From the Departments of Diagnostic and Interventional Imaging (C.C., A.M., J.P.L., B.L., D.G., F.L., M.M.), Hepatogastroenterology and Digestive Oncology (E.T.), Pathology (G.B.), Radiotherapy (V.V.), and Visceral Surgery (L.C., T.W.), Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, 1 Avenue de Magellan, 33604 Cedex, Pessac, France; INSERM U1053, Université Bordeaux Segalen, Bordeaux, France (C.C.); Departments of Hepatogastroenterology and Digestive Oncology (J.F.B.), Visceral Surgery (C.L.), and Diagnostic and Interventional Imaging (H.T.), Hôpîtal Saint-André, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; and Department of Visceral Surgery, APHP, Paris, France (A.S.).
Radiology. 2014 Oct;273(1):108-16. doi: 10.1148/radiol.14132914. Epub 2014 Jun 24.
To prospectively evaluate the utility of computed tomography (CT) for determination of tumor response and prediction of resectability after neoadjuvant combined chemotherapy and radiation therapy (CRT) in patients with nonmetastatic locally advanced pancreatic cancer.
This study received institutional review board approval, and all participants provided written informed consent. Consecutive patients with cephalic locally advanced pancreatic cancer who underwent surgical exploration and/or resection following neoadjuvant CRT were prospectively enrolled from June 2009 to May 2013. Two radiologists independently analyzed the baseline and post-CRT CT scans for the size, attenuation, and circumferential vascular contacts of the tumor. Associations between the postoperative histologic grade of the tumor response (pTNM) and the clinical, biologic, and CT criteria were assessed by using Spearman correlation coefficients. CT criteria related to the presence of complete (ie, R0) resection were assessed by using logistic regression.
Forty-seven patients were included, 33 with an R0 resection and 14 with positive margins (ie, R1) or no resection. Variables demonstrating a significant correlation with the histologic tumor classification of tumor response were post-CRT carbohydrate antigen 19-9 level (r = 0.46), post-CRT largest tumor axis (r = 0.44), post-CRT sum of the largest and smallest tumor axes (r = 0.46), change in the largest axis (r = -0.31), change in the sum of the largest and smallest axes (r = -0.39), change in superior mesenteric vein (SMV) and/or portal vein (hereafter, SMV/portal vein) contact (r = -0.38), and post-CRT superior mesenteric artery contact (r = 0.34). Partial regression of tumor contact with the SMV/portal vein was associated in all cases with R0 resection (10 of 10 patients, positive predictive value = 100%), and partial regression of tumor contact with any peripancreatic vascular axis was associated with R0 resection in 91% of cases (20 of 22 patients, positive predictive value = 91%). Persistence of SMV/portal vein stenosis after CRT was not predictive of R1 resection.
Partial regression of tumor-vessel contact indicates suitability for surgical exploration, irrespective of the degree of decrease in tumor size or the degree of residual vascular involvement.
前瞻性评估计算机断层扫描（CT）在局部晚期非转移性胰腺癌患者新辅助联合化疗和放疗（CRT）后确定肿瘤反应和预测可切除性的作用。
本研究获得了机构审查委员会的批准，所有参与者均提供了书面知情同意书。连续入组 2009 年 6 月至 2013 年 5 月期间接受新辅助 CRT 后行手术探查和/或切除术的头侧局部晚期胰腺癌患者。两位放射科医生分别分析基线和 CRT 后 CT 扫描的肿瘤大小、衰减和周缘血管接触情况。采用 Spearman 相关系数评估肿瘤反应的术后组织学分级（pTNM）与临床、生物学和 CT 标准之间的相关性。采用逻辑回归评估与完全（即 R0）切除相关的 CT 标准。
共纳入 47 例患者，其中 33 例获得 R0 切除，14 例获得阳性切缘（即 R1）或未行切除。与肿瘤反应的组织学肿瘤分类具有显著相关性的变量包括 CRT 后肿瘤标志物 19-9 水平（r = 0.46）、CRT 后最大肿瘤轴（r = 0.44）、CRT 后最大和最小肿瘤轴之和（r = 0.46）、最大轴变化（r = -0.31）、最大和最小轴之和的变化（r = -0.39）、肠系膜上静脉（SMV）和/或门静脉（以下简称 SMV/门静脉）接触的变化（r = -0.38）和 CRT 后 SMV 接触（r = 0.34）。SMV/门静脉接触的部分消退在所有 R0 切除患者中均与肿瘤接触（10/10 例，阳性预测值 = 100%）相关，任何胰周血管轴的肿瘤接触部分消退与 91%的 R0 切除患者相关（20/22 例，阳性预测值 = 91%）。CRT 后 SMV/门静脉狭窄的持续存在不能预测 R1 切除。
肿瘤-血管接触的部分消退表明适合手术探查，而与肿瘤大小的减小程度或残留血管受累程度无关。
