Synapse - Recurrence after resection of pancreatic cancer: Can radiomics predict patients at greatest risk of liver metastasis?

Recurrence after resection of pancreatic cancer: Can radiomics predict patients at greatest risk of liver metastasis? Journal Article

Authors:	Zambirinis, C. P.; Midya, A.; Chakraborty, J.; Chou, J. F.; Zheng, J.; McIntyre, C. A.; Koszalka, M. A.; Wang, T.; Do, R. K.; Balachandran, V. P.; Drebin, J. A.; Kingham, T. P.; D’Angelica, M. I.; Allen, P. J.; Gönen, M.; Simpson, A. L.; Jarnagin, W. R.
Article Title:	Recurrence after resection of pancreatic cancer: Can radiomics predict patients at greatest risk of liver metastasis?
Abstract:	Background: Liver metastasis (LM) after pancreatic ductal adenocarcinoma (PDAC) resection is common but difficult to predict and has grave prognosis. We combined preoperative clinicopathological variables and quantitative analysis of computed tomography (CT) imaging to predict early LM. Methods: We retrospectively evaluated patients with PDAC submitted to resection between 2005 and 2014 and identified clinicopathological variables associated with early LM. We performed liver radiomic analysis on preoperative contrast-enhanced CT scans and developed a logistic regression classifier to predict early LM (< 6 months). Results: In 688 resected PDAC patients, there were 516 recurrences (75%). The cumulative incidence of LM at 5 years was 41%, and patients who developed LM first (n = 194) had the lowest 1-year overall survival (OS) (34%), compared with 322 patients who developed extrahepatic recurrence first (61%). Independent predictors of time to LM included poor tumor differentiation (hazard ratio (HR) = 2.30; P < 0.001), large tumor size (HR = 1.17 per 2-cm increase; P = 0.048), lymphovascular invasion (HR = 1.50; P = 0.015), and liver Fibrosis-4 score (HR = 0.89 per 1-unit increase; P = 0.029) on multivariate analysis. A model using radiomic variables that reflect hepatic parenchymal heterogeneity identified patients at risk for early LM with an area under the receiver operating characteristic curve (AUC) of 0.71; the performance of the model was improved by incorporating preoperative clinicopathological variables (tumor size and differentiation status; AUC = 0.74, negative predictive value (NPV) = 0.86). Conclusions: We confirm the adverse survival impact of early LM after resection of PDAC. We further show that a model using radiomic data from preoperative imaging combined with tumor-related variables has great potential for identifying patients at high risk for LM and may help guide treatment selection. © 2022, Society of Surgical Oncology.
Keywords:	adult; aged; cancer surgery; retrospective studies; major clinical study; overall survival; clinical feature; cancer recurrence; liver neoplasms; comparative study; pancreatic neoplasms; preoperative evaluation; computer assisted tomography; tumor volume; tumor differentiation; carcinoma, pancreatic ductal; pathology; diagnostic imaging; retrospective study; pancreas carcinoma; liver metastasis; quantitative analysis; liver tumor; pancreas tumor; scoring system; iohexol; predictive value; receiver operating characteristic; cumulative incidence; pancreatic ductal carcinoma; contrast-enhanced ultrasound; liver fibrosis; lymph vessel metastasis; humans; human; male; female; article; radiomics
Journal Title:	Annals of Surgical Oncology
Volume:	29
Issue:	8
ISSN:	1068-9265
Publisher:	Springer
Date Published:	2022-08-01
Start Page:	4962
End Page:	4974
Language:	English
DOI:	10.1245/s10434-022-11579-0
PUBMED:	35366706
PROVIDER:	scopus
PMCID:	PMC9253095
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85127431174&doi=10.1245%2fs10434-022-11579-0&partnerID=40&md5=9b34af95e53345f30ecd63d5ec1441c8
Notes:	Article -- Export Date: 1 August 2022 -- Source: Scopus