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Cancer Imaging
Published in: Cancer Imaging 1/2024

Open Access 01-12-2024 | Pancreatic Cancer | Research article

Development and validation of a nomogram model based on pretreatment ultrasound and contrast-enhanced ultrasound to predict the efficacy of neoadjuvant chemotherapy in patients with borderline resectable or locally advanced pancreatic cancer

Authors: Xiaoyi Yan, Xianshui Fu, Yang Gui, Xueqi Chen, Yuejuan Cheng, Menghua Dai, Weibin Wang, Mengsu Xiao, Li Tan, Jing Zhang, Yuming Shao, Huanyu Wang, Xiaoyan Chang, Ke Lv

Published in: Cancer Imaging | Issue 1/2024

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Abstract

Objectives

To develop a nomogram using pretreatment ultrasound (US) and contrast-enhanced ultrasound (CEUS) to predict the clinical response of neoadjuvant chemotherapy (NAC) in patients with borderline resectable pancreatic cancer (BRPC) or locally advanced pancreatic cancer (LAPC).

Methods

A total of 111 patients with pancreatic ductal adenocarcinoma (PDAC) treated with NAC between October 2017 and February 2022 were retrospectively enrolled. The patients were randomly divided (7:3) into training and validation cohorts. The pretreatment US and CEUS features were reviewed. Univariate and multivariate logistic regression analyses were used to determine the independent predictors of clinical response in the training cohort. Then a prediction nomogram model based on the independent predictors was constructed. The area under the curve (AUC), calibration plot, C-index and decision curve analysis (DCA) were used to assess the nomogram’s performance, calibration, discrimination and clinical benefit.

Results

The multivariate logistic regression analysis showed that the taller-than-wide shape in the longitudinal plane (odds ratio [OR]:0.20, p = 0.01), time from injection of contrast agent to peak enhancement (OR:3.64; p = 0.05) and Peaktumor/ Peaknormal (OR:1.51; p = 0.03) were independent predictors of clinical response to NAC. The predictive nomogram developed based on the above imaging features showed AUCs were 0.852 and 0.854 in the primary and validation cohorts, respectively. Good calibration was achieved in the training datasets, with C-index of 0.852. DCA verified the clinical usefulness of the nomogram.

