European journal of radiology · 2025
Dynamic contrast-enhanced CT-derived extracellular volume fraction for predicting postoperative oncologic outcomes in pancreatic ductal adenocarcinoma.
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Fukui Hideyuki, Fukuda Yasunari, Onishi Hiromitsu, Ota Takashi, Nakamoto Atsushi, Honda Toru, Aihara Ryo, Enchi Yukihiro, Yamada Daisaku, Kobayashi Shogo, Eguchi Hidetoshi, Tatsumi Mitsuaki, Tomiyama Noriyuki
Аннотация
OBJECTIVE: To evaluate the prognostic value of the extracellular volume fraction (fECV) derived from contrast-enhanced computed tomography (CE-CT) for recurrence-free survival (RFS) and overall survival (OS) rates after pancreatic ductal adenocarcinoma (PDAC) surgery.
METHODS: This retrospective study evaluated 71 patients diagnosed with PDAC postsurgery who underwent CE-CT with precontrast and equilibrium phases before neoadjuvant chemotherapy (35 males, 36 females; mean age, 70.3 years; 95 % CI, 68.1-72.6; SD, 9.8; range, 45-89 years), were enrolled. Noncancerous pancreatic parenchyma and pancreatic tumors were automatically segmented from nonenhanced and equilibrium-phase images, excluding focal lesions, major-vessel, and ducts. Uni- and multivariate analyses (Cox proportional hazards model) were performed to evaluate fECV [=(100 - hematocrit) × (ΔPancreas/ΔAorta] in the nonaffected pancreas and tumor, with age, sex, chemotherapeutic scheme, tumor marker/location/size, stage, histological type, RFS, and OS as factors. Time-dependent receiver-operating characteristic curves showed the optimal fECV cutoff values for predicting RFS and OS.
RESULTS: Adjuvant chemotherapy regimen, histological type, and fECV of noncancerous pancreatic parenchyma were independent prognostic factors of OS (p < 0.001, 0.049, and 0.018, respectively), and TNM stage (IB) was an independent predictor of RFS (p = 0.025). RFS and OS were worse in patients with noncancerous pancreatic tissue with higher fECV than in those with lower fECV (optimal cutoffs: 40.32 % for RFS, p = 0.036; 43.65 % for OS, p < 0.001).
CONCLUSION: The fECV of noncancerous pancreatic parenchyma from CE-CT was a significant predictor of survival outcomes in PDAC.
METHODS: This retrospective study evaluated 71 patients diagnosed with PDAC postsurgery who underwent CE-CT with precontrast and equilibrium phases before neoadjuvant chemotherapy (35 males, 36 females; mean age, 70.3 years; 95 % CI, 68.1-72.6; SD, 9.8; range, 45-89 years), were enrolled. Noncancerous pancreatic parenchyma and pancreatic tumors were automatically segmented from nonenhanced and equilibrium-phase images, excluding focal lesions, major-vessel, and ducts. Uni- and multivariate analyses (Cox proportional hazards model) were performed to evaluate fECV [=(100 - hematocrit) × (ΔPancreas/ΔAorta] in the nonaffected pancreas and tumor, with age, sex, chemotherapeutic scheme, tumor marker/location/size, stage, histological type, RFS, and OS as factors. Time-dependent receiver-operating characteristic curves showed the optimal fECV cutoff values for predicting RFS and OS.
RESULTS: Adjuvant chemotherapy regimen, histological type, and fECV of noncancerous pancreatic parenchyma were independent prognostic factors of OS (p < 0.001, 0.049, and 0.018, respectively), and TNM stage (IB) was an independent predictor of RFS (p = 0.025). RFS and OS were worse in patients with noncancerous pancreatic tissue with higher fECV than in those with lower fECV (optimal cutoffs: 40.32 % for RFS, p = 0.036; 43.65 % for OS, p < 0.001).
CONCLUSION: The fECV of noncancerous pancreatic parenchyma from CE-CT was a significant predictor of survival outcomes in PDAC.