Abstract
BackgroundThere has been scanty data regarding the clinical significance of tumor conspicuity in pancreatic cancer. In this study, we attempted to investigate the prognostic significance of pancreatic tumor conspicuity and determine prognostic factors for postoperative recurrence in patients with surgically resected pancreatic cancer.MethodsBetween January 2011 and September 2019, 62 patients who underwent preoperative computed tomography (CT) for pancreatic cancer were retrospectively included. Two reviewers evaluated various clinical, imaging, and pathologic variables and reviewed all available medical records to determine patient outcomes after surgery. Tumor conspicuity was defined as the attenuation ratio between normal parenchyma and tumor lesions on dynamic-enhanced CT images and represented the conspicuity score. Recurrence-free survival and overall survival were investigated using Cox regression analysis.ResultsPatient mean age was 65.9 (±11.6) years, and 56.5% were male. The median follow-up period was 11 months (range 2–138). Forty patients (64.5%) experienced postoperative recurrence, and the median time to recurrence was 6 months (range 1–101). Tumor conspicuity scores were positively correlated with both radiologic and pathologic tumor sizes (r = 0.252, 0.321, p < 0.01). Conspicuity score ≥ 2 (HR 3.8, 95% CI 1.73–8.47), elevated preoperative (HR 1.15, 95% CI; 1.02–1.28) and postoperative CA19–9 (HR 1.11, 95% CI 1.01–1.23), pathologic tumor size (HR 1.61, 95% CI 1.06–2.45), and lymphatic invasion (HR 2.76, 95% CI 1.22–6.21) were significant factors for recurrence-free survival in the multivariate analysis.ConclusionsOver half of the patients with pancreatic cancer experienced postoperative recurrence (64.5%). Increased tumor conspicuity correlated with larger tumor size and postoperative recurrence.
Highlights
Pancreatic ductal adenocarcinoma (PDAC) is the third leading cause of cancer-related death worldwide, with a 5year overall survival of 6–7.2% when all stages are considered [1, 2]
A conspicuity score < 2 was the low lesion contrast group, and a conspicuity score ≥ 2 was the high lesion contrast group; a conspicuity score ≥ 2 was seen in 40.3% (25/62) of patients
Subsequent multivariate analysis showed preoperative (HR 1.15; 95% Confidence interval (CI) 1.02–1.29) and postoperative Carbohydrate antigen 19–9 (CA19–9) level (HR 1.11; 95% CI 1.01–1.23), conspicuity score ≥ 2 (HR3.67;95% CI 1.73–7.76), pathologic tumor size (HR 1.61; 95% CI 1.06–2.45), and presence of lymphatic invasion (HR 2.76; 95% CI 1.22–6.21) to be significant predictors for postoperative recurrence (Figs. 3 and 4)
Summary
Pancreatic ductal adenocarcinoma (PDAC) is the third leading cause of cancer-related death worldwide, with a 5year overall survival of 6–7.2% when all stages are considered [1, 2]. Surgery with adjuvant chemotherapy offers the best chance of disease cure; only 10–20% of patients present with resectable disease, and even after resection, the cancer recurs in up to 80% of patients, mostly within 2 years after surgery [3]. This high recurrence and dismal prognosis have been attributed to the presence of occult micrometastatic disease at the time of resection and lack of effective systemic therapies [4]. We attempted to investigate the prognostic significance of pancreatic tumor conspicuity and determine prognostic factors for postoperative recurrence in patients with surgically resected pancreatic cancer
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