Evidence map›Paper›PMID 27034792›Full record

ArticleJournal of gastrointestinal oncology2016

Impact of margin status and lymphadenectomy on clinical outcomes in resected pancreatic adenocarcinoma: implications for adjuvant radiotherapy.

Arsen Osipov, Jason Naziri, Andrew Hendifar, Deepti Dhall, Joanne K Rutgers, Shefali Chopra, Quanlin Li, Mourad Tighiouart, Alagappan Annamalai, Nicholas N Nissen and 1 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of gastrointestinal oncology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
0.9field-weighted citation impact, top 23% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 10 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 1 institution in 1 country.

Arsen Osipov1 Department of Medicine, 2 Department of Radiation Oncology, 3 Department of Pathology, 4 Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Jason Naziri1 Department of Medicine, 2 Department of Radiation Oncology, 3 Department of Pathology, 4 Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Andrew Hendifar1 Department of Medicine, 2 Department of Radiation Oncology, 3 Department of Pathology, 4 Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Deepti Dhall1 Department of Medicine, 2 Department of Radiation Oncology, 3 Department of Pathology, 4 Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Joanne K Rutgers1 Department of Medicine, 2 Department of Radiation Oncology, 3 Department of Pathology, 4 Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Shefali Chopra1 Department of Medicine, 2 Department of Radiation Oncology, 3 Department of Pathology, 4 Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Quanlin Li1 Department of Medicine, 2 Department of Radiation Oncology, 3 Department of Pathology, 4 Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Mourad Tighiouart1 Department of Medicine, 2 Department of Radiation Oncology, 3 Department of Pathology, 4 Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Alagappan Annamalai1 Department of Medicine, 2 Department of Radiation Oncology, 3 Department of Pathology, 4 Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Nicholas N Nissen1 Department of Medicine, 2 Department of Radiation Oncology, 3 Department of Pathology, 4 Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Richard Tuli1 Department of Medicine, 2 Department of Radiation Oncology, 3 Department of Pathology, 4 Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Cedars-Sinai Medical Center · US

Funding

UCLA Clinical Translational Science InstituteUL1TR001881 · NCATS · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI ARLEEN F. BROWN, ARASH NAEIM · 2016 to 2026
$118.1M
UCLA Clinical and Translational Science InstituteUL1TR000124 · NCATS · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI DUBINETT, STEVEN M. · 2012 to 2015
$57.0M
NCATS NIH HHS UL1 TR000124NCATS NIH HHS UL1 TR001881
6 · The paper itself

Abstract

backgroundAdjuvant chemoradiotherapy (CRT) in the treatment of pancreatic ductal adenocarcinoma (PDA) is controversial. Minimal data exists regarding the clinical significance of margin clearance distance and lymph node (LN) parameters, such as extent of dissection and LN ratio. We assessed the impact of these variables on clinical outcomes to more clearly define the subset of patients who may benefit from adjuvant radiotherapy (RT).

methodsWe identified 106 patients with resected stage 1-3 PDA from 2007-2013. Resection margins were categorized as positive (tumor at ink), ≤1, or >1 mm. LN evaluation included total number examined (NE), number of positive nodes (NP), ratio of NP to NE (NR), extent of dissection, and positive periportal LNs. The impact of these variables was assessed on disease-free survival (DFS) and overall survival (OS) using multivariate cox proportional hazards modeling.

resultsIn patients receiving adjuvant chemotherapy (CT) alone, greater margin clearance led to improved DFS (P=0.0412, HR =0.51). Range of NE was 4-37, with a mean of 19. NE was not associated with DFS or OS, yet absolute NP of 5 or more was associated with a significantly worse DFS (P=0.005). Whereas periportal lymphadenectomy did not result in improved DFS or OS, patients with positive periportal LN had worse clinical outcomes (DFS, P=0.0052; OS, P=0.023). The use of adjuvant CRT was associated with improved OS (P=0.049; HR=0.29).

conclusionsIn patients receiving adjuvant CT alone, there was a clinically significant benefit to clearing the surgical margin beyond tumor at ink. Having ≥5 NP and positive periportal LN led to significantly worse clinical outcomes. The addition of adjuvant RT to CT in resected PDA improved OS. A comprehensive evaluation of resection margin distance and LN parameters may identify more patients at risk for locoregional failure who may benefit from adjuvant CRT.

Indexed as

Carcinoma pancreatic ductalchemoradiotherapy adjuvant (CRT adjuvant)lymph node excision (LN excision)pancreaticoduodenectomy

Identifiers

PMID27034792
PMCPMC4783734
OpenAlexW1897809477

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.