Can the new RCP R0/R1 classification predict the clinical outcome in ductal adenocarcinoma of the pancreatic head?

• Published in: Langenbeck's archives of surgery Vol. 397; no. 6; pp. 917 - 925
• Main Authors: Janot, M. S., Kersting, S., Belyaev, O., Matuschek, A., Chromik, A. M., Suelberg, D., Uhl, W., Tannapfel, A., Bergmann, U.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01-08-2012
• Subjects: Abdominal Surgery; Adenocarcinoma - classification; Adenocarcinoma - mortality; Adenocarcinoma - surgery; Analysis of Variance; Biopsy, Needle; Carcinoma, Pancreatic Ductal - classification; Carcinoma, Pancreatic Ductal - mortality; Carcinoma, Pancreatic Ductal - surgery; Cardiac Surgery; Cohort Studies; Disease-Free Survival; Female; General Surgery; Humans; Immunohistochemistry; Kaplan-Meier Estimate; Male; Medicine; Medicine & Public Health; Multivariate Analysis; Neoplasm Invasiveness - pathology; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - pathology; Neoplasm Staging; Original Article; Pancreatectomy - methods; Pancreatectomy - mortality; Pancreatic Neoplasms - classification; Pancreatic Neoplasms - mortality; Pancreatic Neoplasms - surgery; Pancreaticoduodenectomy - methods; Pancreaticoduodenectomy - mortality; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Retrospective Studies; Risk Assessment; Societies, Medical; Survival Analysis; Thoracic Surgery; Time Factors; Traumatic Surgery; Treatment Outcome; Vascular Surgery; International Union Against Cancer; Royal College of Pathologists; R classification; Pancreatic ductal adenocarcinoma; Outcome; Curative operation
• ISSN: 1435-2443; 1435-2451
• DOI: 10.1007/s00423-012-0953-5

Purpose
According to the International Union Against Cancer (UICC), R1 is defined as the microscopic presence of tumor cells at the surface of the resection margin (RM). In contrast, the Royal College of Pathologists (RCP) suggested to declare R1 already when tumor cells are found within 1 mm of the RM. The aim of this study was to determine the significance of the RM concerning the prognosis of pancreatic ductal adenocarcinoma (PDAC).
Methods
From 2007 to 2009, 62 patients underwent a curative operation for PDAC of the pancreatic head. The relevance of R status on cumulative overall survival (OS) was assessed on univariate and multivariate analysis for both the classic R classification (UICC) and the suggestion of the RCP.
Results
Following the UICC criteria, a positive RM was detected in 8 %. Along with grading and lymph node ratio, R status revealed a significant impact on OS on univariate and multivariate analysis. Applying the suggestion of the RCP, R1 rate rose to 26 % resulting in no significant impact on OS in univariate analysis.
Conclusions
Our study has shown that the RCP suggestion for R status has no impact on the prognosis of PDAC. In contrast, our data confirmed the UICC R classification of RM as well as N category, grading, and lymph node ratio as significant prognostic factors.