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

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Title: MDCT findings predicting post-operative residual tumor and survival in patients with pancreatic cancer.
Authors: Bae, Jae Seok1,2, Kim, Jung Hoon1,2,3 jhkim2008@gmail.com, Joo, Ijin1,2, Chang, Won4, Han, Joon Koo1,2,3
Source: European Radiology. Jul2019, Vol. 29 Issue 7, p3714-3724. 11p. 3 Diagrams, 3 Charts, 2 Graphs.
Subjects: Pancreatic cancer, Proportional hazards models, Pancreatectomy, Hepatic artery, Portal vein, Multidetector computed tomography
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. [ABSTRACT FROM AUTHOR]
Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: MDCT findings predicting post-operative residual tumor and survival in patients with pancreatic cancer.
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  Data: &lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Bae%2C+Jae+Seok%22&quot;&gt;Bae, Jae Seok&lt;/searchLink&gt;&lt;relatesTo&gt;1,2&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Kim%2C+Jung+Hoon%22&quot;&gt;Kim, Jung Hoon&lt;/searchLink&gt;&lt;relatesTo&gt;1,2,3&lt;/relatesTo&gt;&lt;i&gt; jhkim2008@gmail.com&lt;/i&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Joo%2C+Ijin%22&quot;&gt;Joo, Ijin&lt;/searchLink&gt;&lt;relatesTo&gt;1,2&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Chang%2C+Won%22&quot;&gt;Chang, Won&lt;/searchLink&gt;&lt;relatesTo&gt;4&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Han%2C+Joon+Koo%22&quot;&gt;Han, Joon Koo&lt;/searchLink&gt;&lt;relatesTo&gt;1,2,3&lt;/relatesTo&gt;
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  Data: &lt;searchLink fieldCode=&quot;JN&quot; term=&quot;%22European+Radiology%22&quot;&gt;European Radiology&lt;/searchLink&gt;. Jul2019, Vol. 29 Issue 7, p3714-3724. 11p. 3 Diagrams, 3 Charts, 2 Graphs.
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  Data: &lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Pancreatic+cancer%22&quot;&gt;Pancreatic cancer&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Proportional+hazards+models%22&quot;&gt;Proportional hazards models&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Pancreatectomy%22&quot;&gt;Pancreatectomy&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Hepatic+artery%22&quot;&gt;Hepatic artery&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Portal+vein%22&quot;&gt;Portal vein&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Multidetector+computed+tomography%22&quot;&gt;Multidetector computed tomography&lt;/searchLink&gt;
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  Label: Abstract
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  Data: &lt;bold&gt;Objectives: &lt;/bold&gt;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).&lt;bold&gt;Methods: &lt;/bold&gt;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.&lt;bold&gt;Results: &lt;/bold&gt;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 &lt; .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 &lt; .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.&lt;bold&gt;Conclusion: &lt;/bold&gt;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.&lt;bold&gt;Key Points: &lt;/bold&gt;• 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. [ABSTRACT FROM AUTHOR]
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  Data: &lt;i&gt;Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
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      – Type: doi
        Value: 10.1007/s00330-019-06140-9
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      – Code: eng
        Text: English
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        PageCount: 11
        StartPage: 3714
    Subjects:
      – SubjectFull: Pancreatic cancer
        Type: general
      – SubjectFull: Proportional hazards models
        Type: general
      – SubjectFull: Pancreatectomy
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      – SubjectFull: Hepatic artery
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      – SubjectFull: Portal vein
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      – SubjectFull: Multidetector computed tomography
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      – TitleFull: MDCT findings predicting post-operative residual tumor and survival in patients with pancreatic cancer.
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              Text: Jul2019
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