Preoperative CT predictors of survival in patients with pancreatic ductal adenocarcinoma undergoing curative intent surg
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PANCREAS
Preoperative CT predictors of survival in patients with pancreatic ductal adenocarcinoma undergoing curative intent surgery Shannan M. Dickinson1 · Caitlin A. McIntyre2 · Juliana B. Schilsky1 · Kate A. Harrington1 · Scott R. Gerst1 · Jessica R. Flynn3 · Mithat Gonen3 · Marinela Capanu3 · Winston Wong4 · Sharon Lawrence2 · Peter J. Allen2,5 · Eileen M. O’Reilly4 · William R. Jarnagin2 · Michael I. D’Angelica2 · Vinod P. Balachandran2 · Jeffrey A. Drebin2 · T. Peter Kingham2 · Amber L. Simpson2,6 · Richard K. Do1 Received: 15 June 2020 / Revised: 16 August 2020 / Accepted: 30 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose To evaluate the associations between computed tomography (CT) imaging features extracted from the structured American Pancreatic Association (APA)/Society of Abdominal Radiology (SAR) template and overall survival in patients with resected pancreatic ductal adenocarcinoma (PDAC). Methods This retrospective analysis included consecutive patients with PDAC who consented to genomic tumor testing and underwent preoperative imaging and curative intent surgical resection from December 2006 to July 2017. Two radiologists assessed preoperative CT imaging using the APA/SAR PDAC-reporting template. Univariable associations between overall survival and imaging variables were evaluated using Cox proportional hazards regression. Results The study included 168 patients (66 years ± 11; 91 women). 126/168 patients (75%) received upfront surgical resection whereas 42/168 (25%) received neoadjuvant therapy prior to surgical resection. In the entire cohort, features associated with decreased overall survival were tumor arterial contact of any kind (hazard ratio (HR) 1.89, 95% CI 1.13–3.14, p = 0.020), tumor contact with the common hepatic artery (HR 2.33, 95% CI 1.35–4.04, p = 0.009), and portal vein deformity (HR 3.22, 95% CI 1.63–6.37, p = 0.003). In the upfront surgical group, larger tumor size was associated with decreased overall survival (HR 2.30, 95% CI 1.19–4.42, p = 0.013). In the neoadjuvant therapy group, the presence of venous collaterals was the only feature associated with decreased overall survival (HR 2.28, 95% CI 1.04–4.99, p = 0.042). Conclusion The application of the APA/SAR pancreatic adenocarcinoma reporting template may identify predictors of survival that can aid in preoperative stratification of patients. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00261-020-02726-w) contains supplementary material, which is available to authorized users. * Shannan M. Dickinson [email protected] 1
Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
2
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
3
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
4
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
5
Pr
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