Abstract
Purpose
This study was designed to assess the computed tomography maximum (CTmax) value on pretherapeutic arterial phase computed tomography (APCT) images to predict pancreatic neuroendocrine tumours (pNETs) recurrence and clarify its role in predicting the outcome of tumour therapy.
Methods
This retrospective study enrolled 250 surgical patients and 24 nonsurgical patients with sunitinib-based treatment in our hospital from 2008 to 2019. CT images were assessed, the maximum value was defined as “CTmax,” and recurrence-free survival (RFS) or progression-free survival (PFS) was compared between a high-CTmax group and a low-CTmax group among patients who underwent surgical resection or nonsurgical, sunitinib-based treatment according to the CTmax cutoff value.
Results
In ROC curve analysis, a CTmax of 108 Hounsfield units, as the cutoff value, achieved an AUC of 0.796 in predicting recurrence. Compared with the low-CTmax group, the high-CTmax group had a longer RFS (p < 0.001). Low CTmax was identified as an independent factor for RFS (p < 0.001) in multivariate analysis; these results were confirmed using the internal validation set. The CTmax value was significantly correlated with the microvascular density (MVD) value (p < 0.001) and the vascular endothelial growth factor receptor 2 (VEGFR2) score (p < 0.001). Furthermore, the high-CTmax group had a better PFS than the low-CTmax group among the sunitinib treatment group (p = 0.007).
Conclusions
The tumour CTmax on APCT might be a potential and independent indicator for predicting recurrence in patients who have undergone surgical resection and assessing the efficacy of sunitinib for patients with advanced metastatic pNETs.
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Acknowledgment
This work was supported in part by the National Natural Science Foundation of China (U21A20374), the Shanghai Municipal Science and Technology Major Project (21JC1401500), the Scientific Innovation Project of Shanghai Education Committee (2019-01-07-00-07-E00057), the Clinical Research Plan of Shanghai Hospital Development Center (SHDC2020CR1006A), the Xuhui District Artificial Intelligence Medical Hospital Cooperation Project (2021-011), the Shanghai Municipal Science and Technology Commission (20ZR1471100), and the National Science Foundation of China (No. 82141129, 82173281, 82173282, 82172577 and 82172948).
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SRJ, XJY, and WT contributed to the conception of the study; ZY, XL, WHZ, HLG, YQ, and JC contributed significantly to analysis and manuscript preparation; HDC, ZL, YHH, XMC, YZ, and XWX performed the data analyses and wrote the manuscript; HDC helped perform the analysis with constructive discussions.
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Chen, H., Li, Z., Hu, Y. et al. Maximum Value on Arterial Phase Computed Tomography Predicts Prognosis and Treatment Efficacy of Sunitinib for Pancreatic Neuroendocrine Tumours. Ann Surg Oncol 30, 2988–2998 (2023). https://doi.org/10.1245/s10434-022-12693-9
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DOI: https://doi.org/10.1245/s10434-022-12693-9