Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu Seoul, 110-744, Republic of Korea.
Eur Radiol. 2023 Apr;33(4):2713-2724. doi: 10.1007/s00330-022-09235-y. Epub 2022 Nov 15.
We aimed to evaluate the prognostic value of tumor-to-parenchymal contrast enhancement ratio on portal venous-phase CT (CER on PVP) and compare its prognostic performance to prevailing grading and staging systems in pancreatic neuroendocrine neoplasms (PanNENs).
In this retrospective study, data on 465 patients (development cohort) who underwent upfront curative-intent resection for PanNEN were used to assess the performance of CER on PVP and tumor size measured by CT (CT-Size) in predicting recurrence-free survival (RFS) using Harrell's C-index and to determine their optimal cutoffs to stratify RFS using a multi-way partitioning algorithm. External data on 184 patients (test cohort) were used to validate the performance of CER on PVP in predicting RFS and overall survival (OS) and compare its predictive performance with those of CT-Size, 2019 World Health Organization classification system (WHO), and the 8th American Joint Committee on Cancer staging system (AJCC).
In the test cohort, CER on PVP showed C-indexes of 0.83 (95% confidence interval [CI], 0.74-0.91) and 0.84 (95% CI, 0.73-0.95) for predicting RFS and OS, respectively, which were higher than those for the WHO (C-index: 0.73 for RFS [p = .002] and 0.72 for OS [p = .004]) and AJCC (C-index, 0.67 for RFS [p = .002] and 0.58 for OS [p = .002]). CT-Size obtained C-indexes of 0.71 for RFS and 0.61 for OS.
CER on PVP showed superior predictive performance on postoperative survival in PanNEN than current grading and staging systems, indicating its potential as a noninvasive preoperative prognostic tool.
• In pancreatic neuroendocrine neoplasms, the tumor-to-parenchymal enhancement ratio on portal venous-phase CT (CER on PVP) showed acceptable predictive performance of postoperative outcomes. • CER on PVP showed superior predictive performance of postoperative survival over the current WHO classification and AJCC staging system.
我们旨在评估门静脉期 CT（PVP 时的 CER）肿瘤与实质增强比（tumor-to-parenchymal contrast enhancement ratio）对胰腺神经内分泌肿瘤（PanNEN）患者的预后价值，并比较其与目前的分级和分期系统在预测无复发生存率（RFS）方面的性能。
在这项回顾性研究中，我们使用了 465 例接受根治性切除术治疗 PanNEN 的患者的数据（开发队列），评估 PVP 时的 CER 和 CT 测量的肿瘤大小（CT-Size）在预测无复发生存率（RFS）方面的表现，使用 Harrell 的 C 指数来确定其最佳截断值，以使用多向分区算法对 RFS 进行分层。使用 184 例患者的数据（验证队列）来验证 PVP 时的 CER 在预测 RFS 和总生存率（OS）方面的性能，并将其预测性能与 CT-Size、2019 年世界卫生组织（WHO）分类系统和第 8 版美国癌症联合委员会（AJCC）分期系统进行比较。
在验证队列中，PVP 时的 CER 预测 RFS 和 OS 的 C 指数分别为 0.83（95%置信区间[CI]，0.74-0.91）和 0.84（95%CI，0.73-0.95），高于 WHO（RFS 的 C 指数：0.73 [p =.002]和 OS 的 C 指数：0.72 [p =.004]）和 AJCC（RFS 的 C 指数：0.67 [p =.002]和 OS 的 C 指数：0.58 [p =.002]）。CT-Size 预测 RFS 和 OS 的 C 指数分别为 0.71 和 0.61。
PVP 时的 CER 在预测 PanNEN 术后生存方面优于目前的分级和分期系统，表明其作为一种非侵入性术前预后工具的潜力。
在胰腺神经内分泌肿瘤中，门静脉期 CT（PVP 时的 CER）肿瘤与实质增强比显示出对术后结局具有可接受的预测性能。
PVP 时的 CER 在预测术后生存方面优于目前的 WHO 分级和 AJCC 分期系统。
