CT-determined resectability of borderline resectable and unresectable pancreatic adenocarcinoma following FOLFIRINOX therapy
Objectives We aimed to assess the ability of CT-determined resectability, as defined by a recent version of NCCN criteria, and associated CT findings to predict margin-negative (R0) resection in patients with PDAC after neoadjuvant FOLFIRINOX chemotherapy. Methods Sixty-four patients (36 men and 28...
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| Veröffentlicht in: | European radiology 2021-02, Vol.31 (2), p.813-823 |
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| creator | Jang, Jong Keon Byun, Jae Ho Kang, Ji Hun Son, Jung Hee Kim, Jin Hee Lee, Seung Soo Kim, Hyoung Jung Yoo, Changhoon Kim, Kyu-pyo Hong, Seung-Mo Seo, Dong-Wan Kim, Song Cheol Lee, Moon-Gyu |
| description | Objectives
We aimed to assess the ability of CT-determined resectability, as defined by a recent version of NCCN criteria, and associated CT findings to predict margin-negative (R0) resection in patients with PDAC after neoadjuvant FOLFIRINOX chemotherapy.
Methods
Sixty-four patients (36 men and 28 women; mean age, 58.8 years) with borderline resectable or unresectable PDAC who received neoadjuvant FOLFIRINOX were evaluated retrospectively. CT findings were independently assessed by two abdominal radiologists according to NCCN criteria (version 3. 2019). Tumor resectability was classified as resectable, borderline resectable, or unresectable, and change in resectability was classified as regression, stability, or progression. The associations of R0 resection rate with CT-determined resectability and change in resectability categories were evaluated, as were the sensitivity and specificity of NCCN criteria for R0 resection. Factors associated with R0 resection were identified by logistic regression analysis.
Results
R0 resection rate did not differ significantly among the resectable, borderline resectable, or unresectable PDAC (67–73%,
p
= 0.95) or among PDAC with regression, stability, or progression (56–77%,
p
= 0.39). The sensitivity and specificity for R0 resection were 67% and 37%, respectively, for resectability (resectable/borderline vs. unresectable) and 80% and 21%, respectively, for changes in resectability (regression/stable vs. progression). Low-contrast enhancement of soft tissue contacting artery (≤ 46.4 HU) was independently associated with R0 resection (
p
= 0.01).
Conclusion
CT-determined resectability after neoadjuvant FOLFIRINOX chemotherapy was relatively insensitive and non-specific for predicting R0 resection. Low-contrast enhancement of soft tissue contacting artery may increase the ability of CT to predict R0 resection.
Key Points
• Margin-negative resection rate of pancreatic cancer following FOLFIRINOX therapy did not differ among each resectability (67–73%, p = 0.95) based on NCCN criteria or changes in resectability categories (56–77%, p = 0.39).
• The sensitivity and specificity for margin-negative resection were 67% and 37% for resectability (resectable/borderline vs. unresectable) and 80% and 21% for changes in resectability (regression/stable vs. progression).
