This clinical retrospective study included 148 consecutive patients who underwent surgical resection for PDAC from March 2008 to December 2020, in our department, without neoadjuvant treatment. Routinely, a laparotomic cephalic pancreaticoduodenectomy (CPD) without pyloric preservation was the technique used for tumors with a cephalic location. Clinicopathological data were obtained by reviewing the patients’ clinical histories, using the hospital database records. The study was approved by our hospital’s Ethics Committee [21 (link)].
For preoperative analytical parameters, hyponatremia was considered when sodium <135 mEq/L, increased aspartate aminotransferase (AST) ≥35 U/L, increased alanine aminotransferase (ALT) ≥45 U/L, increased alkaline phosphatase (AP) >120 U/L, increased gamma-glutamyltransferase (GGT) ≥55 U/L and hypoalbuminemia when albumin <3.5 g/dL. For carbohydrate antigen (CA) 19.9 and carcinoembryonic antigen (CEA), cutoff values of 500 U/mL [22 (link)] and 5 ng/mL [23 (link)] were defined, respectively. Jaundice was considered for a total bilirubin (BR) value greater than 2.5 mg/dL [24 (link)]. Postoperative complications were defined as those occurring in the first 30 days after surgery and classified according to the Clavien–Dindo classification [25 (link)]. Delayed gastric emptying (DGE) [26 (link)] and postoperative pancreatic fistula (POPF) [27 (link)] were defined according to the International Study Group of Pancreatic Surgery. R1 resections were defined as those with a tumor-free margin ≤1 mm.
Lymph node (LN) ratio was calculated by dividing the number of invaded LNs by the number of resected LNs. The TSA was calculated for 78 patients. For each patient, 3 representative histological areas of the surgical specimen were selected by an expert pathologist and photographed with a total magnification of 20×. Image collection and analysis were blinded to the outcome. Hematoxylin and eosin-stained slides were observed using a light microscope (Nikon Eclipse 50i) and images were obtained using a Nikon Digital Slight DS-Fi1 camera. Subsequently, using the software [28 (link),29 (link)] QuPath-0.2.3, the stromal area was delimited and calculated to then determine the mean of the 3 areas. Several cutoff values were tested for the study of the TSA. The DFS was calculated from the date of surgery to the date of relapse and the OS from the date of surgery to the date of death or of data analysis.
For preoperative analytical parameters, hyponatremia was considered when sodium <135 mEq/L, increased aspartate aminotransferase (AST) ≥35 U/L, increased alanine aminotransferase (ALT) ≥45 U/L, increased alkaline phosphatase (AP) >120 U/L, increased gamma-glutamyltransferase (GGT) ≥55 U/L and hypoalbuminemia when albumin <3.5 g/dL. For carbohydrate antigen (CA) 19.9 and carcinoembryonic antigen (CEA), cutoff values of 500 U/mL [22 (link)] and 5 ng/mL [23 (link)] were defined, respectively. Jaundice was considered for a total bilirubin (BR) value greater than 2.5 mg/dL [24 (link)]. Postoperative complications were defined as those occurring in the first 30 days after surgery and classified according to the Clavien–Dindo classification [25 (link)]. Delayed gastric emptying (DGE) [26 (link)] and postoperative pancreatic fistula (POPF) [27 (link)] were defined according to the International Study Group of Pancreatic Surgery. R1 resections were defined as those with a tumor-free margin ≤1 mm.
Lymph node (LN) ratio was calculated by dividing the number of invaded LNs by the number of resected LNs. The TSA was calculated for 78 patients. For each patient, 3 representative histological areas of the surgical specimen were selected by an expert pathologist and photographed with a total magnification of 20×. Image collection and analysis were blinded to the outcome. Hematoxylin and eosin-stained slides were observed using a light microscope (Nikon Eclipse 50i) and images were obtained using a Nikon Digital Slight DS-Fi1 camera. Subsequently, using the software [28 (link),29 (link)] QuPath-0.2.3, the stromal area was delimited and calculated to then determine the mean of the 3 areas. Several cutoff values were tested for the study of the TSA. The DFS was calculated from the date of surgery to the date of relapse and the OS from the date of surgery to the date of death or of data analysis.
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