OBJECTIVE To assess the prognostic impact of margin status in patients with resected intraductal papillary mucinous neoplasms (IPMN)-derived pancreatic ductal adenocarcinoma (PDAC) and to inform future intraoperative decision-making on handling differing degrees of dysplasia on frozen section. SUMMARY BACKGROUND DATA The ideal oncologic surgical outcome is a negative transection margin with normal pancreatic epithelium left behind. However, the prognostic significance of reresecting certain degrees of dysplasia or invasive cancer at the pancreatic neck margin during pancreatectomy for IPMN-derived PDAC is debatable. METHODS Consecutive patients with resected and histologically confirmed IPMN-derived PDAC (2002-2022) from six international high-volume centers were included. The prognostic relevance of a positive resection margin (R1) and degrees of dysplasia at the pancreatic neck margin were assessed by log-rank test and multivariable Cox-regression for overall survival (OS) and recurrence-free survival (RFS). RESULTS Overall, 832 patients with IPMN-derived PDAC were included with 322 patients (39%) having an R1-resection on final pathology. Median OS (mOS) was significantly longer in patients with an R0 status compared to those with an R1 status (65.8 vs. 26.3 mo P<0.001). Patients without dysplasia at the pancreatic neck margin had similar OS compared to those with low-grade dysplasia (mOS: 78.8 vs. 66.8 months, P=0.344). However, high-grade dysplasia (mOS: 26.1 mo, P=0.001) and invasive cancer (mOS: 25.0 mo, P<0.001) were associated with significantly worse OS compared to no or low-grade dysplasia. Patients who underwent conversion of high-risk margins (high-grade or invasive cancer) to a low-risk margin (low-grade or no dysplasia) after intraoperative frozen section had significantly superior OS compared to those with a high-risk neck margin on final pathology (mOS: 76.9 vs. 26.1 mo P<0.001). CONCLUSIONS In IPMN-derived PDAC, normal epithelium or low-grade dysplasia at the neck have similar outcomes while pancreatic neck margins with high-grade dysplasia or invasive cancer are associated with poorer outcomes. Conversion of a high-risk to low-risk margin after intraoperative frozen section is associated with survival benefit and should be performed when feasible.

中文翻译：

---

为导管内乳头状粘液性肿瘤来源的 PDAC 横断边缘再切除决策提供信息：一项国际多中心研究。


目的 评估切缘状态对切除的导管内乳头状粘液性肿瘤 (IPMN) 来源的胰腺导管腺癌 (PDAC) 患者的预后影响，并为未来处理冰冻切片上不同程度的不典型增生的术中决策提供信息。摘要背景数据 理想的肿瘤手术结果是横切边缘呈负值，并留下正常的胰腺上皮。然而，在 IPMN 衍生的 PDAC 胰腺切除术中重新切除胰颈边缘一定程度的不典型增生或浸润性癌症的预后意义尚有争议。方法 纳入来自六个国际大容量中心的连续切除并经组织学证实的 IPMN 衍生 PDAC 患者（2002-2022 年）。通过对数秩检验和多变量 Cox 回归评估总生存期 (OS) 和无复发生存期 (RFS) 阳性切除边缘 (R1) 和胰颈边缘不典型增生程度的预后相关性。结果 总体而言，832 名 IPMN 衍生的 PDAC 患者被纳入其中，其中 322 名患者 (39%) 在最终病理学上进行了 R1 切除。与 R1 状态患者相比，R0 状态患者的中位 OS (mOS) 显着更长（65.8 个月 vs. 26.3 个月 P<0.001）。胰颈边缘无不典型增生的患者与低度不典型增生患者的 OS 相似（mOS：78.8 个月与 66.8 个月，P=0.344）。然而，与无或低度不典型增生相比，高度不典型增生（mOS：26.1 个月，P=0.001）和浸润性癌症（mOS：25.0 个月，P<0.001）与显着较差的 OS 相关。 术中冰冻切片后将高风险边缘（高级别或浸润性癌症）转换为低风险边缘（低级别或无异型增生）的患者与颈部边缘高风险患者相比，OS 显着提高。最终病理学（mOS：76.9 vs. 26.1 mo P<0.001）。结论 在 IPMN 衍生的 PDAC 中，颈部正常上皮或低度不典型增生具有相似的结果，而具有高度不典型增生或浸润性癌症的胰腺颈部边缘与较差的结果相关。术中冰冻切片后将高风险边缘转换为低风险边缘与生存获益相关，应在可行时进行。