Department of Pathology and Bioscience, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori 036‑8562, Japan.
Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori 036‑8562, Japan.
Oncol Rep. 2023 Mar;49(3). doi: 10.3892/or.2023.8498. Epub 2023 Feb 17.
The present study aimed to investigate the histological changes caused by neoadjuvant chemotherapy (NAC) for pancreatic ductal adenocarcinoma (PDAC), and to demonstrate the use of time‑density curves (TDCs) of dynamic contrast‑enhanced computed tomography (CECT) for determination of the histological therapeutic effects of NAC for PDAC. A total of 96 patients with PDAC were examined; 46 underwent NAC (NAC group) and 50 did not undergo NAC (non‑NAC group). Based on histological therapeutic effect and using the area of residual tumor (ART) grading system, the NAC group was divided into low‑responders and high‑responders. Histological analysis was used to evaluate the densities of cancer cells, cancer‑associated fibroblasts (CAFs), microvessels and stromal collagen fibers in the NAC and non‑NAC groups. Radiological analysis was used to evaluate the TDCs of three slopes of the NAC group, namely slopes between the non‑contrast and arterial phases (δ1 and δ1'), between the arterial and portal phases (δ2 and δ2'), and between the portal and equilibrium phases (δ3 and δ3'). δ1‑δ3 were before NAC, whereas δ1'‑δ3' were after NAC. Changes in δ1, δ2 and δ3 before and after NAC were denoted as δδ1 (=δ1'‑δ1), δδ2 (=δ2'‑δ2) and δδ3 (=δ3'‑δ3). ART grading system, histological examination and radiological examination data were also statistically analyzed. Histological examination revealed a significant decrease in cancer cells and CAFs, and a significant increase in stromal collagen fibers due to NAC (P<0.01). Radiological examination revealed that δ1' was significantly higher than δ1 in low‑responders (P<0.05), whereas δ2' was significantly lower than δ2 in high‑responders (P<0.01). δδ2 was significantly lower and δδ3 was significantly higher in high‑responders than in low‑responders (P<0.01 and P<0.05, respectively). Receiver operating characteristic curve showed that δδ2 and δδ3 were effective indicators of the histological therapeutic effect of NAC. In conclusion, the TDC of dynamic CECT may be useful for determining the histological therapeutic effect of NAC for PDAC.
本研究旨在探讨新辅助化疗（NAC）治疗胰腺导管腺癌（PDAC）引起的组织学变化，并展示动态对比增强 CT（CECT）时间密度曲线（TDC）在确定 NAC 治疗 PDAC 的组织学疗效中的应用。共检查了 96 例 PDAC 患者；46 例接受了 NAC（NAC 组），50 例未接受 NAC（非 NAC 组）。根据组织学治疗效果，并采用残留肿瘤面积（ART）分级系统，将 NAC 组分为低反应者和高反应者。组织学分析用于评估 NAC 组和非 NAC 组中癌细胞、癌相关成纤维细胞（CAFs）、微血管和基质胶原纤维的密度。放射学分析用于评估 NAC 组三个斜率的 TDCs，即非对比相与动脉期之间的斜率（δ1 和 δ1'）、动脉相与门静脉期之间的斜率（δ2 和 δ2'）以及门静脉相与平衡期之间的斜率（δ3 和 δ3'）。δ1-δ3 是 NAC 前，而 δ1'-δ3'是 NAC 后。NAC 前后 δ1、δ2 和 δ3 的变化分别表示为 δδ1（=δ1'-δ1）、δδ2（=δ2'-δ2）和 δδ3（=δ3'-δ3）。还对 ART 分级系统、组织学检查和放射学检查数据进行了统计学分析。组织学检查显示，NAC 后癌细胞和 CAFs 显著减少，基质胶原纤维显著增加（P<0.01）。放射学检查显示，低反应者的 δ1'明显高于 δ1（P<0.05），而高反应者的 δ2'明显低于 δ2（P<0.01）。高反应者的 δδ2 明显低于低反应者，δδ3 明显高于低反应者（P<0.01 和 P<0.05）。受试者工作特征曲线表明，δδ2 和 δδ3 是 NAC 治疗 PDAC 组织学疗效的有效指标。总之，动态 CECT 的 TDC 可能有助于确定 NAC 治疗 PDAC 的组织学疗效。
