Patient outcome according to the 2017 international consensus on the definition of borderline resectable pancreatic ductal adenocarcinoma.

Abstract

BACKGROUND/OBJECTIVE\nWe evaluated the usefulness of the 2017 definition of borderline pancreatic ductal adenocarcinoma (BR-PDAC) in fit patients (performance status 0-1) based on anatomical (A) and biological dimensions (B).\n\n\nMETHODS\nFrom 2011 to 2018, 139 resected patients with BR-PDAC according to the 2017 definition were included: 18 patients underwent upfront pancreatectomy (CA 19-9\xa0>\xa0500 U/mL and/or regional lymph node metastasis; BR-B group), and 121 received FOLFIRINOX (FX) induction chemotherapy and were divided into BR-A (CA 19-9\xa0<\xa0500 U/mL, no regional lymph node metastasis; n\xa0=\xa068) and BR-AB (CA 19-9\xa0>\xa0500 U/mL and/or regional lymph node metastasis; n\xa0=\xa053) groups.\n\n\nRESULTS\nThe 3 groups were comparable according to patient characteristics (except for back pain (P\xa0<\xa0.01) and CA 19-9 (P\xa0<\xa0.01)), intraoperative data, and postoperative courses. BR-AB patients required more venous resections (P\xa0<\xa0.01). The 3 groups were comparable on pathologic findings, except that BR-B patients had more lymph node invasions (P\xa0=\xa0.02). Median overall survival (OS) of the 121 patients was 45 months. In multivariate analysis, venous resection (P\xa0=\xa0.039) and R1 resection (P\xa0=\xa0.012) were poorly linked with OS, whereas BR-A classification (P\xa0<\xa0.01) independently favored OS. Median survival times of BR-A, BR-AB, and BR-B groups were undetermined, 27 months, and 20 months (P < .001), respectively.\n\n\nCONCLUSIONS\nThe 2017 definition was relevant for sub-classifying patients with BR-PDAC. The anatomical dimension (BR-A) was a favorable prognostic factor, whereas the biological dimension (BR-AB and BR-B) poorly impacted survival.