Development and validation of a predictive model for portal-systemic venous invasion grading in borderline resectable pancreatic cancer

doi:10.3748/wjg.v31.i42.112354

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Gastroenterol. Nov 14, 2025; 31(42): 112354
Published online Nov 14, 2025. doi: 10.3748/wjg.v31.i42.112354

Development and validation of a predictive model for portal-systemic venous invasion grading in borderline resectable pancreatic cancer

Fang-Fei Wang, Xiao-Di Dai, Xin Zhao, Qiang He, Shao-Cheng Lyu

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.

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.

Keywords: Borderline resectable pancreatic cancer; Portosystemic venous invasion; Pathological grading; Predictive model; Adventitial invasion; Muscularis propria invasion; Intimal invasion

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.