatic adenocarcinoma

Philip Bao, Douglas Potter, David P. Eisenberg, Diana Lenzner, Herbert J. Zeh, Kenneth K.W. Lee, Steven J. Hughes, Michael K. Sanders, Jennifer L. Young, A. James Moser

Research output: Contribution to journalArticlepeer-review

20 Scopus citations

Abstract

Background: The surgeon's contribution to patients with localized pancreatic adenocarcinoma (PAC) is a margin negative (R0) resection. We hypothesized that a prediction rule based on pre-operative imaging would maximize the R0 resection rate while reducing non-therapeutic intervention. Methods: The prediction rule was developed using computed tomography (CT) and endoscopic ultrasound (EUS) data from 65 patients with biopsy-proven PAC who underwent attempted resection. The rule classified patients as low or high risk for non-R0 outcome and was validated in 78 subsequent patients. Results: Model variables were: any evidence of vascular involvement on CT; EUS stage and EUS size dichotomized at 2.6 cm. In the validation cohort, 77% underwent resection and 58% achieved R0 status. If only patients in the low-risk group underwent surgery, the prediction rule would have increased the resection rate to 92% and the R0 rate to 73%. The R0 rate was 40% higher in low-risk compared with high-risk patients (P < 0.001). High risk was associated with a 67% rate of non-curative surgery (unresectable disease and metastases). Conclusion: The prediction rule identified patients most likely to benefit from resection for PAC using pre-operative CT and EUS findings. Model predictions would have increased the R0 rate and reduced non-therapeutic interventions.

Original languageEnglish (US)
Pages (from-to)606-611
Number of pages6
JournalHPB
Volume11
Issue number7
DOIs
StatePublished - 2009

Keywords

  • Margin negative
  • Pancreatic adenocarcinoma
  • Prediction model
  • R0
  • Resectability

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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