Sa1464 QUANTITATIVE CONTRAST-ENHANCED ENDOSCOPIC ULTRASOUND IN PANCREATIC DUCTAL ADENOCARCINOMA AND PANCREATIC NEUROENDOCRINE TUMORS: CAN WE PREDICT SURVIVAL USING PERFUSION PARAMETERS?

Abstract

Contrast-enhanced harmonic endoscopic ultrasound (CEH-EUS) parameters may be used to predict prognosis of pancreatic ductal adenocarcinoma (PDAC) and pancreatic neuroendocrine tumors (pNET). The perfusion parameters obtained through time intensity curve (TIC) analysis may have different degrees of impact on overall survival (OS). The aim of this study was to investigate the association between several perfusion parameters on CEH-EUS performed before treatment and survival outcome in patients with PDAC or pNET. Patients with PDAC or pNET who underwent CEH-EUS at our institution between 2017-2019 were included in the study. Quantitative analysis of tumor vascularity was performed using TIC analysis-derived parameters, obtained from processing CEH-EUS recordings with a commercially available software. Cox proportional hazards models were used to determine associations with survival outcome Twenty-two patients with PDAC (tumor size on EUS: median, 33 mm; range, 23–45 mm) and eight patients with pNET (tumor size: median, 40mm; range, 18-65mm) were identified. During CEH-EUS, all PDACs were hypoenhanced in all phases, while pNETs appeared as hyperenhancing masses in the arterial phase. Median OS for PDAC patients was 9.61 months (95%CI, 0.1-38.7) while the median OS for pNET patients was 15.81 months (95%CI, 5.8-24.5). In a multivariate model for OS, a lower peak enhancement (HR=1.76, P=0.02) and a lower wash-in area under the curve (HR=1.06, P=0.001) were associated with worse survival outcome for patients with PDAC. CEH-EUS parameters may be used as a surrogate to predict PDAC aggressiveness and survival before treatment. After validation by large-scale studies, CEH-EUS perfusion parameters have the potential to be used in pretreatment risk stratification of patients with PDAC and in evidence-based clinical decision support.