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MDCT findings predicting post-operative residual tumor and survival in patients with pancreatic cancer

  • Hepatobiliary-Pancreas
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To predict residual tumor (R) classification and overall survival (OS) on preoperative MDCT in patients who underwent first-line surgery for pancreatic ductal adenocarcinoma (PDA).

Methods

Three hundred sixteen patients with PDA who underwent MDCT and first-line surgery were included. Patients were divided into a test (n = 216) and a validation group (n = 100). The R classification was categorized into R0 (no residual tumor) and R1/R2 (microscopic/macroscopic residual tumor). We assessed the correlation between the MDCT findings and the R classification. For survival analysis, we used the Kaplan–Meier estimation and Cox proportional hazard model to determine the prognostic factors for OS. Validation of the prediction models for the R classification and OS was performed using C statistics and calibration plot.

Results

Peritumoral fat stranding (odds ratio (OR) 3.826), suspicious distant metastasis (OR 2.916), portal vein involvement (OR 2.795), and tumor size (OR 1.045) were independent predictors for residual tumor (p < .05). On survival analysis, common hepatic artery involvement (hazard ratio (HR) 5.656), R1/R2 stage (HR 2.476), and N1 stage (HR 1.745) were predictors of poor OS (p < .05). C statistics for prediction models for R classification and OS were 0.816 and 0.662, respectively. Calibration plots showed good predictive performance in a high probability of the R1/R2 stage or poor OS.

Conclusion

Preoperative MDCT is useful for predicting the R classification using the tumor size, peritumoral fat stranding, portal vein involvement, and suspicious distant metastasis, as well as for anticipating poor OS using the N1 stage, common hepatic artery involvement, and R1/R2 stage in patients with PDA.

Key Points

• Thorough assessment of the involvement of common hepatic artery or portal vein and peritumoral fat stranding is warranted for predicting prognosis in patients with pancreatic ductal adenocarcinoma.

• Not only encasement but also abutment of common hepatic artery or portal vein by tumor predicts poor prognosis after upfront surgery.

• If residual tumor or poor overall survival is anticipated on preoperative MDCT, neoadjuvant treatment can be performed.

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Abbreviations

CA:

Celiac axis

CHA:

Common hepatic artery

MDCT:

Multiple detector computed tomography

OS:

Overall survival

PDA:

Pancreatic ductal adenocarcinoma

PV:

Portal vein

R:

Residual tumor

SMA:

Superior mesenteric artery

SMV:

Superior mesenteric vein

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Acknowledgements

We would like to thank Bonnie Hami, MA (USA), for her editorial assistance in the preparation of this manuscript.

The authors appreciate the Medical Research Collaborating Center at Seoul National University Hospital for statistical analysis and consultation.

Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Jae Seok Bae, Jung Hoon Kim, Ijin Joo & Joon Koo Han

  2. Department of Radiology, College of Medicine, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Jae Seok Bae, Jung Hoon Kim, Ijin Joo & Joon Koo Han

  3. Institute of Radiation Medicine, Medical Research Center, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Jung Hoon Kim & Joon Koo Han

  4. Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea

    Won Chang

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  1. Jae Seok Bae
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Correspondence to Jung Hoon Kim.

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The scientific guarantor of this publication is Joon Koo Han, M.D.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Medical Research Collaborating Center at Seoul National University Hospital has been consulted for statistical analysis.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained (IRB No. 1609-130-796).

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• Retrospective

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• Performed at one institution

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Bae, J.S., Kim, J.H., Joo, I. et al. MDCT findings predicting post-operative residual tumor and survival in patients with pancreatic cancer. Eur Radiol 29, 3714–3724 (2019). https://doi.org/10.1007/s00330-019-06140-9

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  • DOI: https://doi.org/10.1007/s00330-019-06140-9

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