Preoperative radiographic vascular involvement score predicts the prognosis of resected pancreatic head adenocarcinoma.

Abstract

Operative indications for pancreatic head adenocarcinoma (PHC) with vascular invasion remain unclear. We aimed to develop a new prognostic model focusing on preoperative portal/superior mesenteric vein (PV/SMV) and superior mesenteric artery (SMA) invasiveness. From 2005 to 2012, 103 patients underwent pancreatoduodenectomy for PHC. The CT findings for both PV/SMV and SMA invasion were evaluated separately [PV/SMV, none (score 0), unilateral narrowing (score 1), bilateral narrowing/stenosis (score 2); SMA, none or <90° (score 0), ≥90° (score 3)]. The total score defined the preoperative vascular involvement score (VI score); VI scores 0 (n=39), 1 (n=32), 2 (n=17) and ≥3 (n=15) were compared. PV/SMV resection was performed in 1 (3%), 29 (91%), 16 (94%) and 13 (87%) cases of VI scores 0, 1, 2 and ≥3, respectively (P<0.001). No patients with VI scores ≥3 had margin-negative resection; pathologically curative resection was achieved in 37 of 39 (95%), 27 of 32 (84%) and 13 of 17 (76%) patients with VI scores of 0, 1 and 2, respectively (P<0.001). The survival rate and median survival time (MST) were reduced with an increasing VI score (MST, 40.9, 16.5, 8.9 and 6.3months, respectively). The comparison of each survival curve revealed significant differences (P<0.005), except when comparing VI scores 1 and 2 (P=0.134). Higher VI score predicts shorter survival. Proposed scoring system may be useful for determining the choice between undergoing neoadjuvant treatment, or upfront resection with adjuvant treatment.