• Low-contrast enhancement of soft tissue contacting artery (≤ 46.4 HU) was independently associated with margin-negative resection (p = 0.01). |
| doi_str_mv | 10.1007/s00330-020-07188-8 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_2478669756</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2478669756</sourcerecordid><originalsourceid>FETCH-LOGICAL-c441t-d67f81c99fc56c9aefc0a9e9c38e018e4be7a24968bef95b0f00119dc18138073</originalsourceid><addsrcrecordid>eNp9kEFrGzEQhUVpqJ2kf6CHIuh5k9FKXknHYOLGYGIIDuQmtNpRumEtOdKaYMiP7yZ2nJ56GAbmvXkPPkJ-MLhgAPIyA3AOBZTDSKZUob6QMRO8LBgo8ZWMQXNVSK3FiJzm_AQAmgn5jYx4qcSEKz0mr9NV0WCPad0GbGjCjK63ddu1_Y5GT-uYGkzdIB61DqkNDd2Gfw4bG1xC27eO2gZDdDa5NsS1pT52XXxpwyOdLRez-d38dvlA-z-Y7GZ3Tk687TJ-P-wzcj-7Xk1visXy93x6tSicEKwvmkp6xZzW3k0qpy16B1ajdlwhMIWiRmlLoStVo9eTGjwAY7pxTDGuQPIz8mufu0nxeYu5N09xm8JQaUohVVVpOakGV7l3uRRzTujNJrVrm3aGgXkDbvbAzQDcvAM3anj6eYje1mtsji8fhAcD3xvyIIVHTJ_d_4n9C2NZjZ0</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2478669756</pqid></control><display><type>article</type><title>CT-determined resectability of borderline resectable and unresectable pancreatic adenocarcinoma following FOLFIRINOX therapy</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Jang, Jong Keon ; Byun, Jae Ho ; Kang, Ji Hun ; Son, Jung Hee ; Kim, Jin Hee ; Lee, Seung Soo ; Kim, Hyoung Jung ; Yoo, Changhoon ; Kim, Kyu-pyo ; Hong, Seung-Mo ; Seo, Dong-Wan ; Kim, Song Cheol ; Lee, Moon-Gyu</creator><creatorcontrib>Jang, Jong Keon ; Byun, Jae Ho ; Kang, Ji Hun ; Son, Jung Hee ; Kim, Jin Hee ; Lee, Seung Soo ; Kim, Hyoung Jung ; Yoo, Changhoon ; Kim, Kyu-pyo ; Hong, Seung-Mo ; Seo, Dong-Wan ; Kim, Song Cheol ; Lee, Moon-Gyu</creatorcontrib><description>Objectives
We aimed to assess the ability of CT-determined resectability, as defined by a recent version of NCCN criteria, and associated CT findings to predict margin-negative (R0) resection in patients with PDAC after neoadjuvant FOLFIRINOX chemotherapy.
Methods
Sixty-four patients (36 men and 28 women; mean age, 58.8 years) with borderline resectable or unresectable PDAC who received neoadjuvant FOLFIRINOX were evaluated retrospectively. CT findings were independently assessed by two abdominal radiologists according to NCCN criteria (version 3. 2019). Tumor resectability was classified as resectable, borderline resectable, or unresectable, and change in resectability was classified as regression, stability, or progression. The associations of R0 resection rate with CT-determined resectability and change in resectability categories were evaluated, as were the sensitivity and specificity of NCCN criteria for R0 resection. Factors associated with R0 resection were identified by logistic regression analysis.
Results
R0 resection rate did not differ significantly among the resectable, borderline resectable, or unresectable PDAC (67–73%,
p
= 0.95) or among PDAC with regression, stability, or progression (56–77%,
p
= 0.39). The sensitivity and specificity for R0 resection were 67% and 37%, respectively, for resectability (resectable/borderline vs. unresectable) and 80% and 21%, respectively, for changes in resectability (regression/stable vs. progression). Low-contrast enhancement of soft tissue contacting artery (≤ 46.4 HU) was independently associated with R0 resection (
p
= 0.01).
Conclusion
CT-determined resectability after neoadjuvant FOLFIRINOX chemotherapy was relatively insensitive and non-specific for predicting R0 resection. Low-contrast enhancement of soft tissue contacting artery may increase the ability of CT to predict R0 resection.
Key Points
• Margin-negative resection rate of pancreatic cancer following FOLFIRINOX therapy did not differ among each resectability (67–73%, p = 0.95) based on NCCN criteria or changes in resectability categories (56–77%, p = 0.39).
• The sensitivity and specificity for margin-negative resection were 67% and 37% for resectability (resectable/borderline vs. unresectable) and 80% and 21% for changes in resectability (regression/stable vs. progression).
