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Diffusion-weighted MRI predicts the histologic response for neoadjuvant therapy in patients with pancreatic cancer: a prospective study (DIFFERENT trial)

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Abstract

Purpose

Pre-operative prediction of histological response to neoadjuvant therapy aids decisions regarding surgical management of borderline resectable pancreatic cancer (BRPC). We elucidate correlation between pre-/post-treatment whole-tumor apparent diffusion coefficient (ADC) value and rate of tumor cell destruction. We newly verify whether post-treatment ADC value at the site of vascular contact predicts R0 resectability of BRPC.

Methods

We prospectively reviewed 28 patients with BRPC who underwent diffusion-weighted magnetic resonance imaging before neoadjuvant chemotherapy and surgery. Correlation between the percentage of tumor cell destruction and various parameters was analyzed. Strong parameters were assessed for their ability to predict therapeutic histological response and R0 resectability.

Results

Pre-/post-treatment whole-tumor ADC value correlated with tumor cell destruction rate by all parameters (R = 0.630/0.714, P < 0.001/< 0.0001). The post-treatment cutoff value of ADC at the site of vascular contact for discriminating histological response of tumor destruction of ≤ 50% and tumor destruction of > 50% was determined at 1.42 × 10−3 mm2/s. It predicts R0 with 88% sensitivity, 50% specificity, and 61% accuracy. For histological response, the post-treatment whole-tumor ADC cutoff value for discriminating between tumor destruction of ≤ 50% and tumor destruction of > 50% was determined at 1.40 × 10−3 mm2/s. It predicts histological response with 100% sensitivity, 81% specificity, and 89% accuracy. It predicts R0 with 88% sensitivity, 70% specificity, and 75% accuracy.

Conclusions

Post-treatment whole-tumor ADC value may be a predictor of R0 resectability in patients with BRPC. Tumor cell destruction rate is indicated by the difference between pre-/post-treatment ADC values. This difference is strongly affected by the pre-treatment ADC value. The cutoff value of ADC at the site of vascular contact could not discriminate R0 resectability.

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Acknowledgments

We would like to thank Benjamin Phillis at the Clinical Study Support Center, WMUH, for proofreading and editing the manuscript.

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Authors and Affiliations

  1. Second Department of Surgery, Wakayama Medical University, Wakayama, 641-8510, Japan

    Ken-ichi Okada, Manabu Kawai, Seiko Hirono, Motoki Miyazawa, Yuji Kitahata, Masaki Ueno, Shinya Hayami & Hiroki Yamaue

  2. Department of Human Pathology, Wakayama Medical University, Wakayama, 641-8510, Japan

    Fumiyoshi Kojima, Yoshifumi Iwahashi & Shin-ichi Murata

  3. Clinical Study Support Center, Wakayama Medical University, Wakayama, 641-8510, Japan

    Kensuke Tanioka & Toshio Shimokawa

  4. Wakayama Minami Radiology Clinic, Wakayama, 641-0012, Japan

    Masaki Terada

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  1. Ken-ichi Okada
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Contributions

Study concept and design: acquisition of data: MM, YK, MU, SH; analysis and interpretation of data: evaluation of findings of imaging study: MT; pathological evaluation: FK, YI, SM; statistical analysis: KT, TS; drafting of manuscript: KO, MK, SH; critical revision of manuscript: HY

Corresponding author

Correspondence to Hiroki Yamaue.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional (WMUH) and national research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Presented at the 51st Meeting of the European Pancreatic Club, June 2019, Bergen, Norway and the 50th Anniversary Joint Meeting of American Pancreatic Association (APA) and Japan Pancreas Society (JPS), November, 2019, Maui, Hawaii, United States.

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Okada, Ki., Kawai, M., Hirono, S. et al. Diffusion-weighted MRI predicts the histologic response for neoadjuvant therapy in patients with pancreatic cancer: a prospective study (DIFFERENT trial). Langenbecks Arch Surg 405, 23–33 (2020). https://doi.org/10.1007/s00423-020-01857-4

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