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CT-diagnosed extra-pancreatic extension of pancreatic ductal adenocarcinoma is a more reliable prognostic factor for survival than pathology-diagnosed extension

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To determine the correlation between CT-diagnosed extra-pancreatic extension of pancreatic ductal adenocarcinoma (PDAC), pathology-diagnosed extra-pancreatic extension, and survival in patients with PDAC.

Methods

This retrospective study included 87 patients with resected PDAC. Two radiologists evaluated negative ((i) tumours surrounded by the pancreatic parenchyma and (ii) tumours contacting the pancreatic surface) or positive ((iii) tumours with peri-pancreatic strand appearances and/or with expansive growth) CT-diagnosed extra-pancreatic extension. Clinical, pathological, and CT imaging characteristics predicting disease-free survival (DFS) and overall survival (OS) were assessed using Cox proportional-hazards models. Diagnostic accuracy for pathology-diagnosed extra-pancreatic extension was also assessed.

Results

CT-diagnosed extra-pancreatic extension (42/87 tumours, 48.3%; κ = 0.82) had a higher hazard ratio (HR) for the DFS (HR, 5.30; p < 0.01) and OS (HR, 5.31; p < 0.01) rates than pathology-diagnosed extension in univariable analyses. It was also an independent prognostic factor for the DFS (HR, 4.22; p < 0.01) and OS (HR, 4.38; p < 0.01) rates in multivariable analyses. Of 45 tumours without CT-diagnosed extra-pancreatic extension, pathology-diagnosed extra-pancreatic extension was observed in 2/8 (25.0%) and 32/37 (86.5%) tumours with CT categories (i) and (ii), respectively. However, the differences in the survival rates between patients with CT categories (i) and (ii) were insignificant, although those in the latter category had significantly better survival rates than those with CT-diagnosed extra-pancreatic extension (category (iii)).

Conclusions

CT-diagnosed extra-pancreatic extension was a better prognostic factor than pathology-diagnosed extension and considered an independent factor for the postoperative DFS and OS rates with reasonable frequency and high reproducibility, despite the low diagnostic accuracy for predicting pathology-diagnosed extra-pancreatic extension.

Key Points

• A CT-diagnosed extra-pancreatic extension had a higher hazard ratio for both disease-free survival and overall survival compared to pathology-diagnosed extension in univariable survival analyses.

• A CT-diagnosed extra-pancreatic extension was a significant independent predictor of both disease-free survival and overall survival, as observed in multivariable survival analyses.

• Patients with tumours contacting with the pancreatic surface on CT images (CT category (ii)) showed similar survival rates to those whose tumours were surrounded by the pancreatic parenchyma (CT category (i)), although many tumours with CT category (ii) extended pathologically beyond the pancreas.

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Abbreviations

95% CI:

95% confidence interval

DFS:

Disease-free survival

HR:

Hazard ratio

LN:

Lymph nodule

NCCN:

National Comprehensive Cancer Network

OS:

Overall survival

PDAC:

Pancreatic ductal adenocarcinoma

UICC:

Union for International Cancer Control

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The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan

    Fumihito Toshima, Dai Inoue, Kotaro Yoshida, Akira Izumozaki, Norihide Yoneda & Toshifumi Gabata

  2. Department of Radiology, Kanazawa University Hospital, 13-1, Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan

    Kaori Minehiro

Authors
  1. Fumihito Toshima
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  2. Dai Inoue
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  3. Kotaro Yoshida
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  4. Akira Izumozaki
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  5. Norihide Yoneda
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  6. Kaori Minehiro
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  7. Toshifumi Gabata
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Correspondence to Fumihito Toshima.

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The scientific guarantor of this publication is Dai Inoue, M.D., Ph.D.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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Toshima, F., Inoue, D., Yoshida, K. et al. CT-diagnosed extra-pancreatic extension of pancreatic ductal adenocarcinoma is a more reliable prognostic factor for survival than pathology-diagnosed extension. Eur Radiol 32, 22–33 (2022). https://doi.org/10.1007/s00330-021-08180-6

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  • DOI: https://doi.org/10.1007/s00330-021-08180-6

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