• Low-contrast enhancement of soft tissue contacting artery (≤ 46.4 HU) was independently associated with margin-negative resection (p = 0.01).</description><identifier>ISSN: 0938-7994</identifier><identifier>EISSN: 1432-1084</identifier><identifier>DOI: 10.1007/s00330-020-07188-8</identifier><identifier>PMID: 32845389</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adenocarcinoma ; Adenocarcinoma - diagnostic imaging ; Adenocarcinoma - drug therapy ; Adenocarcinoma - surgery ; Antineoplastic Combined Chemotherapy Protocols - therapeutic use ; Chemotherapy ; Criteria ; Diagnostic Radiology ; Evaluation ; Female ; Fluorouracil ; Gastrointestinal ; Humans ; Imaging ; Internal Medicine ; Interventional Radiology ; Irinotecan ; Leucovorin ; Male ; Medical diagnosis ; Medicine ; Medicine & Public Health ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Staging ; Neuroradiology ; Oxaliplatin ; Pancreatic cancer ; Pancreatic Neoplasms - diagnostic imaging ; Pancreatic Neoplasms - drug therapy ; Pancreatic Neoplasms - surgery ; Radiology ; Regression analysis ; Retrospective Studies ; Soft tissues ; Stability ; Tissues ; Tomography, X-Ray Computed ; Treatment Outcome ; Ultrasound</subject><ispartof>European radiology, 2021-02, Vol.31 (2), p.813-823</ispartof><rights>European Society of Radiology 2020</rights><rights>European Society of Radiology 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c441t-d67f81c99fc56c9aefc0a9e9c38e018e4be7a24968bef95b0f00119dc18138073</citedby><cites>FETCH-LOGICAL-c441t-d67f81c99fc56c9aefc0a9e9c38e018e4be7a24968bef95b0f00119dc18138073</cites><orcidid>0000-0003-2076-9979</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00330-020-07188-8$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00330-020-07188-8$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>315,781,785,27926,27927,41490,42559,51321</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32845389$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jang, Jong Keon</creatorcontrib><creatorcontrib>Byun, Jae Ho</creatorcontrib><creatorcontrib>Kang, Ji Hun</creatorcontrib><creatorcontrib>Son, Jung Hee</creatorcontrib><creatorcontrib>Kim, Jin Hee</creatorcontrib><creatorcontrib>Lee, Seung Soo</creatorcontrib><creatorcontrib>Kim, Hyoung Jung</creatorcontrib><creatorcontrib>Yoo, Changhoon</creatorcontrib><creatorcontrib>Kim, Kyu-pyo</creatorcontrib><creatorcontrib>Hong, Seung-Mo</creatorcontrib><creatorcontrib>Seo, Dong-Wan</creatorcontrib><creatorcontrib>Kim, Song Cheol</creatorcontrib><creatorcontrib>Lee, Moon-Gyu</creatorcontrib><title>CT-determined resectability of borderline resectable and unresectable pancreatic adenocarcinoma following FOLFIRINOX therapy</title><title>European radiology</title><addtitle>Eur Radiol</addtitle><addtitle>Eur Radiol</addtitle><description>Objectives
We aimed to assess the ability of CT-determined resectability, as defined by a recent version of NCCN criteria, and associated CT findings to predict margin-negative (R0) resection in patients with PDAC after neoadjuvant FOLFIRINOX chemotherapy.
Methods
Sixty-four patients (36 men and 28 women; mean age, 58.8 years) with borderline resectable or unresectable PDAC who received neoadjuvant FOLFIRINOX were evaluated retrospectively. CT findings were independently assessed by two abdominal radiologists according to NCCN criteria (version 3. 2019). Tumor resectability was classified as resectable, borderline resectable, or unresectable, and change in resectability was classified as regression, stability, or progression. The associations of R0 resection rate with CT-determined resectability and change in resectability categories were evaluated, as were the sensitivity and specificity of NCCN criteria for R0 resection. Factors associated with R0 resection were identified by logistic regression analysis.
Results
R0 resection rate did not differ significantly among the resectable, borderline resectable, or unresectable PDAC (67–73%,
p
= 0.95) or among PDAC with regression, stability, or progression (56–77%,
p
= 0.39). The sensitivity and specificity for R0 resection were 67% and 37%, respectively, for resectability (resectable/borderline vs. unresectable) and 80% and 21%, respectively, for changes in resectability (regression/stable vs. progression). Low-contrast enhancement of soft tissue contacting artery (≤ 46.4 HU) was independently associated with R0 resection (
p
= 0.01).
