Okada Ken-Ichi, Hirono Seiko, Kawai Manabu, Miyazawa Motoki, Shimizu Atsushi, Kitahata Yuji, Ueno Masaki, Hayami Shinya, Kojima Fumiyoshi, Yamaue Hiroki
Second Department of Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
Department of Human Pathology, Wakayama Medical University, Wakayama, Japan.
J Hepatobiliary Pancreat Sci. 2017 Mar;24(3):161-168. doi: 10.1002/jhbp.430.
The parameters to predict histological response to neoadjuvant therapy remain controversial in borderline resectable pancreatic carcinoma (BRPC).
Twenty-four patients who underwent diffusion-weighted magnetic resonance imaging (DW-MRI) prior to expected neoadjuvant chemo/chemoradiotherapy and surgery were reviewed retrospectively. Analyses for correlation between percent tumor cell destruction and the following was performed to investigate the parameter and cut off value: tumor size, whole tumor apparent diffusion coefficient (ADC) value of DW-MRI, maximum standardized uptake value of F-fluorodeoxyglucose positron emission tomography, carbohydrate antigen 19-9, and their change ratios. The selected parameter was assessed for prediction ability of the histological response to neoadjuvant chemo/chemoradiotherapy and R0 curability.
Pre-treatment ADC value was correlated with tumor cell destruction rate among all parameters (R = 0.625, P = 0.001). The ADC cut-off value for discriminating between nonresponders (grade I) and responders (grade IIa and more) after treatment was determined as 1.20 × 10 mm /s and the sensitivity, 100%; specificity, 75%; accuracy, 83% for responder, and the sensitivity, 100%; specificity, 63%; accuracy, 71% for R0 curability.
Pre-treatment ADC value appeared to be a predictor of R0 curability in BRPC patients because of effective histological response to neoadjuvant therapy, and there was a significant correlation between the baseline ADC value and histological tumor cell destruction rate.
在可切除边缘的胰腺癌（BRPC）中，预测新辅助治疗组织学反应的参数仍存在争议。
回顾性分析24例在预期新辅助化疗/放化疗及手术前接受扩散加权磁共振成像（DW-MRI）的患者。分析肿瘤细胞破坏百分比与以下因素之间的相关性，以研究参数和临界值：肿瘤大小、DW-MRI的全肿瘤表观扩散系数（ADC）值、F-氟脱氧葡萄糖正电子发射断层扫描的最大标准化摄取值、糖类抗原19-9及其变化率。评估所选参数对新辅助化疗/放化疗组织学反应和R0治愈率的预测能力。
在所有参数中，治疗前ADC值与肿瘤细胞破坏率相关（R = 0.625，P = 0.001）。治疗后区分无反应者（I级）和有反应者（IIa级及以上）的ADC临界值确定为1.20×10⁻³mm²/s，对于有反应者，敏感性为100%；特异性为75%；准确性为83%，对于R0治愈率，敏感性为100%；特异性为63%；准确性为71%。
由于对新辅助治疗有有效的组织学反应，治疗前ADC值似乎是BRPC患者R0治愈率的预测指标，且基线ADC值与组织学肿瘤细胞破坏率之间存在显著相关性。
