Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2022; 28(22): 2468-2481
Published online Jun 14, 2022. 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, Yu Pan, Xian-Chao Lin, Feng-Chun Lu, Ding-Shen Qiu, Jun-Jun Liu, He-Guang Huang
Jian-Feng Gao, Yu Pan, Xian-Chao Lin, Feng-Chun Lu, He-Guang Huang, Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
Ding-Shen Qiu, Jun-Jun Liu, Department of Radiology, The Hospital of Changle, Fuzhou 350200, Fujian Province, China
Author contributions: All authors contributed to this paper; Gao JF, Pan Y, Lin XC, Lu FC, Qiu DS, Liu JJ, and Huang HG substantially contributed to conception and design of the study, acquisition of data, or analysis and interpretation of data; Gao JF, Lu FC, and Huang HG contributed to drafting the article or making critical revisions related to important intellectual content of the manuscript; Gao JF, Pan Y, Lin XC, Lu FC, Qiu DS, Liu JJ, and Huang HG finally approved the version of the article to be published.
Supported by the Medical Centre of Minimally Invasive Technology of Fujian Province, No. 2017[171], and No. 2017[4]; Joint Funds for the Innovation of Science and Technology, Fujian Province, No. 2017Y9059; and the United Fujian Provincial Health and Education Project for Tackling the Key Research, No. 2019-WJ-07.
Institutional review board statement: The Ethics Committee of Fujian Medical University Union Hospital approved this retrospective study (No. 2020KY0141).
Informed consent statement: Because of the retrospective and anonymous character of this study, the institutional review committee waived the requirement for informed consent.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: He-Guang Huang, MD, Chief Physician, Department of General Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou 350001, Fujian Province, China. Heguanghuang22@163.com
Received: August 3, 2021
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
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: Pancreatic cancer; Computed tomography; Diagnostic imaging; Kaplan-Meier curve; Prognosis; Survival analysis

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.