Conclusion
CT-determined resectability after neoadjuvant FOLFIRINOX chemotherapy was relatively insensitive and non-specific for predicting R0 resection. Low-contrast enhancement of soft tissue contacting artery may increase the ability of CT to predict R0 resection.
Key Points
• Margin-negative resection rate of pancreatic cancer following FOLFIRINOX therapy did not differ among each resectability (67–73%, p = 0.95) based on NCCN criteria or changes in resectability categories (56–77%, p = 0.39).
• The sensitivity and specificity for margin-negative resection were 67% and 37% for resectability (resectable/borderline vs. unresectable) and 80% and 21% for changes in resectability (regression/stable vs. progression).
• Low-contrast enhancement of soft tissue contacting artery (≤ 46.4 HU) was independently associated with margin-negative resection (p = 0.01).</description><subject>Adenocarcinoma</subject><subject>Adenocarcinoma - diagnostic imaging</subject><subject>Adenocarcinoma - drug therapy</subject><subject>Adenocarcinoma - surgery</subject><subject>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</subject><subject>Chemotherapy</subject><subject>Criteria</subject><subject>Diagnostic Radiology</subject><subject>Evaluation</subject><subject>Female</subject><subject>Fluorouracil</subject><subject>Gastrointestinal</subject><subject>Humans</subject><subject>Imaging</subject><subject>Internal Medicine</subject><subject>Interventional Radiology</subject><subject>Irinotecan</subject><subject>Leucovorin</subject><subject>Male</subject><subject>Medical diagnosis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Neoadjuvant Therapy</subject><subject>Neoplasm Staging</subject><subject>Neuroradiology</subject><subject>Oxaliplatin</subject><subject>Pancreatic cancer</subject><subject>Pancreatic Neoplasms - diagnostic imaging</subject><subject>Pancreatic Neoplasms - drug therapy</subject><subject>Pancreatic Neoplasms - surgery</subject><subject>Radiology</subject><subject>Regression analysis</subject><subject>Retrospective Studies</subject><subject>Soft tissues</subject><subject>Stability</subject><subject>Tissues</subject><subject>Tomography, X-Ray Computed</subject><subject>Treatment Outcome</subject><subject>Ultrasound</subject><issn>0938-7994</issn><issn>1432-1084</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp9kEFrGzEQhUVpqJ2kf6CHIuh5k9FKXknHYOLGYGIIDuQmtNpRumEtOdKaYMiP7yZ2nJ56GAbmvXkPPkJ-MLhgAPIyA3AOBZTDSKZUob6QMRO8LBgo8ZWMQXNVSK3FiJzm_AQAmgn5jYx4qcSEKz0mr9NV0WCPad0GbGjCjK63ddu1_Y5GT-uYGkzdIB61DqkNDd2Gfw4bG1xC27eO2gZDdDa5NsS1pT52XXxpwyOdLRez-d38dvlA-z-Y7GZ3Tk687TJ-P-wzcj-7Xk1visXy93x6tSicEKwvmkp6xZzW3k0qpy16B1ajdlwhMIWiRmlLoStVo9eTGjwAY7pxTDGuQPIz8mufu0nxeYu5N09xm8JQaUohVVVpOakGV7l3uRRzTujNJrVrm3aGgXkDbvbAzQDcvAM3anj6eYje1mtsji8fhAcD3xvyIIVHTJ_d_4n9C2NZjZ0</recordid><startdate>20210201</startdate><enddate>20210201</enddate><creator>Jang, Jong Keon</creator><creator>Byun, Jae Ho</creator><creator>Kang, Ji Hun</creator><creator>Son, Jung Hee</creator><creator>Kim, Jin Hee</creator><creator>Lee, Seung Soo</creator><creator>Kim, Hyoung Jung</creator><creator>Yoo, Changhoon</creator><creator>Kim, Kyu-pyo</creator><creator>Hong, Seung-Mo</creator><creator>Seo, Dong-Wan</creator><creator>Kim, Song Cheol</creator><creator>Lee, Moon-Gyu</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><orcidid>https://orcid.org/0000-0003-2076-9979</orcidid></search><sort><creationdate>20210201</creationdate><title>CT-determined resectability of borderline resectable and unresectable pancreatic adenocarcinoma following FOLFIRINOX