Post-neoadjuvant treatment pancreatic cancer resectability and outcome prediction using CT, 18F-FDG PET/MRI and CA 19–9

Cancer Imaging

Research Article

Jin-Young Jang¹  Sang Hyub Lee²  Jeongin Yoo³  Jeong Hee Yoon⁴  Dong Ho Lee⁴  Jeong Min Lee⁵  Ijin Joo⁵  Mi Hye Yu⁶ 

[1] Department of General Surgery, Seoul National University College of Medicine, Seoul, Korea;Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea;Department of Radiology, Seoul National University Hospital, Seoul, Korea;Department of Radiology, Seoul National University Hospital, Seoul, Korea;Department of Radiology, Seoul National University College of Medicine, Seoul, Korea;Department of Radiology, Seoul National University Hospital, Seoul, Korea;Department of Radiology, Seoul National University College of Medicine, Seoul, Korea;Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea;Department of Radiology, Konkuk University School of Medicine, Seoul, Korea;Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea;Department of Radiology, Konkuk University School of Medicine, Seoul, Korea;

关键词: Pancreatic cancer;    Neoadjuvant therapy;    Computed tomography;    Postiron emission tomography/magnetic resonance imaging;    Carbohydrate antigen 19–9;    Resectability;   

DOI  :  10.1186/s40644-023-00565-8

 received in 2023-03-14, accepted in 2023-05-01,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundCT prediction of resectability and prognosis following neoadjuvant treatment (NAT) in patients with pancreatic ductal adenocarcinoma (PDAC) remains challenging. This study aims to determine whether addition of 18F-fluorodeoxyglucose (FDG) postiron emission tomography (PET)/MRI and carbohydrate antigen (CA) 19–9 to contrast-enhanced CT (CECT) can improve accuracy of predicting resectability compared to CECT alone and predict prognosis in PDAC patients after NAT.MethodsIn this retrospective study, 120 PDAC patients (65 women; mean age, 66.7 years [standard deviation, 8.4]) underwent CECT, PET/MRI, and CA 19–9 examinations after NAT between January 2013 and June 2021. Three board-certified radiologists independently rated the overall resectability on a 5-point scale (score 5, definitely resectable) in three sessions (session 1, CECT; 2, CECT plus PET/MRI─no FDG avidity and no diffusion restriction at tumor-vessel contact indicated modification of CECT scores to ≥ 3; 3, CECT plus PET plus CA 19–9─no FDG avidity at tumor-vessel contact and normalized CA 19–9 indicated modification of CECT scores to ≥ 3). Jackknife free-response receiver operating characteristic method and generalized estimating equations were used to compare pooled area under the curve (AUC), sensitivity, and specificity of three sessions. Predictors for recurrence-free survival (RFS) were assessed using Cox regression analyses.ResultsEach session showed different pooled AUC (session 1 vs. 2 vs. 3, 0.853 vs. 0.873 vs. 0.874, p = 0.026), sensitivity (66.2% [137/207] vs. 86.0% [178/207] vs. 84.5% [175/207], p < 0.001) and specificity (67.3% [103/153] vs. 58.8% [90/153] vs. 60.1% [92/153], p = 0.048). According to pairwise comparison, specificity of CECT plus PET/MRI was lower than that of CECT alone (adjusted p = 0.042), while there was no significant difference in specificity between CECT alone and CECT plus PET plus CA 19–9 (adjusted p = 0.081). Twenty-eight of 69 patients (40.6%) with R0 resection experienced tumor recurrence (mean follow-up, 18.0 months). FDG avidity at tumor-vessel contact on post-NAT PET (HR = 4.37, p = 0.033) and pathologically confirmed vascular invasion (HR = 5.36, p = 0.004) predicted RFS.ConclusionCombination of CECT, PET and CA 19–9 increased area under the curve and sensitivity for determining resectability, compared to CECT alone, without compromising the specificity. Furthermore, 18F-FDG avidity at tumor-vessel contact on post-NAT PET predicted RFS.

【 授权许可】

CC BY   
© The Author(s) 2023

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