Choi Sang Hyun, Kim Hyoung Jung, Kim Kyung Won, An Soyeon, Hong Seung-Mo, Kim Song Cheol, Kim Myung-Hwan
1 Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
2 Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Br J Radiol. 2017 May;90(1073):20160403. doi: 10.1259/bjr.20160403. Epub 2017 Mar 24.
To investigate the relationship between CT imaging findings and DPC4 gene expression and to determine the prognostic value of DPC4 gene expression to predict overall survival in patients with pancreatic ductal adenocarcinoma.
Between January and December 2011, we retrospectively analyzed 163 pancreatic ductal adenocarcinomas in 163 patients who had undergone surgical resection (mean age = 61.8 years; range = 35-81 years). We divided the study patients into two groups according to DPC4 gene expression: DPC4-expression or DPC4-non-expression group. The CT findings were analyzed by two reviewers. The associations between the CT imaging findings and DPC4 gene expression were evaluated using univariate analysis and multivariate logistic regression analysis. Overall survival was compared according to the DPC4 gene expression (DPC4-expression vs DPC4-non-expression) using Kaplan-Meier analysis and log-rank testing. To avoid bias, subgroup analyses of CT findings in T3 tumour and overall survival in patients with T3 tumour and R0 resection were performed.
Between DPC4-expression group (n = 75) and DPC4-non-expression group (n = 88), three CT findings (i.e., tumour margin, peripancreatic infiltration, and the presence of background intraductal pancreatic mucinous neoplasm) were significantly different in univariate analysis. Of these, a well-defined tumour margin was significantly associated with DPC4-expression tumour (adjusted odds ratio = 2.06; p = 0.032) in multivariate analysis. Of the total 163 patients, the mean overall survival of the DPC4-expression group was significantly longer than that of the DPC4-non-expression group (30.0 vs 22.0 months; p = 0.049). Of the 150 T3 tumours, the presence of well-defined tumour margins was also a significant CT finding (adjusted odd ratio = 2.00; p = 0.044) in multivariate analysis. However, of 131 patients with T3 tumour and R0 resection, the overall survival period of the DPC4-expression group was not significantly different from that of the DPC4-non-expression group (24.0 vs 22.0 months; p = 0.240).
The presence of well-defined tumour margins on CT was significantly linked with DPC4-expression tumour. Advances in knowledge: A well-defined tumour margin is an independent CT finding associated with DPC4-expression pancreatic ductal adenocarcinoma.
探讨CT影像表现与DPC4基因表达之间的关系，并确定DPC4基因表达对预测胰腺导管腺癌患者总生存期的预后价值。
回顾性分析2011年1月至12月期间163例行手术切除的胰腺导管腺癌患者（平均年龄61.8岁；范围35 - 81岁）。根据DPC4基因表达将研究患者分为两组：DPC4表达组或DPC4非表达组。由两名阅片者分析CT表现。采用单因素分析和多因素逻辑回归分析评估CT影像表现与DPC4基因表达之间的关联。根据DPC4基因表达（DPC4表达组与DPC4非表达组），采用Kaplan-Meier分析和对数秩检验比较总生存期。为避免偏倚，对T3肿瘤的CT表现以及T3肿瘤且R0切除患者的总生存期进行亚组分析。
在DPC4表达组（n = 75）和DPC4非表达组（n = 88）之间，单因素分析显示三个CT表现（即肿瘤边缘、胰腺周围浸润和背景胰腺导管内黏液性肿瘤的存在）存在显著差异。其中，在多因素分析中，边界清晰的肿瘤边缘与DPC4表达肿瘤显著相关（校正比值比 = 2.06；p = 0.032）。在163例患者中总数中，DPC4表达组的平均总生存期显著长于DPC4非表达组（30.0个月对22.0个月；p = 0.049）。在150例T3肿瘤中，边界清晰的肿瘤边缘在多因素分析中也是一个显著的CT表现（校正比值比 = 2.00；p = 0.044）。然而，在131例T3肿瘤且R0切除的患者中，DPC4表达组的总生存期与DPC4非表达组无显著差异（24.0个月对22.0个月；p = 0.240）。
CT上边界清晰的肿瘤边缘与DPC4表达肿瘤显著相关。知识进展：边界清晰的肿瘤边缘是与DPC4表达的胰腺导管腺癌相关的独立CT表现。
