title: Preoperative defining system for pancreatic head cancer considering surgical resection.
abstract: OBJECTIVE
  To provide appropriate treatment, it is crucial to share the clinical status of pancreas head cancer among multidisciplinary treatment members.
  
  
  METHODS
  A retrospective analysis of the medical records of 113 patients who underwent surgery for pancreas head cancer from January 2008 to December 2012 was performed. We developed preoperative defining system of pancreatic head cancer by describing "resectability - tumor location - vascular relationship - adjacent organ involvement - preoperative CA19-9 (initial bilirubin level) - vascular anomaly". The oncologic correlations with this reporting system were evaluated.
  
  
  RESULTS
  Among 113 patients, there were 75 patients (66.4%) with resectable, 34 patients (30.1%) with borderline resectable, and 4 patients (3.5%) with locally advanced pancreatic cancer. Mean disease-free survival was 24.8 mo (95%CI: 19.6-30.1) with a 5-year disease-free survival rate of 13.5%. Pretreatment tumor size ≥ 2.4 cm [Exp(B) = 3.608, 95%CI: 1.512-8.609, P = 0.044] and radiologic vascular invasion [Exp(B) = 5.553, 95%CI: 2.269-14.589, P = 0.002] were independent predictive factors for neoadjuvant treatment. Borderline resectability [Exp(B) = 0.222, P = 0.008], pancreatic head cancer involving the pancreatic neck [Exp(B) = 9.461, P = 0.001] and arterial invasion [Exp(B) = 6.208, P = 0.010], and adjusted CA19-9 ≥ 50 [Exp(B) = 1.972 P = 0.019] were identified as prognostic clinical factors to predict tumor recurrence.
  
  
  CONCLUSIONS
  The suggested preoperative defining system can help with designing treatment plans and also predict oncologic outcomes.
authors.affiliation: Seok Jeong Yang, Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, South Korea.
authors.forename: Seok Jeong
authors.initials: SJ
authors.lastname: Yang
authors.affiliation: Seok Jeong Yang, Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, South Korea.
authors.forename: Ho Kyoung
authors.initials: HK
authors.lastname: Hwang
authors.affiliation: Seok Jeong Yang, Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, South Korea.
authors.forename: Chang Moo
authors.initials: CM
authors.lastname: Kang
authors.affiliation: Seok Jeong Yang, Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, South Korea.
authors.forename: Woo Jung
authors.initials: WJ
authors.lastname: Lee
mesh_terms: D018395:CA-19-9 Antigen / Q000378:metabolism; D021441:Carcinoma, Pancreatic Ductal / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D057234:Preoperative Period; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D047368:Tumor Burden
chemical_list: D018395:CA-19-9 Antigen
keywords: Adjusted CA19-9; Borderline resectable; Neoadjuvant therapy; Pancreas head cancer; Preoperative defining system