Impact of Positive Resection Margins on Recurrence and Survival Following Resection and Adjuvant Chemotherapy in Pancreatic Cancer: Results of the PRODIGE 24-CCTG PA-6 Randomized Controlled Trial.

OBJECTIVE: This study investigated the correlation between positive resection margins and outcomes in patients with pancreatic ductal adenocarcinoma who underwent surgery and adjuvant chemotherapy according to the pivotal trial PRODIGE 24-CCTG PA-6. BACKGROUND: The primary focus is on elucidating the prognostic significance of specific resection margins, including those associated with the superior-mesenteric vein (SMV), medial, and posterior pancreas. METHODS: The analysis involved 400 patients across multiple centers in France and Canada. Surgical resection and subsequent adjuvant chemotherapy were core interventions. This study assessed the prognostic impact of resection margins, highlighting the significance of standardized pathology assessments. Additionally, the influence of chemotherapy regimen choice, comparing gemcitabine to mFOLFIRINOX, on the implications of positive resection margins was examined. RESULTS: Only three margins, SMV (HR=1.48 95% CI [1.11;1.96], P<.001), medial (HR=1.92 95% CI [1.36;2.73], P<.001) and posterior (HR=1.65 95% CI [1.21;2.24], P=.002), had a significant prognostic impact on disease-free survival and were sufficient compared with the seven recommended margins (Kappa=0.90 95% CI [0.87; 0.94]). R1 status was significant independent prognostic factor for poorer survival in gemcitabine-treasted patients (HR=1.97 95% CI [1.23;3.16], P=.005) but lost its significance with mFOLFIRINOX (HR=1.46 95% CI [0.91;2.35], P=.114). CONCLUSIONS: All efforts should be made to evaluate the three margins of the highest prognostic value, with the others being secondary. A key finding of this study is the likely effect of mFOLFIRINOX on local invasion in operated patients, which seems to correct the impairment related to margin involvement, probably explaining the improvements in DFS and OS.

Prevalence and Risk Factors for Metamorphopsia after Successful Retinal Detachment Surgery.

INTRODUCTION: The aim of the study was to determine the prevalence of metamorphopsia following rhegmatogenous retinal detachment (RRD) surgery, as well as associated predictive factors. METHODS: A total of 107 eyes successfully operated for RRD underwent metamorphopsia severity assessment using M-CHARTS, and foveal microstructure analysis by spectral domain optical coherence tomography, at 1 and 6 months postoperatively. Univariate and multivariate logistic regression rendered evaluation of preoperative risk factors. The correlation between metamorphopsia score and outer retinal layer (ORL) integrity was investigated and preoperative risk factors evaluated. RESULTS: The prevalence of postoperative metamorphopsia decreased from 51.4 to 29.9% and the median metamorphopsia score significantly improved (0.5, 95% CI: 0.3; 0.9, to 0.2, 95% CI: 0; 0.5, p < 0.001) from 1 to 6 months, respectively. Preoperative macular detachment was the only predictor found (OR 11.0, 95% CI: 3.1; 39.4, p < 0.001). Metamorphopsia severity was significantly associated with outer nuclear layer thickness and the status of the ellipsoid and cone interdigitation zones. One-month M-CHARTS had 81% sensitivity and 87% specificity in predicting full metamorphopsia recovery at 6 months (0.45 cut-off score). CONCLUSION: The prevalence of metamorphopsia decreased in parallel to ORL restoration, thus demonstrating the etiological role of photoreceptor-level morphological changes. M-CHARTS allowed for monitoring and predicting metamorphopsia recovery after RRD.

Evaluation of the Prognostic Value of Pretherapeutic Magnetic Resonance Imaging in Predicting Soft Tissue Sarcoma Radiation Response: A Retrospective Study from a Large Institutional Sarcoma Imaging Database.

Background: RT-induced hyalinization/fibrosis was recently evidenced as a significant independent predictor for complete response to neoadjuvant radiotherapy (RT) and survival in patients with soft tissue sarcoma (STS). Purpose: Non-invasive predictive markers of histologic response after neoadjuvant RT of STS are expected. Materials and Methods: From May 2010 to April 2017, patients with a diagnosis of STS who underwent neoadjuvant RT for limb STS were retrieved from a single center prospective clinical imaging database. Tumor Apparent Diffusion Coefficients (ADC) and areas under the time-intensity perfusion curve (AUC) were compared with the histologic necrosis ratio, fibrosis, and cellularity in post-surgical specimens. Results: We retrieved 29 patients. The median ADC value was 134.3 × 10-3 mm2/s. ADC values positively correlated with the post-treatment tumor necrosis ratio (p = 0.013). Median ADC values were lower in patients with less than 50% necrosis and higher in those with more than 50% (120.3 × 10-3 mm2/s and 202.0 × 10-3 mm2/s, respectively (p = 0.020). ADC values higher than 161 × 10-3 mm2/s presented a 95% sensitivity and a 55% specificity for the identification of tumors with more than 50% tumor necrosis ratio. Tumor-to-muscle AUC ratios were associated with histologic fibrosis (p = 0.036). Conclusions: ADC and perfusion AUC correlated, respectively, with radiation-induced tumor necrosis and fibrosis.