Wang FF, Dai XD, Zhao X, He Q, Lyu SC. Development and validation of a predictive model for portal-systemic venous invasion grading in borderline resectable pancreatic cancer. World J Gastroenterol 2025; 31(42): 112354 [DOI: 10.3748/wjg.v31.i42.112354]
Corresponding Author of This Article
Shao-Cheng Lyu, Department of Hepatobiliary Pancreas and Spleen Surgery, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing 100020, China. shaocheng0502@163.com
Research Domain of This Article
Medicine, General & Internal
Article-Type of This Article
Retrospective Cohort Study
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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/
Nov 14, 2025 (publication date) through Nov 16, 2025
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Journal Information of This Article
Publication Name
World Journal of Gastroenterology
ISSN
1007-9327
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Wang FF, Dai XD, Zhao X, He Q, Lyu SC. Development and validation of a predictive model for portal-systemic venous invasion grading in borderline resectable pancreatic cancer. World J Gastroenterol 2025; 31(42): 112354 [DOI: 10.3748/wjg.v31.i42.112354]
Fang-Fei Wang, Xiao-Di Dai, Xin Zhao, Qiang He, Shao-Cheng Lyu, Department of Hepatobiliary Pancreas and Spleen Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
Author contributions: Wang FF and Lyu SC conceived and designed the study; Lyu SC and He Q provided administrative support; Dai XD and Zhao X provided study materials; Wang FF, Dai XD, and Zhao X collected and assembled data; Wang FF and Lyu SC analyzed and interpreted data; all authors wrote the manuscript and approved the final version to publish.
Institutional review board statement: This study was approved by the Ethics Committee of Beijing Chao-Yang Hospital, Capital Medical University, No. 2024-512.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The de-identified datasets generated during this study are not publicly deposited due to stringent patient privacy protections mandated by Chinese regulations and institutional ethical guidelines. However, qualified researchers may request access by contacting the corresponding author.
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: Shao-Cheng Lyu, Department of Hepatobiliary Pancreas and Spleen Surgery, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing 100020, China. shaocheng0502@163.com
Received: July 25, 2025 Revised: August 18, 2025 Accepted: October 13, 2025 Published online: November 14, 2025 Processing time: 112 Days and 4.2 Hours
Abstract
BACKGROUND
Portosystemic venous invasion (PSVI) depth critically influences prognosis in borderline resectable pancreatic cancer (BRPC), necessitating precise preoperative discrimination for personalized therapy.
AIM
To develop and validate a preoperative nomogram integrating computed tomography parameters and carbohydrate antigen 19-9 (CA19-9) kinetics for predicting PSVI depth in treatment-naive BRPC.
METHODS
This retrospective cohort study analyzed 167 BRPC patients undergoing radical resection between 2011 and 2023. Patients were stratified by pathological PSVI depth [no venous invasion (VI)/adventitial/muscularis propria/intimal]. Kaplan-Meier and ordinal logistic regression identified preoperative predictors from clinical/laboratory/computed tomography parameters (e.g., circumferential involvement and CA19-9). A nomogram was developed and validated via calibration curves/decision curve analysis.
RESULTS
PSVI depth significantly stratified survival.: Intimal VI showed worst prognosis (median overall survival: 9 months, 5-year overall survival: 0% vs no VI: 17 months, 12.5%; P < 0.001). Independent predictors: CA19-9 [odds ratio (OR) = 3.819, Wald = 14.125, 95% confidence interval (CI): 1.980-7.410], circumferential involvement (OR = 8.271, Wald = 33.352, 95%CI: 3.950-17.320), and luminal compromise (OR = 3.544, Wald = 8.489, 95%CI: 1.818-6.447). The nomogram achieved C-index = 0.928 (95%CI: 0.889-0.967), with 100-250 points indicating high invasiveness risk. Decision curve analysis confirmed clinical utility (threshold: 0-0.7).
CONCLUSION
This model integrates routine indicators to preoperatively quantify PSVI depth, guiding precision treatment.
Core Tip: This study developed a predictive model for pathological grading of portosystemic venous invasion depth in borderline resectable pancreatic cancer using routine preoperative indicators: Serum carbohydrate antigen 19-9, computed tomography circumferential involvement angle, and luminal compromise. The model achieved high accuracy (C-index 0.928) in stratifying venous invasion depth into adventitial, muscularis propria, or intimal invasion, which significantly affected prognosis (e.g., intimal invasion showed worst median overall survival of 9 months). This innovative tool enables preoperative risk quantification, guiding personalized therapy decisions such as neoadjuvant intensification or surgical planning, and addresses a critical unmet need in precision oncology for borderline resectable pancreatic cancer.