Conclusions

The nomogram based on pretreatment US and CEUS can effectively predict the clinical response of NAC in patients with BRPC and LAPC; it may help guide personalized treatment.
Literature
1.
Rahib L, Smith BD, Aizenberg R, Rosenzweig AB, Fleshman JM, Matrisian LM. Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States. Cancer Res. 2014;74:2913–21.CrossRefPubMed
2.
3.
Conlon KC, Klimstra DS, Brennan MF. Long-term survival after curative resection for pancreatic ductal adenocarcinoma. Clinicopathologic analysis of 5-year survivors. Ann Surg. 1996;223:273–9.CrossRefPubMedPubMedCentral
4.
Versteijne E, van Dam JL, Suker M, Janssen QP, Groothuis K, Akkermans-Vogelaar JM, et al. Neoadjuvant chemoradiotherapy versus upfront surgery for resectable and borderline resectable pancreatic cancer: long-term results of the Dutch randomized PREOPANC trial. J Clin Oncol. 2022;40:1220–30.CrossRefPubMed
5.
Sohal DPS, Duong M, Ahmad SA, Gandhi NS, Beg MS, Wang-Gillam A, et al. Efficacy of perioperative chemotherapy for resectable pancreatic adenocarcinoma: a phase 2 randomized clinical trial. JAMA Oncol. 2021;7:421–7.CrossRefPubMed
6.
Sherman MH, Beatty GL. Tumor microenvironment in pancreatic cancer pathogenesis and therapeutic resistance. Annu Rev Pathol. 2023;18:123–48.CrossRefPubMed
7.
Jung HS, Kim HS, Kang JS, Kang YH, Sohn HJ, Byun Y, et al. Oncologic benefits of neoadjuvant treatment versus upfront surgery in borderline resectable pancreatic cancer: a systematic review and meta-analysis. Cancers (Basel). 2022;14:4360.CrossRefPubMed
8.
Versteijne E, Vogel JA, Besselink MG, Busch ORC, Wilmink JW, Daams JG, et al. Meta-analysis comparing upfront surgery with neoadjuvant treatment in patients with resectable or borderline resectable pancreatic cancer. Br J Surg. 2018;105:946–58.CrossRefPubMed
9.
10.
Chen BB, Tien YW, Chang MC, Cheng MF, Chang YT, Wu CH, et al. PET/MRI in pancreatic and periampullary cancer: correlating diffusion-weighted imaging, MR spectroscopy and glucose metabolic activity with clinical stage and prognosis. Eur J Nucl Med Mol Imaging. 2016;43:1753–64.CrossRefPubMed
11.
Emori T, Ashida R, Tamura T, Kawaji Y, Hatamaru K, Itonaga M, et al. Contrast-enhanced harmonic endoscopic ultrasonography for predicting the efficacy of first-line gemcitabine and nab-paclitaxel chemotherapy in pancreatic cancer. Pancreatology. 2022;22:525–33.CrossRefPubMed
12.
Tanaka H, Kamata K, Takenaka M, Yoshikawa T, Ishikawa R, Okamoto A, et al. Contrast-enhanced harmonic endoscopic ultrasonography for evaluating the response to chemotherapy in pancreatic cancer. Dig Liver Dis. 2019;51:1130–4.CrossRefPubMed
13.
Dietrich CF, Nolsøe CP, Barr RG, Berzigotti A, Burns PN, Cantisani V, et al. Guidelines and good clinical practice recommendations for Contrast-Enhanced Ultrasound (CEUS) in the liver-update 2020 WFUMB in cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS. Ultrasound Med Biol. 2020;46:2579–604.CrossRefPubMed
14.
Zhou T, Tan L, Gui Y, Zhang J, Chen X, Dai M, et al. correlation between enhancement patterns on transabdominal ultrasound and survival for pancreatic ductal adenocarcinoma. Cancer Manag Res. 2021;13:6823–32.CrossRefPubMedPubMedCentral
15.
Jia WY, Gui Y, Chen XQ, Zhang XQ, Zhang JH, Dai MH, et al. Evaluation of the diagnostic performance of the EFSUMB CEUS pancreatic applications guidelines (2017 version): a retrospective single-center analysis of 455 solid pancreatic masses. Eur Radiol. 2022;32:8485–96.CrossRefPubMed
16.
Huang J, Yang J, Ding J, Zhou J, Yang R, Li J, et al. Development and validation of an ultrasound-based prediction model for differentiating between malignant and benign solid pancreatic lesions. Eur Radiol. 2022;32:8296–305.CrossRefPubMedPubMedCentral
17.
Huang J, Xie X, Wu H, Zhang X, Zheng Y, Xie X, et al. Development and validation of a combined nomogram model based on deep learning contrast-enhanced ultrasound and clinical factors to predict preoperative aggressiveness in pancreatic neuroendocrine neoplasms. Eur Radiol. 2022;32:7965–75.CrossRefPubMed
18.
Perri G, Prakash L, Qiao W, Varadhachary GR, Wolff R, Fogelman D, et al. Response and survival associated with first-line FOLFIRINOX vs gemcitabine and nab-paclitaxel chemotherapy for localized pancreatic ductal adenocarcinoma. JAMA Surg. 2020;155:832–9.CrossRefPubMedPubMedCentral
19.
Hester CA, Perri G, Prakash LR, Maxwell JE, Ikoma N, Kim MP, et al. Radiographic and serologic response to first-line chemotherapy in unresected localized pancreatic cancer. J Natl Compr Canc Netw. 2022;20:887-897.e883.CrossRefPubMed
20.
Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45:228–47.CrossRefPubMed
21.