therapy</title><author>Jang, Jong Keon ; Byun, Jae Ho ; Kang, Ji Hun ; Son, Jung Hee ; Kim, Jin Hee ; Lee, Seung Soo ; Kim, Hyoung Jung ; Yoo, Changhoon ; Kim, Kyu-pyo ; Hong, Seung-Mo ; Seo, Dong-Wan ; Kim, Song Cheol ; Lee, Moon-Gyu</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c441t-d67f81c99fc56c9aefc0a9e9c38e018e4be7a24968bef95b0f00119dc18138073</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adenocarcinoma</topic><topic>Adenocarcinoma - diagnostic imaging</topic><topic>Adenocarcinoma - drug therapy</topic><topic>Adenocarcinoma - surgery</topic><topic>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</topic><topic>Chemotherapy</topic><topic>Criteria</topic><topic>Diagnostic Radiology</topic><topic>Evaluation</topic><topic>Female</topic><topic>Fluorouracil</topic><topic>Gastrointestinal</topic><topic>Humans</topic><topic>Imaging</topic><topic>Internal Medicine</topic><topic>Interventional Radiology</topic><topic>Irinotecan</topic><topic>Leucovorin</topic><topic>Male</topic><topic>Medical diagnosis</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Neoadjuvant Therapy</topic><topic>Neoplasm Staging</topic><topic>Neuroradiology</topic><topic>Oxaliplatin</topic><topic>Pancreatic cancer</topic><topic>Pancreatic Neoplasms - diagnostic imaging</topic><topic>Pancreatic Neoplasms - drug therapy</topic><topic>Pancreatic Neoplasms - surgery</topic><topic>Radiology</topic><topic>Regression analysis</topic><topic>Retrospective Studies</topic><topic>Soft tissues</topic><topic>Stability</topic><topic>Tissues</topic><topic>Tomography, X-Ray Computed</topic><topic>Treatment Outcome</topic><topic>Ultrasound</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jang, Jong Keon</creatorcontrib><creatorcontrib>Byun, Jae Ho</creatorcontrib><creatorcontrib>Kang, Ji Hun</creatorcontrib><creatorcontrib>Son, Jung Hee</creatorcontrib><creatorcontrib>Kim, Jin Hee</creatorcontrib><creatorcontrib>Lee, Seung Soo</creatorcontrib><creatorcontrib>Kim, Hyoung Jung</creatorcontrib><creatorcontrib>Yoo, Changhoon</creatorcontrib><creatorcontrib>Kim, Kyu-pyo</creatorcontrib><creatorcontrib>Hong, Seung-Mo</creatorcontrib><creatorcontrib>Seo, Dong-Wan</creatorcontrib><creatorcontrib>Kim, Song Cheol</creatorcontrib><creatorcontrib>Lee, Moon-Gyu</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central 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Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biological Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><jtitle>European radiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jang, Jong Keon</au><au>Byun, Jae Ho</au><au>Kang, Ji Hun</au><au>Son, Jung Hee</au><au>Kim, Jin Hee</au><au>Lee, Seung Soo</au><au>Kim, Hyoung Jung</au><au>Yoo, Changhoon</au><au>Kim, Kyu-pyo</au><au>Hong, Seung-Mo</au><au>Seo, Dong-Wan</au><au>Kim, Song Cheol</au><au>Lee, Moon-Gyu</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>CT-determined resectability of borderline resectable and unresectable pancreatic adenocarcinoma following FOLFIRINOX therapy</atitle><jtitle>European radiology</jtitle><stitle>Eur Radiol</stitle><addtitle>Eur Radiol</addtitle><date>2021-02-01</date><risdate>2021</risdate><volume>31</volume><issue>2</issue><spage>813</spage><epage>823</epage><pages>813-823</pages><issn>0938-7994</issn><eissn>1432-1084</eissn><abstract>Objectives
We aimed to assess the ability of CT-determined resectability, as defined by a recent version of NCCN criteria, and associated CT findings to predict margin-negative (R0) resection in patients with PDAC after neoadjuvant FOLFIRINOX chemotherapy.
