CT features of extra-pancreatic nerve plexus invasion predict mortality in early-stage pancreatic cancer.

OBJECTIVE

The presence of extra-pancreatic nerve plexus invasion (EPNI) in pancreatic ductal adenocarcinoma (PDAC) is known to correlate with aggressive disease, however, it is unknown whether specific pathways or morphologies carry different prognostic implications. This study evaluates whether distinct CT-defined patterns of EPNI predict mortality in PDAC.

MATERIALS AND

METHODS

This retrospective, single-center study included 89 patients with pathologically confirmed PDAC who underwent preoperative pancreatic protocol multidetector CT (MDCT) followed by surgical resection. Patients were identified from an institutional database and required available preoperative CT and histopathology. Two blinded, experienced radiologists reviewed MDCT images to assess EPNI, which was categorized by anatomic pathway and morphologic pattern. Overall survival was compared between EPNI-positive and EPNI-negative groups and among EPNI subtypes using log-rank testing, with stratification by tumor stage. Cox proportional hazards models adjusted for age, sex, and surgical margin were performed.

RESULTS

A total of 89 patients (M/F: 54/35), median age: 66 years (IQR, 60-70 years), were evaluated. CT evidence of EPNI was present in 65 patients (73%) and was associated with decreased overall survival (p < 0.001). This association remained significant in Stage I tumors (p < 0.001). PPC2 pathway involvement (p < 0.001) and mass-with-stranding morphology (p < 0.001) were each associated with reduced overall survival. PPC2 (p = 0.003) and mass-with-stranding (p < 0.001) remained significant in stage I tumors.

CONCLUSION

Preoperative CT detection of EPNI, especially PPC2 pathway involvement and mass-with-stranding morphology, identifies high-risk PDAC patients.

KEY POINTS: Question Extra pancreatic nerve plexus invasion in pancreatic adenocarcinoma is associated with aggressive disease, but the prognostic significance of specific pathways or morphologies remains unknown. Findings Plexus pancreaticus capitalis 2 involvement and mass-with-stranding morphology in EPNI of pancreatic adenocarcinoma are associated with decreased overall survival. Clinical relevance Identifying high-risk EPNI features on CT may facilitate early prognostic stratification and inform surgical and neoadjuvant treatment planning in pancreatic adenocarcinoma.