Truty MJ, Kendrick ML, Nagorney DM, Smoot RL, Cleary SP, Graham RP, et al. Factors predicting response, perioperative outcomes, and survival following total neoadjuvant therapy for borderline/locally advanced pancreatic cancer. Ann Surg. 2021;273:341–9.CrossRefPubMed
22.
Botta GP, Huynh TR, Spierling-Bagsic SR, Agelidis A, Schaffer R, Lin R, et al. Neoadjuvant chemotherapy and radiotherapy outcomes in borderline-resectable and locally-advanced pancreatic cancer patients. Cancer Med. 2023;12:7713–23.CrossRefPubMed
23.
Khorana AA, Mangu PB, Berlin J, Engebretson A, Hong TS, Maitra A, et al. Potentially curable pancreatic cancer: american society of clinical oncology clinical practice guideline update. J Clin Oncol. 2017;35:2324–8.CrossRefPubMed
24.
Seppälä TT, Zimmerman JW, Suri R, Zlomke H, Ivey GD, Szabolcs A, et al. Precision medicine in pancreatic cancer: patient-derived organoid pharmacotyping is a predictive biomarker of clinical treatment response. Clin Cancer Res. 2022;28:3296–307.CrossRefPubMedPubMedCentral
25.
Lee YJ, Kim SH, Kang BJ, Kim YJ. Contrast-enhanced ultrasound for early prediction of response of breast cancer to neoadjuvant chemotherapy. Ultraschall Med. 2019;40:194–204.CrossRefPubMed
26.
Wan CF, Liu XS, Wang L, Zhang J, Lu JS, Li FH. Quantitative contrast-enhanced ultrasound evaluation of pathological complete response in patients with locally advanced breast cancer receiving neoadjuvant chemotherapy. Eur J Radiol. 2018;103:118–23.CrossRefPubMed
27.
Kim Y, Kim SH, Song BJ, Kang BJ, Yim KI, Lee A, et al. Early prediction of response to neoadjuvant chemotherapy using dynamic contrast-enhanced MRI and ultrasound in breast cancer. Korean J Radiol. 2018;19:682–91.CrossRefPubMedPubMedCentral
28.
Amadori M, Barone D, Scarpi E, Oboldi D, Amadori E, Bandi G, et al. Dynamic contrast-enhanced ultrasonography (D-CEUS) for the early prediction of bevacizumab efficacy in patients with metastatic colorectal cancer. Eur Radiol. 2018;28:2969–78.CrossRefPubMed
29.
Lu XY, Guo X, Zhang Q, Qiu YJ, Zuo D, Chen S, et al. Early assessment of chemoradiotherapy response for locally advanced pancreatic ductal adenocarcinoma by dynamic contrast-enhanced ultrasound. Diagnostics (Basel). 2022;12:2662.CrossRefPubMed
30.
Li Y, Chen Y, Zhao R, Ji Y, Li J, Zhang Y, et al. Development and validation of a nomogram based on pretreatment dynamic contrast-enhanced MRI for the prediction of pathologic response after neoadjuvant chemotherapy for triple-negative breast cancer. Eur Radiol. 2022;32:1676–87.CrossRefPubMed
31.
Cui Y, Zhang J, Li Z, Wei K, Lei Y, Ren J, et al. A CT-based deep learning radiomics nomogram for predicting the response to neoadjuvant chemotherapy in patients with locally advanced gastric cancer: a multicenter cohort study. EClinicalMedicine. 2022;46:101348.CrossRefPubMedPubMedCentral
32.
Guo BL, Ouyang FS, Ouyang LZ, Liu ZW, Lin SJ, Meng W, et al. Development and validation of an ultrasound-based nomogram to improve the diagnostic accuracy for malignant thyroid nodules. Eur Radiol. 2019;29:1518–26.CrossRefPubMed
33.
Richman DM, Benson CB, Doubilet PM, Peters HE, Huang SA, Asch E, et al. Thyroid nodules in pediatric patients: sonographic characteristics and likelihood of cancer. Radiology. 2018;288:591–9.CrossRefPubMed
34.
Zhu YC, AlZoubi A, Jassim S, Jiang Q, Zhang Y, Wang YB, et al. A generic deep learning framework to classify thyroid and breast lesions in ultrasound images. Ultrasonics. 2021;110:106300.CrossRefPubMed
35.
Payen T, Oberstein PE, Saharkhiz N, Palermo CF, Sastra SA, Han Y, et al. Harmonic motion imaging of pancreatic tumor stiffness indicates disease state and treatment response. Clin Cancer Res. 2020;26:1297–308.CrossRefPubMed
36.
D’Onofrio M, Zamboni GA, Malagò R, Mantovani W, Principe F, Gallotti A, et al. Resectable pancreatic adenocarcinoma: is the enhancement pattern at contrast-enhanced ultrasonography a pre-operative prognostic factor? Ultrasound Med Biol. 2009;35:1929–37.CrossRefPubMed
37.
Akasu G, Kawahara R, Yasumoto M, Sakai T, Goto Y, Sato T, et al. Clinicopathological analysis of contrast-enhanced ultrasonography using perflubutane in pancreatic adenocarcinoma. Kurume Med J. 2012;59:45–52.CrossRefPubMed
Metadata
Title
Development and validation of a nomogram model based on pretreatment ultrasound and contrast-enhanced ultrasound to predict the efficacy of neoadjuvant chemotherapy in patients with borderline resectable or locally advanced pancreatic cancer
Authors
Xiaoyi Yan
Xianshui Fu
Yang Gui
Xueqi Chen
Yuejuan Cheng
Menghua Dai
Weibin Wang
Mengsu Xiao
Li Tan
Jing Zhang
Yuming Shao
Huanyu Wang
Xiaoyan Chang
Ke Lv
Publication date
01-12-2024
Publisher
BioMed Central
Published in
Cancer Imaging / Issue 1/2024
Electronic ISSN: 1470-7330
DOI
https://doi.org/10.1186/s40644-024-00662-2

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