Christophe Cassinotto1, Jaron Chong2, George Zogopoulos3, Caroline Reinhold4, Laurence Chiche5, Jean-Pierre Lafourcade6, Adeline Cuggia7, Eric Terrebonne8, Anthony Dohan9, Benoît Gallix10. 1. Department of Radiology, Royal Victoria Hospital, McGill University Health Center, 1001 Boulevard Decarie, Montreal, QC H4A 3J1, Canada. Electronic address: Cassinotto@gmail.com. 2. Department of Radiology, Royal Victoria Hospital, McGill University Health Center, 1001 Boulevard Decarie, Montreal, QC H4A 3J1, Canada. Electronic address: jaron.chong@mcgill.ca. 3. Department of Visceral Surgery, Royal Victoria Hospital, McGill University Health Center, 1001 Boulevard Decarie, Montreal, QC H4A 3J1, Canada. Electronic address: George.zogopoulos@mcgill.ca. 4. Department of Radiology, Royal Victoria Hospital, McGill University Health Center, 1001 Boulevard Decarie, Montreal, QC H4A 3J1, Canada. Electronic address: caroline.reinhold@mcgill.ca. 5. Department of Visceral Surgery, Hôpital Haut-Lévêque, University Hospital of Bordeaux, 1 Avenue de Magellan, 33604 Pessac, France. Electronic address: Laurence.chiche@chu-bordeaux.fr. 6. Department of Diagnostic and Interventional Radiology, Hôpital Haut-Lévêque, University Hospital of Bordeaux, 1 avenue de Magellan, 33604 Pessac, France. Electronic address: jean-pierre.lafourcade@chu-bordeaux.fr. 7. Department of Visceral Surgery, Royal Victoria Hospital, McGill University Health Center, 1001 Boulevard Decarie, Montreal, QC H4A 3J1, Canada. Electronic address: adeline.cuggia@mcgill.ca. 8. Department of Digestive Oncology, Hôpital Haut-Lévêque, University Hospital of Bordeaux, 1 Avenue de Magellan, 33604 Pessac, France. Electronic address: eric.terrebonne@mcgill.ca. 9. Department of Radiology, Royal Victoria Hospital, McGill University Health Center, 1001 Boulevard Decarie, Montreal, QC H4A 3J1, Canada. Electronic address: Anthony.dohan@mcgill.ca. 10. Department of Radiology, Royal Victoria Hospital, McGill University Health Center, 1001 Boulevard Decarie, Montreal, QC H4A 3J1, Canada. Electronic address: benoit.gallix@mcgill.ca.
Abstract
BACKGROUNDS: Patients with a pancreatic cancer amenable to surgery still have a poor prognosis and high risk of post-operative recurrence. We aimed to assess the value of quantitative imaging biomarkers using computed-tomography (CT) texture analysis to evaluate the pathologic tumor aggressiveness and predict disease-free survival (DFS) in patients with resectable pancreatic adenocarcinoma. METHODS: We retrospectively performed attenuation measurements and texture analysis on the portal-venous phase of the pre-operative CT scan of 99 patients that underwent resection of a pancreatic ductal adenocarcinoma in two university hospitals. Tumor attenuation parameters included: mean attenuation value of the whole tumor (WHOLE-AV), and of the most hypoattenuating area within the tumor (CENTRAL-AV). Tumor heterogeneity parameters included: standard deviation, entropy, skewness, and kurtosis. RESULTS: Tumor attenuation parameters showed significant association with the tumor differentiation grade (CENTRAL-AV, Odds ratio (OR) 0.968, 95% confidence interval (CI) 0.94-0.998) and lymph node invasion (WHOLE-AV, OR 0.886, CI 0.823-0.955). Variables associated with early-recurrence were: lymph node ratio (R2=0.15), kurtosis (R2=0.08), and CENTRAL-AV (R2=0.04). Lymph node ratio (Hazard ratio (HR) 1.02), and CENTRAL-AV (HR 0.98) were independently associated with shorter DFS. Patients with CENTRAL-AV<62 Hounsfield units had a shorter 1-year DFS (35% versus 68%, p=0.004). CONCLUSION: Tumors that are more hypoattenuating on the portal-venous phase on CT scan are potentially more aggressive with higher tumor grade, greater lymph node invasion, and shorter DFS.
BACKGROUNDS: Patients with a pancreatic cancer amenable to surgery still have a poor prognosis and high risk of post-operative recurrence. We aimed to assess the value of quantitative imaging biomarkers using computed-tomography (CT) texture analysis to evaluate the pathologic tumor aggressiveness and predict disease-free survival (DFS) in patients with resectable pancreatic adenocarcinoma. METHODS: We retrospectively performed attenuation measurements and texture analysis on the portal-venous phase of the pre-operative CT scan of 99 patients that underwent resection of a pancreatic ductal adenocarcinoma in two university hospitals. Tumor attenuation parameters included: mean attenuation value of the whole tumor (WHOLE-AV), and of the most hypoattenuating area within the tumor (CENTRAL-AV). Tumor heterogeneity parameters included: standard deviation, entropy, skewness, and kurtosis. RESULTS:Tumor attenuation parameters showed significant association with the tumor differentiation grade (CENTRAL-AV, Odds ratio (OR) 0.968, 95% confidence interval (CI) 0.94-0.998) and lymph node invasion (WHOLE-AV, OR 0.886, CI 0.823-0.955). Variables associated with early-recurrence were: lymph node ratio (R2=0.15), kurtosis (R2=0.08), and CENTRAL-AV (R2=0.04). Lymph node ratio (Hazard ratio (HR) 1.02), and CENTRAL-AV (HR 0.98) were independently associated with shorter DFS. Patients with CENTRAL-AV<62 Hounsfield units had a shorter 1-year DFS (35% versus 68%, p=0.004). CONCLUSION:Tumors that are more hypoattenuating on the portal-venous phase on CT scan are potentially more aggressive with higher tumor grade, greater lymph node invasion, and shorter DFS.
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Authors: Shannan M Dickinson; Caitlin A McIntyre; Juliana B Schilsky; Kate A Harrington; Scott R Gerst; Jessica R Flynn; Mithat Gonen; Marinela Capanu; Winston Wong; Sharon Lawrence; Peter J Allen; Eileen M O'Reilly; William R Jarnagin; Michael I D'Angelica; Vinod P Balachandran; Jeffrey A Drebin; T Peter Kingham; Amber L Simpson; Richard K Do Journal: Abdom Radiol (NY) Date: 2020-09-28