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Prognostic value of tumor-to-parenchymal contrast enhancement ratio on portal venous-phase CT in pancreatic neuroendocrine neoplasms

  • Hepatobiliary-Pancreas
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Abstract

Objectives

We aimed to evaluate the prognostic value of tumor-to-parenchymal contrast enhancement ratio on portal venous-phase CT (CER on PVP) and compare its prognostic performance to prevailing grading and staging systems in pancreatic neuroendocrine neoplasms (PanNENs).

Methods

In this retrospective study, data on 465 patients (development cohort) who underwent upfront curative-intent resection for PanNEN were used to assess the performance of CER on PVP and tumor size measured by CT (CT-Size) in predicting recurrence-free survival (RFS) using Harrell’s C-index and to determine their optimal cutoffs to stratify RFS using a multi-way partitioning algorithm. External data on 184 patients (test cohort) were used to validate the performance of CER on PVP in predicting RFS and overall survival (OS) and compare its predictive performance with those of CT-Size, 2019 World Health Organization classification system (WHO), and the 8th American Joint Committee on Cancer staging system (AJCC).

Results

In the test cohort, CER on PVP showed C-indexes of 0.83 (95% confidence interval [CI], 0.74–0.91) and 0.84 (95% CI, 0.73–0.95) for predicting RFS and OS, respectively, which were higher than those for the WHO (C-index: 0.73 for RFS [p = .002] and 0.72 for OS [p = .004]) and AJCC (C-index, 0.67 for RFS [p = .002] and 0.58 for OS [p = .002]). CT-Size obtained C-indexes of 0.71 for RFS and 0.61 for OS.

Conclusions

CER on PVP showed superior predictive performance on postoperative survival in PanNEN than current grading and staging systems, indicating its potential as a noninvasive preoperative prognostic tool.

Key Points

• In pancreatic neuroendocrine neoplasms, the tumor-to-parenchymal enhancement ratio on portal venous-phase CT (CER on PVP) showed acceptable predictive performance of postoperative outcomes.

• CER on PVP showed superior predictive performance of postoperative survival over the current WHO classification and AJCC staging system.

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Abbreviations

AP:

Arterial phase

CER:

Contrast enhancement ratio

HR:

Hazard ratio

IQR:

Interquartile range

NEC:

Neuroendocrine carcinoma

NET:

Neuroendocrine tumor

OS:

Overall survival

PanNEN:

Pancreatic neuroendocrine neoplasm

PVP:

Portal venous phase

RFS:

Recurrence-free survival

ROC:

Receiver operating characteristics

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Funding

This study was supported by a grant from the National Research Foundation of Korea (NRF), funded by the Korean government (MSIT) (grant number 2021R1C1C1010138 to Hyo Jung Park). Other authors received no financial support for the work described in this study.

Author information

Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea

    Hyo Jung Park, Hyoung Jung Kim, So Yeon Kim, Sang Hyun Choi & Jae Ho Byun

  2. Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu Seoul, 110-744, Republic of Korea

    Jung Hoon Kim

  3. Division of Hepatobiliary and Pancreas Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Song Cheol Kim

  4. Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Hee Sang Hwang & Seung-Mo Hong

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  1. Hyo Jung Park
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Corresponding author

Correspondence to Hyoung Jung Kim.

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Guarantor

The scientific guarantor of this publication is Hyoung Jung Kim.

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

We consulted an expert statistician (Jung Bok Lee, Associate Professor, Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea) for this study.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Study subjects or cohorts have been previously reported in the articles below.

Kim DW, Kim HJ, Kim KW, et al (2015) Neuroendocrine neoplasms of the pancreas at dynamic enhanced CT: comparison between grade 3 neuroendocrine carcinoma and grade 1/2 neuroendocrine tumour. Eur Radiol 25:1375-1383

Kim DW, Kim HJ, Kim KW et al (2016) Prognostic value of CT findings to predict survival outcomes in patients with pancreatic neuroendocrine neoplasms: a single institutional study of 161 patients. Eur Radiol 26:1320-1329

Choi SH, Kim HJ, Kim SY et al (2017) Computed tomography features predictive of lymph node involvement in patients with a nonfunctioning pancreatic neuroendocrine tumor. Pancreas 46:1056-1063

Park HJ, Kim HJ, Kim KW et al (2020) Comparison between neuroendocrine carcinomas and well-differentiated neuroendocrine tumors of the pancreas using dynamic enhanced CT. Eur Radiol 30:4772-4782

Methodology

• retrospective

• observational study

• multicenter study

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Park, H.J., Kim, H.J., Kim, J.H. et al. Prognostic value of tumor-to-parenchymal contrast enhancement ratio on portal venous-phase CT in pancreatic neuroendocrine neoplasms. Eur Radiol 33, 2713–2724 (2023). https://doi.org/10.1007/s00330-022-09235-y

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