Published online Jun 14, 2022. doi: 10.3748/wjg.v28.i22.2468
Peer-review started: August 3, 2021
First decision: October 2, 2021
Revised: October 31, 2021
Accepted: May 16, 2022
Article in press: May 16, 2022
Published online: June 14, 2022
Processing time: 310 Days and 10 Hours
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.
To analyse whether preoperative enhanced CT could be used to predict postope
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.
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).
TRER ≤ 0.7 in patients with PDAC may represent a tumour with higher clinical stage and result in a shorter overall survival.
Core Tip: Computed tomography (CT) plays an important role in the diagnosis, staging and treatment of pancreatic tumours. Pancreatic cancer generally shows a low enhancement pattern compared with normal pancreatic tissue. In our analysis, the prognosis of patients with the tumour relative enhancement ratio (TRER) less than or equal to 0.7 was significantly worse than that of patients with TRER greater than 0.7. TRER was significantly correlated with American Joint Committee on Cancer stage, tumour stage, and lymph node stage. Preoperative enhanced CT provides a simple and effective prediction of postoperative overall survival in pancreatic ductal adenocarcinoma.