A novel role of the tumor size in pancreatic cancer as an ancillary factor for predicting resectability
Kun-Chun Chiang1, Chun-Hui Lee2, Chun-Nan Yeh3, Shir-Hwa Ueng4, Jun-Te Hsu3, Ta-Sen Yeh3, Yi-Yin Jan3, Tsann-Long Hwang3, Miin-Fu Chen3
1 Department of General Surgery, Chang Gung Memorial Hospital, 222, Mai-Chin Road, Keelung, 204; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei Shan Tao-Yuan, 333, Taiwan
2 Department of General Surgery, Chang Gung Memorial Hospital, 222, Mai-Chin Road, Keelung, 204, Taiwan
3 Department of General Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsing Street, Kwei-Shan, Taoyuan, Taiwan 333, R.O.C, Taiwan
4 Department of Pathology, Chang Gung Memorial Hospital, 5, Fu Hsing Street, Kwei Shan, Taoyuan, Taiwan 333, R.O.C, Taiwan
Department of Surgery, Fu Hsing Street, Kwei-Shan, Taoyuan
Source of Support: This work was supported by Chang Gung Medical Research Program (CMRP) grant 280273G to Dr. Kun-Chun Chiang, Conflict of Interest: None
Background: Pancreatic adenocarcinoma (PCA) is a devastating disease. Only surgery can provide effective treatment. The resectability of pancreatic cancer is mainly determined by image studies. However, half of the patients deemed as operable, radiologically, are found to be inoperable during surgery. Previously, we have showed that both CA 19-9 and tumor size could predict PCA resectability, independently. Here, we aimed to determine the cut-off value for tumor size permitting PCA resectability by receiver operating characteristic (ROC) curve analysis.
Materials and Methods: We retrospectively reviewed 372 patients undergoing surgery for histopathologically proven PCA. We compared tumor sizes of patients in resectable and unresectable groups and analyzed them by the ROC curve.
Results: The tumor size in unresectable groups is significantly larger than that in the resectable group. The area under the ROC curve was 0.73 (95% confidence interval [CI], 0.665-0.789), which represented a good correlation between the tumor size and pancreatic cancer resectability. The PCA patients with a tumor diameter of > 4.8 cm had a 5.043-fold higher chance of unresectability than did those with a tumor diameter < 4.8 cm (odds ratio, 5.043; 95% CI, 3.221-7.894).
Conclusions: A tumor diameter > 4.8 cm is a potential ancillary parameter for determining the resectability of PCA in addition to traditional image studies. Diagnosis laparoscopy may be indicated for radiologically resectable PCA patients with tumor size > 4.8 cm to prevent unnecessary laparotomy.
Abstract in Chinese
背景：胰腺癌（PCA）是一种灾难性的疾病。只有手术才能提供有效的治疗。胰腺癌的可切除性主要决定于影像研究。然而，放射学认为可手术的患者中，有一半在手术过程中发现不能切除。以前，我们已经表明，CA 19 9和肿瘤大小可以独立地预测胰腺癌的可切除性。在这里，我们的目的是通过接收器工作特性（ROC）曲线分析确定可手术的胰腺癌肿瘤大小的临界值。
结果：不能切除组肿瘤体积明显大于可切除组。ROC曲线下面积为0.73（95%置信区间[CI]：0.665~0.789），表现肿瘤大小和胰腺癌可切除性的良好相关性。胰腺癌患者肿瘤直径＞4.8cm比那些肿瘤直径＜4.8cm 患者的不可切除率高5.043倍（优势比，5.043；95% CI：3.221~7.894）。