Background

Optimal treatment of pancreatic ductal adenocarcinoma of the neck, body and tail (PDAC-NBT) necessitates R0 surgical resection. Preoperative radiographic identification of patients likely to achieve successful oncologic resection remains difficult. This study seeks to identify preoperative imaging characteristics predictive of non-R0 resections or impaired survival for PDAC-NBT.

Methods

Patients at five high-volume centers who underwent resection for PDAC-NBT were retrospectively analyzed. The most immediate preoperative cross-sectional scan was assessed along with outcome measures of overall survival and margin status.

Results

330 patients were treated between 2001 and 2016. Margin status included 247 R0 (78.2%), 67 R1 (21.2%), and 2 R2 (0.6%). A non-R0 resection predicted worse survival (p = 0.0002). On preoperative imaging, patients with tumors greater than 20 mm, tumor attenuation greater than 70 Hounsfield units, or who demonstrated pancreatic atrophy and/or calcifications also had worse survival (p = 0.010, p = 0.036, p = 0.025 respectively). Patients with tumors interfacing with the splenic artery or vein or extending posteriorly achieved fewer R0 resections (p = 0.0006, p = 0.0004, p = 0.001, respectively).

Conclusion

Preoperative cross-sectional imaging can identify tumor characteristics associated with poor survival and non-R0 resection. Further investigation is needed to identify the appropriate surgical and treatment modifications necessary to clinically benefit this subset of patients.

中文翻译：

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术前影像学特征预测左侧胰腺癌的不良生存率和切除不充分：一项多机构分析。

背景

颈部、身体和尾部胰腺导管腺癌 (PDAC-NBT) 的最佳治疗需要 R0 手术切除。对可能成功进行肿瘤切除的患者进行术前影像学识别仍然很困难。本研究旨在确定可预测 PDAC-NBT 的非 R0 切除或生存受损的术前影像学特征。

方法

回顾性分析了五个大容量中心接受 PDAC-NBT 切除术的患者。评估最直接的术前横断面扫描以及总生存期和边缘状态的结果测量。

结果

330 名患者在 2001 年至 2016 年间接受了治疗。边缘状态包括 247 R0 (78.2%)、67 R1 (21.2%) 和 2 R2 (0.6%)。非 R0 切除预测更差的生存率 (p = 0.0002)。在术前成像中，肿瘤大于 20 mm、肿瘤衰减大于 70 Hounsfield 单位或表现出胰腺萎缩和/或钙化的患者的生存率也较差（分别为 p = 0.010、p = 0.036、p = 0.025）。肿瘤与脾动脉或静脉交界或向后延伸的患者获得较少的 R0 切除（分别为 p = 0.0006、p = 0.0004、p = 0.001）。

结论

术前横断面成像可以识别与生存率差和非 R0 切除相关的肿瘤特征。需要进一步调查以确定临床上使这部分患者受益所需的适当手术和治疗修改。