Preoperative defining system for pancreatic head cancer considering surgical resection

Table 1 Important abbreviations used in the new preoperative defining system for pancreatic cancer

Symbol	Description	Comments
Resectability
R	Resectable
BR	Borderline resectable
LA	Locally advanced
Location
H	Pancreatic head	Hu: uncinate process,
		Hn: neck portion
Vascular structure
CA	Celiac axis
CHA	Common hepatic artery
GDA	Gastroduodenal artery	OGA: origin of gastroduodenal artery
aRHA	Aberrant right hepatic artery
Rt/Lt	Right/left
SMA	Superior mesenteric artery
SMV	Superior mesenteric vein
SMV-SV-PV	Superior mesenteric vein-splenic vein-portal vein

R: Resectable pancreatic cancer; BR: Resectable pancreatic cancer; LA: Locally advanced pancreatic cancer.

Table 2 Univariate analysis to predict combined venous vascular resection in treating pancreatic head cancer

	Combined venous vascular resection		P value
	No	Yes
Resectability
R	54	21
BR	17	17
LA	2	2	0.054
Radiologic tumor size (cm)	2.3 ± 0.7	2.6 ± 0.8	0.044
Tumor location
Head	49	24
Uncinate	22	13
Including neck	2	3	0.485
Radiologic vascular component
No	52	21
Yes	21	19	0.002
Initial preoperative serum CA19-9	846.7 ± 2193.9	805.3 ± 1761.9	0.919
Initial serum total bilirubin	4.3 ± 5.0	4.9 ± 4.6	0.528

R: Resectable pancreatic cancer; BR: Resectable pancreatic cancer; LA: Locally advanced pancreatic cancer.

Table 3 Univariate analysis to predict neoadjuvant treatment for pancreatic head cancer

	Neoadjuvant treatment		P value
	No	Yes
Resectability
R	52	23
BR	10	24
LA	1	3	< 0.001
Radiologic tumor size (cm)	2.1 ± 5.7	2.7 ± 0.9	< 0.001
Tumor location
Head	46	27
Uncinate	15	20
Including neck	2	3	0.049
Radiologic vascular component
No	52	21
Yes	11	29	< 0.001
Initial preoperative serum CA19-9	600.8 ± 1640.6	1109.0 ± 2437.1	0.189
Initial serum total bilirubin	3.9 ± 4.9	5.5 ± 4.9	0.087

R: Resectable pancreatic cancer; BR: Resectable pancreatic cancer; LA: Locally advanced pancreatic cancer.

Table 4 Oncologic impact of clinical variables used in the new preoperative defining system

Clinical variables	Exp(B)	95%CI	P value
Resectability			0.019
BR	0.222	0.073-0.676	0.008
LA	0.557	0.105-2.955	0.492
Radiologic tumor size (cm) ≥ 2.4	1.696	0.993-2.897	0.053
Tumor location			0.007
Hu	0.952	0.557-1.629	0.858
Hn	9.461	2.634-33.976	0.001
Vascular relationship with			0.064
Venous system	2.788	0.952-8.165	0.061
Arterial system	6.208	1.562-24.669	0.010
Both	2.200	0.484-10.006	0.307
CA19-9 ≥ 825	1.709	0.777-3.761	0.183
Total bilirubin ≥ 4.6	0.588	0.339-1.022	0.060
Adjusted CA19-9 ≥ 50	1.972	1.118-3.480	0.019

BR: Resectable pancreatic cancer; LA: Locally advanced pancreatic cancer.