European Radiology: This CT feature predicts the prognosis of PDAC patients

Pancreatic ductal adenocarcinoma (PDAC) accounts for approximately 90% of all pancreatic tumors and has a poor prognosis , with a 5-year overall survival (OS) rate of only 9%
.

Although surgical resection remains the only treatment option, most patients experience local tumor recurrence or distant metastasis after surgery

Pancreatic ductal adenocarcinoma (PDAC) accounts for approximately 90% of all pancreatic tumors and has a poor prognosis , with a 5-year overall survival (OS) rate of only 9%

The most recent edition of the International Union for Cancer Control (UICC) staging system proposes a size-based T (T1-3) classification that replaces the assessment of extrapancreatic progression

With the continuous advancement of CT technology , the extrapancreatic progression of PDAC can be observed using a multiphase pancreatic scanning protocol .
However, the value of CT-diagnosed extrapancreatic progression for predicting survival in PDAC patients has not yet been demonstrated .
To our knowledge, no report has so far mentioned the relationship between CT diagnosis and pathological diagnosis of extrapancreatic progression and survival .

Recently, a study published in the journal European Radiology evaluated the correlation between CT-diagnosed extrapancreatic progression , pathologically diagnosed pancreatic progression , and survival in patients undergoing PDAC surgery , providing clinical preoperative prognostic assessment.

Imaging support .
 

Recently, a study published in the journal European Radiology evaluated the correlation between CT-diagnosed extrapancreatic progression , pathologically diagnosed pancreatic progression , and survival in patients undergoing PDAC surgery , providing clinical preoperative prognostic assessment.
Imaging support .
 

This retrospective study included 87 patients with PDAC who underwent surgical resection .
Two radiologists evaluated CT diagnoses that were negative ((i) tumors surrounded by pancreatic parenchyma and (ii) tumors touching the surface of the pancreas) or positive ((iii) had a peripancreatic nodular appearance and/or invasive growth tumor) with extrapancreatic progression .
Clinical, pathological, and CT imaging features predicting disease-free survival (DFS) and overall survival (OS) were assessed using the Cox proportional-Haze model .
The diagnostic accuracy of pathologically diagnosed extrapancreatic progression was also assessed .
 

In univariate analysis, CT-diagnosed extrapancreatic progression (42/87 tumors, 48.

3%; κ=0.
82) had high rates of DFS (HR, 5.
30; p<0.
01) and OS (HR, 5.

In univariate analysis, CT-diagnosed extrapancreatic progression (42/87 tumors, 48.

Figure 1.
Classification pattern of extrapancreatic progression of PDAC diagnosed by CT .
The progression of PDAC beyond the pancreas is divided into three categories .
(i) Tumor surrounded by pancreatic parenchyma (arrow), defined as tumor completely covered by pancreatic parenchyma on all sides; (ii) Tumor in contact with pancreatic surface (arrow), defined as tumor directly attached to peripancreatic adipose tissue (arrow) or Duodenal wall (no pancreatic parenchyma between tumor and surrounding pancreas map.
2 Classification map of extrapancreatic extension of PDAC diagnosed by CT.
Extension of PDAC beyond the pancreas can be divided into three categories .
(i) Tumor surrounded by pancreatic parenchyma ( (arrow), defined as tumor completely covered by pancreatic parenchyma in all respects; (ii) tumor touching the pancreatic surface (arrow), defined as tumor directly attached to peripancreatic adipose tissue (arrow) or duodenal wall (tumor and peripancreatic adipose tissue) (iii) Tumors with peripancreatic femoral structures (arrows) and/or expansive growths outside the pancreas, defined as tumors with a mass or Nodular structures extend directly from the intrapancreatic tumor to the extrapancreatic adipose tissue or duodenal wall (arrows) .
Among these three categories, CT categories (i) and (ii) and CT category (iii), respectively, were identified as CT diagnostic extension of negative and positive .
 

Figure 1.

Classification pattern of extrapancreatic progression of PDAC diagnosed by CT .
The progression of PDAC beyond the pancreas is divided into three categories .
(i) Tumor surrounded by pancreatic parenchyma (arrow), defined as tumor completely covered by pancreatic parenchyma on all sides; (ii) Tumor in contact with pancreatic surface (arrow), defined as tumor directly attached to peripancreatic adipose tissue (arrow) or Duodenal wall (no pancreatic parenchyma between tumor and surrounding pancreas map.
2 Classification map of extrapancreatic extension of PDAC diagnosed by CT.
Extension of PDAC beyond the pancreas can be divided into three categories .
(i) Tumor surrounded by pancreatic parenchyma ( (arrow), defined as tumor completely covered by pancreatic parenchyma in all respects; (ii) tumor touching the pancreatic surface (arrow), defined as tumor directly attached to peripancreatic adipose tissue (arrow) or duodenal wall (tumor and peripancreatic adipose tissue) (iii) Tumors with peripancreatic femoral structures (arrows) and/or expansive growths outside the pancreas, defined as tumors with a mass or Nodular structures extend directly from the intrapancreatic tumor to the extrapancreatic adipose tissue or duodenal wall (arrows) .
Among these three categories, CT categories (i) and (ii) and CT category (iii), respectively, were identified as Negative and positive for CT-diagnosed extension .

The present study demonstrates that tumor-pancreatic surface contact is a key CT finding

Original source :

Fumihito Toshima , Dai Inoue , Kotaro Yoshida , et al .

CT-diagnosed extra-pancreatic extension of pancreatic ductal adenocarcinoma is a more reliable prognostic factor for survival than pathology-diagnosed extension .
DOI: 10.
1007/s00330-021-08180-6

Fumihito Toshima Dai Inoue Kotaro Yoshida , et al CT-diagnosed extra-pancreatic extension of pancreatic ductal adenocarcinoma is a more reliable prognostic factor for survival than pathology-diagnosed extension 10.
1007/s00330-021-08180-6 10.
1007/s00330-021-08180- 6 Leave a message here