Zhang ZW, Liu HT, Zhou ZH, Liao HF, Zhang LL, Li YM, Liang HW. Preoperative risk stratification of early recurrence in resected pancreatic ductal adenocarcinoma: Novel equilibrium-phase-computed tomography biomarker of extracellular volume. World J Gastroenterol 2025; 31(35): 109687 [DOI: 10.3748/wjg.v31.i35.109687]
Corresponding Author of This Article
Hong-Wei Liang, PhD, Doctor, Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China. lianghongwei2021@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
World J Gastroenterol. Sep 21, 2025; 31(35): 109687 Published online Sep 21, 2025. doi: 10.3748/wjg.v31.i35.109687
Preoperative risk stratification of early recurrence in resected pancreatic ductal adenocarcinoma: Novel equilibrium-phase-computed tomography biomarker of extracellular volume
Zhi-Wei Zhang, Hao-Tian Liu, Zhuo-Hang Zhou, Hong-Fan Liao, Lan-Ling Zhang, Yong-Mei Li, Hong-Wei Liang, Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
Co-first authors: Zhi-Wei Zhang and Hao-Tian Liu.
Co-corresponding authors: Yong-Mei Li and Hong-Wei Liang.
Author contributions: Liang HW, Liu HT, Zhou ZH contributed to material preparation, data collection and analysis; Liao HF and Zhang LL contributed to study monitoring; Liang HW contributed to the first draft of the manuscript; Li YM and Zhang ZW contributed to manuscript editing and reviewing; All authors contributed to the study conception and design, read and approved the final manuscript.
Supported by the Chongqing Medical Scientific Research Project (Joint Project of Chongqing Health Commission and Science and Technology Bureau), No. 2025MSXM043.
Institutional review board statement: The study was approved by the ethics committee of the First Affiliated Hospital of Chongqing Medical University (No. K2023-356).
Informed consent statement: Due to the retrospective nature of the study, the informed consent form was waived.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at lianghongwei2021@163.com.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong-Wei Liang, PhD, Doctor, Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China. lianghongwei2021@163.com
Received: May 26, 2025 Revised: June 21, 2025 Accepted: August 15, 2025 Published online: September 21, 2025 Processing time: 118 Days and 6.5 Hours
Abstract
BACKGROUND
Predicting early recurrence (ER), (≤ 12 months) after pancreatic ductal adenocarcinoma (PDAC) resection remains challenging. Preoperative biomarkers such as carbohydrate antigen 19-9 (CA19-9) and computed tomography (CT) lack optimal specificity and reproducibility. Extracellular volume (ECV), measured on equilibrium-phase CT to quantify stromal fibrosis, correlates with PDAC progression but its utility for ER prediction is unknown. This study evaluates preoperative CT-ECV as a novel biomarker to predict ER following curative-intent PDAC resection.
AIM
To investigate the utility of CT-ECV for preoperative prediction of ER in PDAC patients after R0 resection.
METHODS
This retrospective study included 93 PDAC patients undergoing R0 resection and preoperative pancreatic CT from January 2020 to November 2023. Clinical and CT features were analyzed. ECV was calculated using unenhanced and equilibrium-phase CT. Univariable and multivariable Cox regression identified ER predictors, followed by receiver operating characteristic analysis. Recurrence-free survival (RFS) was assessed by the Kaplan-Meier method.
RESULTS
Multivariable analysis identified elevated CT-ECV [hazard ratio (HR) = 1.05; 95% confidence interval (CI): 1.02-1.09; P = 0.003], high preoperative CA19-9 (HR = 1.00; 95%CI: 1.00-1.00; P = 0.002), and poor tumor grade (HR = 2.51; 95%CI: 1.20-5.22; P = 0.014) as independent ER predictors. CT-ECV demonstrated comparable predictive accuracy to tumor grade [areas under the curve (AUC): 0.736 vs 0.650; P = 0.202]. Combining CT-ECV and CA19-9 achieved a higher AUC than tumor grade alone (0.759 vs 0.650; P < 0.05). Kaplan-Meier analysis revealed significantly shorter RFS in patients with low CT-ECV (≤ 35.37%), elevated CA19-9 (> 55 U/mL), or poorly differentiated tumors compared to those with high CT-ECV (> 35.37%), low CA19-9 (≤ 55 U/mL), or moderately/well-differentiated tumors.
CONCLUSION
CT-derived ECV is a promising non-invasive biomarker for preoperative ER prediction in PDAC. Combined with CA19-9, it outperforms tumor grade in stratifying recurrence risk, offering a clinically actionable tool for optimizing postoperative management.
Core Tip: This study demonstrates that preoperative computed tomography (CT)-derived extracellular volume (CT-ECV) is an independent predictor of early recurrence in pancreatic ductal adenocarcinoma after R0 resection. Elevated CT-ECV, high carbohydrate antigen 19-9 (CA19-9), and poor tumor grade were significantly associated with shorter recurrence-free survival. Combining CT-ECV and CA19-9 improved predictive accuracy over tumor grade alone, offering a non-invasive tool for preoperative risk stratification and personalized postoperative management.
