30 July 2012
Garvan’s Pancreatic Cancer Research Group, led by Professor Andrew Biankin, recently won the inaugural Cancer Institute NSW ‘Wildfire award’ at CINSW’s annual cancer awards night, held to honour the work of the State's most innovative and dynamic cancer researchers.
The Wildfire award recognises a highly-cited publication where the research results have significantly influenced how cancer is treated. The paper must have been published in a peer-reviewed journal during 2009, and the citations themselves should have been in well-respected, high-ranking journals.
The awarded data were published in the Journal of Clinical Oncology, the highest-ranking clinical oncology journal (fourth-highest-ranking among all 184 oncology journals) with an impact factor of 18.97 in 2010. The paper was cited in 41 manuscripts during the 24 months following publication.
The paper assesses clinico-pathological prognostic factors that are important in decision making, with the aim of refining the management of patients with pancreatic cancer. The relationship between ‘surgical margin’ (the boundary of surgically removed tissue) and patient prognosis was assessed in a large cohort of NSW patients who had had pancreatic cancer removed by surgery.
The paper showed that the average survival of patients with surgically removed pancreatic cancer is similar, regardless of the degree of margin clearance, as long as they are clear of cancer cells. Average survival is determined by the presence of non-detectable metastatic disease that may already be present at the time of surgery, but which cannot be picked up by current preoperative investigations.
Importantly, the paper also showed that long-term survival (longer than 3 years) is determined by the degree of margin clearance, and a surgical margin clearance of greater than 1.5 mm is important for long-term survival in a subgroup of patients.
“For surgeons and pathologists, there has been a newfound focus on more careful assessment of surgical margins in recent years, and possibly a new unified definition of ‘involved margin’, which is currently different around the world,” said first author of the paper, Dr David Chang, researcher at Garvan and pancreatic cancer surgeon at Bankstown Hospital.
“These results not only demonstrate the importance of absolute margin clearance, but also show that the degree of margin clearance is critical. For radiation oncologists who have tried to assess the benefit of additional postoperative radiotherapy through various trials in the last few decades, the findings demonstrate and support the concept of ‘occult metastatic disease’, or disease undetectable by current technologies, and may explain why previous trials were underpowered to address the question. They also help to identify a subgroup of patients who may benefit from aggressive additional therapy, such as radiotherapy, to facilitate personalised treatment for patients with pancreatic cancer.”
Although the assessment of the degree of margin clearance in pancreatic cancer resection has not been made compulsory by The Royal College of Pathologists of Australia yet, the practice has been adopted by many practicing pancreatic pathologists around the country. The majority of the pathologists associated with the Australian Pancreatic Cancer Network are using it in routine reporting, reporting which accounts for over 85% of pancreatic cancer surgery performed in Australia.
The Pancreatic Cancer Research Group wishes to acknowledge the members of the Australian Pancreatic Cancer Network, the Australian Pancreatic Cancer Genome Initiative and the generous patients who have made translational cancer research possible. We would also like to thank our funding bodies which include the Cancer Institute NSW, the NHMRC, Cancer Council NSW and the Avner Nahmani Foundation. Please refer to APGI website (www.pancreaticcancer.net.au) for a detailed list of funders and collaborators.