• Thijs J Schouten, Victor J Kroon, Marc G Besselink, Koop Bosscha, Olivier R Busch, A Stijn L P Crobach, Ronald M van Dam, Michail Doukas, Arantza Fariña Sarasquesta, Sebastiaan Festen, Bas Groot Koerkamp, Erwin van der Harst, Lara R Heij, de HinghIgnace H J TIHJTGROW - School for Oncology & Developmental Biology, Maastricht University, Maastricht, The Netherlands.Dept. of Surgery, Catharina Hospital, Eindhoven, the Netherlands., Geert Kazemier, LiemMike S LMSLDept. of Surgery, Medical Spectrum Twente, Enschede, the Netherlands., Vincent E de Meijer, MieogJ Sven DJSDDept. of Surgery, Leiden University Medical Center, Leiden, the Netherlands., Gijs A Patijn, G Mihaela Raicu, Daphne Roos, SchreinemakersJennifer M JJMJDept. of Surgery, Amphia Hospital, Breda, the Netherlands., StommelMartijn W JMWJDept. of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands., Hanneke J Wilmink, Fennie Wit, BrosensLodewijk A ALAADept. of Pathology, University Medical Center Utrecht Cancer Center, Utrecht, the Netherlands.Dept. of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands., Hjalmar C van Santvoort, I Quintus Molenaar, Lois A Daamen, and Dutch Pancreatic Cancer Group.
• Dept. of Surgery, Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, Utrecht University, the Netherlands.
• Ann. Surg. 2024 May 6.

ObjectiveTo investigate the association between perineural invasion (PNI) and overall survival (OS) in a nationwide cohort of patients with resected pancreatic ductal adenocarcinoma (PDAC), stratified for margin negative (R0) or positive (R1) resection and absence or presence of lymph node metastasis (pN0 or pN1-N2, respectively).BackgroundPatients with R0 and pN0 resected PDAC have a relatively favorable prognosis. As PNI is associated with worse OS, this might be a useful factor to provide further prognostic information for patients counselling.MethodsA nationwide observational cohort study was performed including all patients who underwent PDAC resection in the Netherlands (2014-2019) with complete information on relevant pathological features (PNI, R status, and N status). OS was assessed using Kaplan-Meier curves, and Cox-proportional hazard analyses were performed to calculate hazard ratio's (HR) with corresponding 95% confidence intervals (CI).ResultsIn total, 1630 patients were included with a median follow-up of 43 (interquartile range 33-58) months. PNI was independently associated with worse OS in both R0 patients (HR 1.49 [95%CI 1.18-1.88]; P<0.001) and R1 patients (HR 1.39 [95% CI 1.06-1.83]; P=0.02), as well as in pN0 patients (HR 1.75 [95%CI 1.27-2.41]; P<0.001) and pN1-N2 patients (HR 1.35 [95% CI 1.10-1.67]; P<0.01). In 315 patients with R0N0, multivariable analysis showed that PNI was the strongest predictor of OS (HR 2.24 [95% CI 1.52-3.30]; P<0.001).ConclusionPNI is strongly associated with worse survival in patients with resected PDAC, in particular in patients with relatively favorable pathological features. These findings may aid patient stratification and counselling and help guide treatment strategies.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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