title: Validation of a prediction rule to maximize curative (R0) resection of early-stage pancreatic adenocarcinoma.
abstract: BACKGROUND
  The surgeon's contribution to patients with localized pancreatic adenocarcinoma (PAC) is a margin negative (R0) resection. We hypothesized that a prediction rule based on pre-operative imaging would maximize the R0 resection rate while reducing non-therapeutic intervention.
  
  
  METHODS
  The prediction rule was developed using computed tomography (CT) and endoscopic ultrasound (EUS) data from 65 patients with biopsy-proven PAC who underwent attempted resection. The rule classified patients as low or high risk for non-R0 outcome and was validated in 78 subsequent patients.
  
  
  RESULTS
  MODEL VARIABLES WERE: any evidence of vascular involvement on CT; EUS stage and EUS size dichotomized at 2.6 cm. In the validation cohort, 77% underwent resection and 58% achieved R0 status. If only patients in the low-risk group underwent surgery, the prediction rule would have increased the resection rate to 92% and the R0 rate to 73%. The R0 rate was 40% higher in low-risk compared with high-risk patients (P < 0.001). High risk was associated with a 67% rate of non-curative surgery (unresectable disease and metastases).
  
  
  CONCLUSIONS
  The prediction rule identified patients most likely to benefit from resection for PAC using pre-operative CT and EUS findings. Model predictions would have increased the R0 rate and reduced non-therapeutic interventions.
authors.forename: Philip
authors.initials: P
authors.lastname: Bao
authors.forename: Douglas
authors.initials: D
authors.lastname: Potter
authors.forename: David P
authors.initials: DP
authors.lastname: Eisenberg
authors.forename: Diana
authors.initials: D
authors.lastname: Lenzner
authors.forename: Herbert J
authors.initials: HJ
authors.lastname: Zeh
authors.forename: Kenneth Kw
authors.initials: KK
authors.lastname: Lee Iii
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Hughes
authors.forename: Michael K
authors.initials: MK
authors.lastname: Sanders
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Young
authors.forename: A James
authors.initials: AJ
authors.lastname: Moser