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. 2022 Jun 14;28(22):2468-2481.
doi: 10.3748/wjg.v28.i22.2468.

Prognostic value of preoperative enhanced computed tomography as a quantitative imaging biomarker in pancreatic cancer

Jian-Feng Gao  1 , Yu Pan  1 , Xian-Chao Lin  1 , Feng-Chun Lu  1 , Ding-Shen Qiu  2 , Jun-Jun Liu  2 , He-Guang Huang  3
Affiliations

Prognostic value of preoperative enhanced computed tomography as a quantitative imaging biomarker in pancreatic cancer

Jian-Feng Gao et al. World J Gastroenterol. .

Abstract

Background: Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal malignancies with high mortality and short survival time. Computed tomography (CT) plays an important role in the diagnosis, staging and treatment of pancreatic tumour. Pancreatic cancer generally shows a low enhancement pattern compared with normal pancreatic tissue.

Aim: To analyse whether preoperative enhanced CT could be used to predict postoperative overall survival in patients with PDAC.

Methods: Sixty-seven patients with PDAC undergoing pancreatic resection were enrolled retrospectively. All patients underwent preoperative unenhanced and enhanced CT examination, the CT values of which were measured. The ratio of the preoperative CT value increase from the nonenhancement phase to the portal venous phase between pancreatic tumour and normal pancreatic tissue was calculated. The cut-off value of ratios was obtained by the receiver operating characteristic (ROC) curve of the tumour relative enhancement ratio (TRER), according to which patients were divided into low- and high-enhancement groups. Univariate and multivariate analyses were performed using Cox regression based on TRER grouping. Finally, the correlation between TRER and clinicopathological characteristics was analysed.

Results: The area under the curve of the ROC curve was 0.768 (P < 0.05), and the cut-off value of the ROC curve was calculated as 0.7. TRER ≤ 0.7 was defined as the low-enhancement group, and TRER > 0.7 was defined as the high-enhancement group. According to the TRER grouping, the Kaplan-Meier survival curve analysis results showed that the median survival (10.0 mo) with TRER ≤ 0.7 was significantly shorter than that (22.0 mo) with TRER > 0.7 (P < 0.05). In the univariate and multivariate analyses, the prognosis of patients with TRER ≤ 0.7 was significantly worse than that of patients with TRER > 0.7 (P < 0.05). Our results demonstrated that patients in the low TRER group were more likely to have higher American Joint Committee on Cancer stage, tumour stage and lymph node stage (all P < 0.05), and TRER was significantly negatively correlated with tumour size (P < 0.05).

Conclusion: TRER ≤ 0.7 in patients with PDAC may represent a tumour with higher clinical stage and result in a shorter overall survival.

Keywords: Computed tomography; Diagnostic imaging; Kaplan-Meier curve; Pancreatic cancer; Prognosis; Survival analysis.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
The study flowchart for patient selection. CT: Computed tomography.
Figure 2
Figure 2
The receiver operating characteristic curve and Kaplan-Meier survival curve analysis. A: The receiver operating characteristic curve of tumour relative enhancement ratio (TRER) for patients with pancreatic ductal adenocarcinoma. The area under the curve was 0.768 (P = 0.007). The cut-off value was 0.7; B: Kaplan-Meier survival curve of postoperative overall survival for low-TRER patients and high-TRER patients. TRER: Tumour relative enhancement ratio.
Figure 3
Figure 3
A 61-year-old woman with a mass in the head of the pancreas. A-C: The nonenhancement phase (A), pancreatic parenchymal (PP) phase (B) and portal venous (PV) phase (C) of region of the overall tumour, respectively; D-F: The nonenhancement phase (D), PP phase (E) and PV phase (F) of pancreatic tissue outside the tumour, respectively. Tumour relative enhancement ratio ≤ 0.7, and the postoperative overall survival was 5.5 mo.
Figure 4
Figure 4
A 54-year-old woman with a mass in the head of the pancreas. A-C: The nonenhancement phase (A), pancreatic parenchymal (PP) phase (B) and portal venous (PV) phase (C) of region of the overall tumour, respectively; D-F: The nonenhancement phase (D), PP phase (E) and PV phase (F) of pancreatic tissue outside the tumour, respectively. Tumour relative enhancement ratio > 0.7, and the postoperative overall survival was 27.3 mo.
Figure 5
Figure 5
Correlation analysis between tumour size and tumour relative enhancement ratio. TRER: Tumour relative enhancement ratio.
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