Department of Radiology, Seoul National University Hospital, 101 Daehakro, Jongno-gu, Seoul, 03080, South Korea.
Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea.
Eur Radiol. 2021 Sep;31(9):6889-6897. doi: 10.1007/s00330-021-07847-4. Epub 2021 Mar 19.
For patients with pancreatic adenocarcinoma (PAC), adequate determination of disease extent is critical for optimal management. We aimed to evaluate diagnostic accuracy of CT in determining the resectability of PAC based on 2020 NCCN Guidelines.
We retrospectively enrolled 368 consecutive patients who underwent upfront surgery for PAC and preoperative pancreas protocol CT from January 2012 to December 2017. The resectability of PAC was assessed based on 2020 NCCN Guidelines and compared to 2017 NCCN Guidelines using chi-square tests. Overall survival (OS) was estimated using the Kaplan-Meier method and compared using log-rank test. R0 resection-associated factors were identified using logistic regression analysis.
R0 rates were 80.8% (189/234), 67% (71/106), and 10.7% (3/28) for resectable, borderline resectable, and unresectable PAC according to 2020 NCCN Guidelines, respectively (p < 0.001). The estimated 3-year OS was 28.9% for borderline resectable PAC, which was significantly lower than for resectable PAC (43.6%) (p = 0.004) but significantly higher than for unresectable PAC (0.0%) (p < 0.001). R0 rate was significantly lower in patients with unresectable PAC according to 2020 NCCN Guidelines (10.7%, 3/28) than in those with unresectable PAC according to the previous version (31.7%, 20/63) (p = 0.038). In resectable PAC, tumor size ≥ 3 cm (p = 0.03) and abutment to portal vein (PV) (p = 0.04) were independently associated with margin-positive resection.
The current NCCN Guidelines are useful for stratifying patients according to prognosis and perform better in R0 prediction in unresectable PAC than the previous version. Larger tumor size and abutment to PV were associated with margin-positive resection in patients with resectable PAC.
• The updated 2020 NCCN Guidelines were useful for stratifying patients according to prognosis. • The updated 2020 NCCN Guidelines performed better in the prediction of margin-positive resection in unresectable cases than the previous version. • Tumor size ≥ 3 cm and abutment to the portal vein were associated with margin-positive resection in patients with resectable pancreatic adenocarcinoma.
对于胰腺导管腺癌（PAC）患者，充分确定疾病范围对于最佳管理至关重要。本研究旨在根据 2020 年 NCCN 指南评估 CT 对 PAC 可切除性的诊断准确性。
我们回顾性纳入了 2012 年 1 月至 2017 年 12 月期间因 PAC 接受初次手术且术前行胰腺方案 CT 检查的 368 例连续患者。根据 2020 年 NCCN 指南评估 PAC 的可切除性，并与 2017 年 NCCN 指南进行比较，采用卡方检验。使用 Kaplan-Meier 方法估计总生存期（OS），并采用对数秩检验进行比较。采用 logistic 回归分析识别 R0 切除相关因素。
根据 2020 年 NCCN 指南，可切除、交界可切除和不可切除 PAC 的 R0 切除率分别为 80.8%（189/234）、67%（71/106）和 10.7%（3/28）（p<0.001）。交界可切除 PAC 的 3 年估计 OS 为 28.9%，显著低于可切除 PAC（43.6%）（p=0.004），但显著高于不可切除 PAC（0.0%）（p<0.001）。根据 2020 年 NCCN 指南，不可切除 PAC 的 R0 切除率（10.7%，3/28）明显低于旧版（31.7%，20/63）（p=0.038）。在可切除 PAC 中，肿瘤直径≥3cm（p=0.03）和毗邻门静脉（PV）（p=0.04）与边缘阳性切除独立相关。
目前的 NCCN 指南可用于根据预后对患者进行分层，并且在预测不可切除 PAC 的 R0 方面优于旧版。较大的肿瘤直径和毗邻 PV 与可切除 PAC 患者的边缘阳性切除相关。
更新的 2020 年 NCCN 指南可用于根据预后对患者进行分层。
更新的 2020 年 NCCN 指南在预测不可切除病例的边缘阳性切除方面优于旧版。
肿瘤直径≥3cm 和毗邻门静脉与可切除胰腺导管腺癌患者的边缘阳性切除相关。
