@article{9002c52a154c4f11b2dd21d8b3514ee3,
title = "Prediction of Recurrence with KRAS Mutational Burden Using Ultrasensitive Digital Polymerase Chain Reaction of Radial Resection Margin of Resected Pancreatic Ductal Adenocarcinoma",
abstract = "Objective Although complete surgical resection is the only curative method for pancreatic cancer, the radial resection margins of pylorus-preserving pancreaticoduodenectomy specimens might be underevaluated. Methods KRAS mutation was assessed with droplet digital polymerase chain reaction on cells collected from the radial resection margins of 81 patients, and the results were compared with those of conventional pathologic resection margin (pRM) evaluation. Results KRAS mutation was detected in 76 patients (94%), and molecular resection margin (mRM) positivity defined by a KRAS mutation rate of 4.19% or greater was observed in 18 patients (22%). Patients with mRM-positive had significantly worse recurrence-free survival (RFS) than those with mRM-negative in entire groups (P = 0.008) and in subgroups without chemotherapy or radiation therapy (all, P < 0.001). When combined pRMs-mRMs were evaluated, patients with combined pRM-mRM-positive (either pRM- or mRM-positive) had significantly worse RFS than those with combined resection margin-negative (both pRM and mRM negative) by univariate (P = 0.002) and multivariate (P = 0.03) analyses. Conclusions KRAS mutational analysis with ultrasensitive droplet digital polymerase chain reaction of the radial resection margin in pancreatic cancer patients who underwent pylorus-preserving pancreaticoduodenectomy can provide more accurate information on RFS by using alone or in combination with conventional pRM evaluation, especially in patients without chemotherapy or radiation therapy.",
keywords = "KRAS, cancer, margin, pancreas, recurrence, survival",
author = "Kim, {Sung Joo} and Kim, {Mi Ju} and Han, {Ji Soo} and Sung, {You Na} and Soyeon An and Lee, {Jae Hoon} and Song, {Ki Byung} and Hwang, {Dae Wook} and Lee, {Sang Soo} and Cho, {Hyung Jun} and Kim, {Song Cheol} and Eshleman, {James R.} and Hong, {Seung Mo}",
note = "Funding Information: From the *Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine; †Asan Institute for Life Sciences, Asan Medical Center; and ‡Department of Statistics, Korea University, Seoul; §Department of Pathology, Incheon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon; Departments of kSurgery and ¶Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; and #Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD. Received for publication June 12, 2018; accepted January 4, 2019. Address correspondence to: Seung-Mo Hong, MD, PhD, Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Seoul 05505, Republic of Korea (e‐mail: smhong28@gmail.com). S.J.K. and M.-J.K. contributed equally to this work. This research was funded by a grant (2016-0550) from the Asan Institute for Life Sciences, Seoul, Republic of Korea. The authors declare no conflict of interest. This work was presented in part at the 69th Annual Fall Meeting of the Korean Society of Pathologists, Seoul, Republic of Korea, October 2017. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal{\textquoteright}s Web site (www.pancreasjournal.com). Copyright {\textcopyright} 2019 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/MPA.0000000000001255 Publisher Copyright: {\textcopyright} 2019 Wolters Kluwer Health, Inc. All rights reserved.",
year = "2019",
month = mar,
day = "1",
doi = "10.1097/MPA.0000000000001255",
language = "English (US)",
volume = "48",
pages = "400--411",
journal = "Pancreas",
issn = "0885-3177",
publisher = "Lippincott Williams and Wilkins",
number = "3",
}