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European Radiology

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01-07-2019 | Metastasis | Hepatobiliary-Pancreas

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

Authors: Jae Seok Bae, Jung Hoon Kim, Ijin Joo, Won Chang, Joon Koo Han

Published in: European Radiology | Issue 7/2019

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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Siegel RL, Miller KD, Jemal A (2018) Cancer statistics, 2018. CA Cancer J Clin 68:7–30CrossRef

Konstantinidis IT, Warshaw AL, Allen JN et al (2013) Pancreatic ductal adenocarcinoma: is there a survival difference for R1 resections versus locally advanced unresectable tumors? What is a “true” R0 resection? Ann Surg 257:731–736CrossRefPubMed

Demir IE, Jager C, Schlitter AM et al (2017) R0 versus R1 resection matters after pancreaticoduodenectomy, and less after distal or total pancreatectomy for pancreatic cancer. Ann Surg. https://doi.org/10.1097/SLA.0000000000002345

Howard TJ, Krug JE, Yu J et al (2006) A margin-negative R0 resection accomplished with minimal postoperative complications is the surgeon's contribution to long-term survival in pancreatic cancer. J Gastrointest Surg 10:1338–1345 discussion 1345-1336CrossRefPubMed

Sohn TA, Yeo CJ, Cameron JL et al (2000) Resected adenocarcinoma of the pancreas-616 patients: results, outcomes, and prognostic indicators. J Gastrointest Surg 4:567–579CrossRefPubMed

Winter JM, Cameron JL, Campbell KA et al (2006) 1423 pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg 10:1199–1210 discussion 1210-1191CrossRefPubMed

Versteijne E, Vogel JA, Besselink MG et al (2018) Meta-analysis comparing upfront surgery with neoadjuvant treatment in patients with resectable or borderline resectable pancreatic cancer. Br J Surg. https://doi.org/10.1002/bjs.10870

Kim JH, Eun HW, Kim KW et al (2013) Diagnostic performance of MDCT for predicting important prognostic factors in pancreatic cancer. Pancreas 42:1316–1322CrossRefPubMed

Karmazanovsky G, Fedorov V, Kubyshkin V, Kotchatkov A (2005) Pancreatic head cancer: accuracy of CT in determination of resectability. Abdom Imaging 30:488–500CrossRefPubMed

10.

Olivie D, Lepanto L, Billiard JS, Audet P, Lavallee JM (2007) Predicting resectability of pancreatic head cancer with multi-detector CT. Surgical and pathologic correlation. JOP 8:753–758PubMed

11.

Lu DS, Reber HA, Krasny RM, Kadell BM, Sayre J (1997) Local staging of pancreatic cancer: criteria for unresectability of major vessels as revealed by pancreatic-phase, thin-section helical CT. AJR Am J Roentgenol 168:1439–1443CrossRefPubMed

12.

Valls C, Andia E, Sanchez A et al (2002) Dual-phase helical CT of pancreatic adenocarcinoma: assessment of resectability before surgery. AJR Am J Roentgenol 178:821–826CrossRefPubMed

13.

Tempero MA, Malafa MP, Al-Hawary M et al (2017) Pancreatic adenocarcinoma, version 2.2017, NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw 15:1028–1061CrossRef

14.

Yamada S, Fujii T, Takami H et al (2017) Evaluation and proposal of novel resectability criteria for pancreatic cancer established by the Japan Pancreas Society. Surgery 162:784–791CrossRefPubMed

15.

Kondo N, Murakami Y, Uemura K et al (2010) Prognostic impact of perioperative serum CA 19-9 levels in patients with resectable pancreatic cancer. Ann Surg Oncol 17:2321–2329CrossRefPubMed

16.

Murakami Y, Satoi S, Sho M et al (2015) National comprehensive cancer network resectability status for pancreatic carcinoma predicts overall survival. World J Surg 39:2306–2314CrossRefPubMed

17.

Zhu L, Shi X, Xue H et al (2016) CT imaging biomarkers predict clinical outcomes after pancreatic cancer surgery. Medicine (Baltimore) 95:e2664CrossRef

18.

Matsumoto S, Mori H, Kiyonaga M et al (2012) “Peripancreatic strands appearance” in pancreatic body and tail carcinoma: evaluation by multi-detector CT with pathological correlation. Abdom Imaging 37:602–608CrossRefPubMed

19.

