Department of General Surgery, Verona University Hospital, Policlinico G. B. Rossi, P.le Scuro 10, 37134, Verona, Italy.
Department of Radiology, Verona University Hospital, Policlinico G. B. Rossi, P.le Scuro 10, 37134, Verona, Italy.
Eur Radiol. 2018 Oct;28(10):4265-4273. doi: 10.1007/s00330-018-5410-6. Epub 2018 Apr 20.
To assess factors associated with radical resection (R0) of pancreatic ductal adenocarcinoma (PDAC) after induction treatment with FOLFIRINOX.
Patients with either locally advanced (LA) and borderline resectable (BR) PDAC undergoing surgical exploration after FOLFIRINOX were retrospectively enrolled. Two pancreatic radiologists reviewed the CT blinded to the final outcome and assessed chemotherapy response and resectability. Patients were then divided into R0 resected (group A) and not resected/R1 resected (group B), which were compared.
Of 59 patients included, 19 were defined as unresectable (32%), 33 borderline resectable (56%) and 7 resectable (12%) during the blind radiological evaluation after FOLFIRINOX. Once in a surgical setting, 27% were non-resectable, whereas 73% received surgical resection with a 70% R0 rate. Consequent sensitivity and specificity were 86% and 29%. At imaging review, significant decreases in longest tumour dimension were observed in both groups: from 32 mm (95% CI 15-55) to 21 (10-44) in group A and from 34 (18-70) to 26 (7-60) in group B, p < 0.05. However, a significant increase in tumour attenuation in all phases was only observed for R0 resected, from 52 HU (26-75) to 65 (35-92) in arterial phase (p < 0.001) and from 62 (36-96) to 78 (40-120) in the venous (p = 0.001).
After neoadjuvant FOLFIRINOX, CT predicted resectability with acceptable sensitivity but low specificity. The observation of increased tumour attenuation at CT scan after FOLFIRINOX treatment might represent a reliable predictor of R0 resection.
• CT drives the assessment of PDAC resectability after FOLFIRINOX • CT predicts resectability with acceptable sensitivity but low specificity • Significant increase in tumour attenuation was only observed for R0 resected PDAC • Tumour attenuation after FOLFIRINOX represents a reliable predictor of R0 resection.
评估接受 FOLFIRINOX 诱导治疗后行根治性切除术（R0）与胰腺导管腺癌（PDAC）相关的因素。
回顾性纳入接受 FOLFIRINOX 治疗后行手术探查的局部晚期（LA）和边界可切除（BR）PDAC 患者。两位胰腺放射科医生对 CT 进行盲法评估，以评估化疗反应和可切除性。然后，将患者分为 R0 切除（A 组）和未切除/R1 切除（B 组），并对其进行比较。
59 例患者中，19 例（32%）在接受 FOLFIRINOX 治疗后的盲法放射学评估中被定义为不可切除，33 例（56%）为边界可切除，7 例（12%）可切除。在手术环境下，27%的患者不可切除，而 73%的患者接受了手术切除，R0 切除率为 70%。相应的敏感性和特异性分别为 86%和 29%。在影像学评估中，两组的最长肿瘤直径均显著减小：A 组从 32mm（95%CI 15-55）降至 21mm（10-44），B 组从 34mm（18-70）降至 26mm（7-60），p＜0.05。然而，仅在 R0 切除的患者中观察到所有阶段的肿瘤衰减显著增加，从动脉期的 52HU（26-75）增加到 65HU（35-92）（p＜0.001），从静脉期的 62HU（36-96）增加到 78HU（40-120）（p=0.001）。
在新辅助 FOLFIRINOX 治疗后，CT 以可接受的敏感性但较低的特异性预测可切除性。在 FOLFIRINOX 治疗后 CT 扫描观察到肿瘤衰减增加可能是 R0 切除的可靠预测指标。
• CT 指导 FOLFIRINOX 后 PDAC 可切除性评估• CT 预测可切除性的敏感性可接受，但特异性较低• 仅在 R0 切除的 PDAC 中观察到肿瘤衰减显著增加• FOLFIRINOX 后肿瘤衰减是 R0 切除的可靠预测指标。