Methods
Sixty-four patients (36 men and 28 women; mean age, 58.8 years) with borderline resectable or unresectable PDAC who received neoadjuvant FOLFIRINOX were evaluated retrospectively. CT findings were independently assessed by two abdominal radiologists according to NCCN criteria (version 3. 2019). Tumor resectability was classified as resectable, borderline resectable, or unresectable, and change in resectability was classified as regression, stability, or progression. The associations of R0 resection rate with CT-determined resectability and change in resectability categories were evaluated, as were the sensitivity and specificity of NCCN criteria for R0 resection. Factors associated with R0 resection were identified by logistic regression analysis.
Results
R0 resection rate did not differ significantly among the resectable, borderline resectable, or unresectable PDAC (67–73%,
p
= 0.95) or among PDAC with regression, stability, or progression (56–77%,
p
= 0.39). The sensitivity and specificity for R0 resection were 67% and 37%, respectively, for resectability (resectable/borderline vs. unresectable) and 80% and 21%, respectively, for changes in resectability (regression/stable vs. progression). Low-contrast enhancement of soft tissue contacting artery (≤ 46.4 HU) was independently associated with R0 resection (
p
= 0.01).
Conclusion
CT-determined resectability after neoadjuvant FOLFIRINOX chemotherapy was relatively insensitive and non-specific for predicting R0 resection. Low-contrast enhancement of soft tissue contacting artery may increase the ability of CT to predict R0 resection.
Key Points
• Margin-negative resection rate of pancreatic cancer following FOLFIRINOX therapy did not differ among each resectability (67–73%, p = 0.95) based on NCCN criteria or changes in resectability categories (56–77%, p = 0.39).
• The sensitivity and specificity for margin-negative resection were 67% and 37% for resectability (resectable/borderline vs. unresectable) and 80% and 21% for changes in resectability (regression/stable vs. progression).
• Low-contrast enhancement of soft tissue contacting artery (≤ 46.4 HU) was independently associated with margin-negative resection (p = 0.01).</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>32845389</pmid><doi>10.1007/s00330-020-07188-8</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0003-2076-9979</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0938-7994 |
| ispartof | European radiology, 2021-02, Vol.31 (2), p.813-823 |
| issn | 0938-7994 1432-1084 |
| language | eng |
| recordid | cdi_proquest_journals_2478669756 |
| source | MEDLINE; SpringerNature Journals |
| subjects | Adenocarcinoma Adenocarcinoma - diagnostic imaging Adenocarcinoma - drug therapy Adenocarcinoma - surgery Antineoplastic Combined Chemotherapy Protocols - therapeutic use Chemotherapy Criteria Diagnostic Radiology Evaluation Female Fluorouracil Gastrointestinal Humans Imaging Internal Medicine Interventional Radiology Irinotecan Leucovorin Male Medical diagnosis Medicine Medicine & Public Health Middle Aged Neoadjuvant Therapy Neoplasm Staging Neuroradiology Oxaliplatin Pancreatic cancer Pancreatic Neoplasms - diagnostic imaging Pancreatic Neoplasms - drug therapy Pancreatic Neoplasms - surgery Radiology Regression analysis Retrospective Studies Soft tissues Stability Tissues Tomography, X-Ray Computed Treatment Outcome Ultrasound |
| title | CT-determined resectability of borderline resectable and unresectable pancreatic adenocarcinoma following FOLFIRINOX therapy |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-18T08%3A24%3A37IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=CT-determined%20resectability%20of%20borderline%20resectable%20and%20unresectable%20pancreatic%20adenocarcinoma%20following%20FOLFIRINOX%20therapy&rft.jtitle=European%20radiology&rft.au=Jang,%20Jong%20Keon&rft.date=2021-02-01&rft.volume=31&rft.issue=2&rft.spage=813&rft.epage=823&rft.pages=813-823&rft.issn=0938-7994&rft.eissn=1432-1084&rft_id=info:doi/10.1007/s00330-020-07188-8&rft_dat=%3Cproquest_cross%3E2478669756%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2478669756&rft_id=info:pmid/32845389&rfr_iscdi=true |