Background: The MDACC group recommends to extend the current borderline classification for pancreatic cancer into three groups: type A patients with resectable/borderline tumor anatomy, type B with resectable/borderline resectable tumor anatomy and clinical findings suspicious for extrapancreatic disease and type C with borderline resectable and marginal performance status/severe pre-existing comorbidity profile or age>80. This study intents to evaluate the proposed borderline classification system in a multicenter patient cohort without neoadjuvant treatment. Methods: Evaluation was based on a multicenter database of pancreatic cancer patients undergoing surgery from 2005 to 2016 (n ¼ 1020). Complications were classified based on the Clavien-Dindo classification. c2-test, KaplaneMeier estimator and Cox regression hazard model were used for statistical analysis. Results: Most patients (55.1%) were assigned as type A patients, followed by type C (35.8%) and type B patients (9.1%). Neither the complication rate, nor the mortality rate revealed a correlation to any subgroup. Type B patients had a significant worse progression free (p < 0.001) and overall survival (p ¼ 0.005). Type B classificationwas identified as an independent prognostic marker for progression free survival (p ¼ 0.005, HR 1.47). Conclusion: The evaluation of the proposed classification in a cohort without neoadjuvant treatment did not justify an additional medical borderline subgroup. A new subgroup based on prognostic borderline patients might be the main target group for neoadjuvant protocols in future.

Evaluation of the MDACC clinical classification system for pancreatic cancer patients in an European multicenter cohort

Maggino, L;Salvia, R;Bassi, C;Malleo, G;
2019

Abstract

Background: The MDACC group recommends to extend the current borderline classification for pancreatic cancer into three groups: type A patients with resectable/borderline tumor anatomy, type B with resectable/borderline resectable tumor anatomy and clinical findings suspicious for extrapancreatic disease and type C with borderline resectable and marginal performance status/severe pre-existing comorbidity profile or age>80. This study intents to evaluate the proposed borderline classification system in a multicenter patient cohort without neoadjuvant treatment. Methods: Evaluation was based on a multicenter database of pancreatic cancer patients undergoing surgery from 2005 to 2016 (n ¼ 1020). Complications were classified based on the Clavien-Dindo classification. c2-test, KaplaneMeier estimator and Cox regression hazard model were used for statistical analysis. Results: Most patients (55.1%) were assigned as type A patients, followed by type C (35.8%) and type B patients (9.1%). Neither the complication rate, nor the mortality rate revealed a correlation to any subgroup. Type B patients had a significant worse progression free (p < 0.001) and overall survival (p ¼ 0.005). Type B classificationwas identified as an independent prognostic marker for progression free survival (p ¼ 0.005, HR 1.47). Conclusion: The evaluation of the proposed classification in a cohort without neoadjuvant treatment did not justify an additional medical borderline subgroup. A new subgroup based on prognostic borderline patients might be the main target group for neoadjuvant protocols in future.
MDACC clinical classification, Pancreatic cancer, Prognosis
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11562/1004943
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