Arterial involvement and resectability scoring system to predict R0 resection in patients with pancreatic ductal adenocarcinoma treated with neoadjuvant chemoradiation therapy

• Published in: European radiology 2022-04, Vol.32 (4), p.2470-2480
• Main Authors: Noda, Yoshifumi, Pisuchpen, Nisanard, Mercaldo, Nathaniel D., Sekigami, Yurie, Michelakos, Theodoros, Parakh, Anushri, Wo, Jennifer Y., Qadan, Motaz, Ferrone, Cristina, Lillemoe, Keith D., Ryan, David P., Clark, Jeffrey W., Fernandez-Del Castillo, Carlos, Hong, Theodore S., Kambadakone, Avinash R.
• Format: Article
• Language: English
• Subjects: Adenocarcinoma; Antineoplastic Combined Chemotherapy Protocols; Cancer therapies; Carcinoma, Pancreatic Ductal - diagnostic imaging; Carcinoma, Pancreatic Ductal - pathology; Carcinoma, Pancreatic Ductal - therapy; Chemoradiotherapy; Chemotherapy; Diagnostic Radiology; Hepatobiliary-Pancreas; Humans; Imaging; Internal Medicine; Interventional Radiology; Medicine; Medicine & Public Health; Neoadjuvant Therapy; Neuroradiology; Pancreas; Pancreatic cancer; Pancreatic Neoplasms - drug therapy; Pancreatic Neoplasms - therapy; Radiation therapy; Radiology; Retrospective Studies; Survival; Ultrasound
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-021-08304-y

Objectives To derive a CT-based scoring system incorporating arterial involvement and resectability status to predict R0 resection in patients with pancreatic ductal adenocarcinoma (PDAC) undergoing neoadjuvant chemoradiation therapy (CRT). Methods This retrospective study included 112 patients with PDAC who underwent dynamic contrast-enhanced CT before and after neoadjuvant CRT. A 5-point score was used to determine arterial involvement ( A score; 1 = no involvement, 2 = haziness, 3 = abutment, 4 = encasement, 5 = deformity) and 4-point score evaluating resectability status ( R score; 1 = resectable, 2 = borderline resectable [BR] with venous involvement, 3 = BR with arterial involvement, 4 = locally advanced [LA]). A score before and after CRT were summed with R score before and after CRT to compute the AR score (AR total ). The associations between AR total , R0 resection, overall survival (OS), and disease-free survival (DFS) were assessed. Results The AR total was associated with R0 resection ( p   9 (median: 35.2 months) compared to patients with AR total  ≤ 9 (median: not estimable) ( p   9 vs median, not estimable in ≤ 9; p    9 could predict patients' overall and disease-free survival .