Al-Hawary MM, Francis IR, Chari ST et al (2014) Pancreatic ductal adenocarcinoma radiology reporting template: consensus statement of the society of abdominal radiology and the American Pancreatic Association. Gastroenterology 146:291–304 e291CrossRefPubMed

20.

Ballehaninna UK, Chamberlain RS (2012) The clinical utility of serum CA 19-9 in the diagnosis, prognosis and management of pancreatic adenocarcinoma: an evidence based appraisal. J Gastrointest Oncol 3:105–119PubMedPubMedCentral

21.

Imaoka H, Mizuno N, Hara K et al (2016) Prognostic impact of carcinoembryonic antigen (CEA) on patients with metastatic pancreatic cancer: a retrospective cohort study. Pancreatology 16:859–864CrossRefPubMed

22.

Gospodarowicz MK, Brierley JD, Wittekind C (2017) TNM classification of malignant tumours. John Wiley & Sons

23.

Campbell F, Smith RA, Whelan P et al (2009) Classification of R1 resections for pancreatic cancer: the prognostic relevance of tumour involvement within 1 mm of a resection margin. Histopathology 55:277–283CrossRefPubMed

24.

Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174CrossRef

25.

Harrell FE Jr, Lee KL, Mark DB (1996) Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med 15:361–387CrossRef

26.

Kim M, Kang TW, Cha DI et al (2018) Prediction and clinical implications of portal vein/superior mesenteric vein invasion in patients with resected pancreatic head cancer: the significance of preoperative CT parameters. Clin Radiol 73:564–573CrossRef

27.

Sai M, Mori H, Kiyonaga M, Kosen K, Yamada Y, Matsumoto S (2010) Peripancreatic lymphatic invasion by pancreatic carcinoma: evaluation with multi-detector row CT. Abdom Imaging 35:154–162CrossRefPubMed

28.

Chang ST, Jeffrey RB, Patel BN et al (2016) Preoperative multidetector CT diagnosis of extrapancreatic perineural or duodenal invasion is associated with reduced postoperative survival after pancreaticoduodenectomy for pancreatic adenocarcinoma: preliminary experience and implications for patient care. Radiology 281:816–825CrossRef

29.

Kozak GM, Epstein JD, Deshmukh SP et al (2018) Common hepatic artery abutment or encasement is an adverse prognostic factor in patients with borderline and Unresectable pancreatic cancer. J Gastrointest Surg 22:288–294CrossRefPubMed

30.

Ravikumar R, Sabin C, Abu Hilal M et al (2017) Impact of portal vein infiltration and type of venous reconstruction in surgery for borderline resectable pancreatic cancer. Br J Surg 104:1539–1548CrossRefPubMed

31.

Kato H, Usui M, Isaji S et al (2013) Clinical features and treatment outcome of borderline resectable pancreatic head/body cancer: a multi-institutional survey by the Japanese Society of Pancreatic Surgery. J Hepatobiliary Pancreat Sci 20:601–610CrossRefPubMed

32.

Kim HS, Jang JY, Han Y et al (2017) Survival outcome and prognostic factors of neoadjuvant treatment followed by resection for borderline resectable pancreatic cancer. Ann Surg Treat Res 93:186–194CrossRefPubMedPubMedCentral

33.

Gemenetzis G, Groot VP, Blair AB et al (2018) Survival in locally advanced pancreatic cancer after neoadjuvant therapy and surgical resection. Ann Surg. https://doi.org/10.1097/SLA.0000000000002753

34.

Jeon SK, Lee JM, Joo I et al (2018) Magnetic resonance with diffusion-weighted imaging improves assessment of focal liver lesions in patients with potentially resectable pancreatic cancer on CT. Eur Radiol 28:3484–3493CrossRefPubMed

35.

Kartalis N (2018) CT and MRI of pancreatic cancer: there is no rose without a thorn! Eur Radiol 28:3482–3483CrossRefPubMed

Title: MDCT findings predicting post-operative residual tumor and survival in patients with pancreatic cancer
Authors: Jae Seok Bae
Jung Hoon Kim
Ijin Joo
Won Chang
Joon Koo Han
Publication date: 01-07-2019
Publisher: Springer Berlin Heidelberg
Keyword: Metastasis
Published in: European Radiology / Issue 7/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-019-06140-9

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

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

Abstract

Objectives

Methods

Results

Conclusion

Key Points

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

Key Points

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