Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa- gu, Seoul, 05505, Republic of Korea.
Department of Radiology, Inje University Haeundae Paik Hospital, Busan, 48108, Republic of Korea.
Abdom Radiol (NY). 2024 Aug;49(8):2737-2745. doi: 10.1007/s00261-024-04299-4. Epub 2024 May 28.
The purpose of this study was to compare the different versions of the National Comprehensive Cancer Network (NCCN) guidelines for defining resectability of pancreatic ductal adenocarcinoma (PDAC) in predicting margin-negative (R0) resection, and to assess inter-reader agreement.
This retrospective study included 283 patients (mean age, 65.1 years ± 9.4 [SD]; 155 men) who underwent upfront pancreatectomy for PDAC between 2017 and 2019. Two radiologists independently determined the resectability on preoperative CT according to the 2017, 2019, and 2020 NCCN guidelines. The sensitivity and specificity for R0 resection were analyzed using a multivariable logistic regression analysis with generalized estimating equations. Inter-reader agreement was assessed using kappa statistics.
R0 resection was accomplished in 239 patients (84.5%). The sensitivity and specificity averaged across two readers were, respectively, 76.6% and 29.5% for the 2020 guidelines, 74.1% and 32.9% for the 2019 guidelines, and 72.6% and 34.1% for the 2017 guidelines. Compared with the 2020 guidelines, both 2019 and 2017 guidelines showed significantly lower sensitivity for R0 resection (p ≤ .009). Specificity was significantly higher with the 2017 guidelines (p = .043) than with the 2020 guidelines. Inter-reader agreements for determining the resectability of PDCA were strong (k ≥ 0.83) with all guidelines, being highest with the 2020 guidelines (k = 0.91).
The 2020 NCCN guidelines showed significantly higher sensitivity for prediction of R0 resection than the 2017 and 2019 guidelines.
本研究旨在比较美国国家综合癌症网络（NCCN）指南的不同版本在预测胰腺导管腺癌（PDAC）切缘阴性（R0）切除方面对可切除性的定义，并评估读者间的一致性。
本回顾性研究纳入了 2017 年至 2019 年间接受 PDAC 初始胰腺切除术的 283 例患者（平均年龄 65.1 岁±9.4[SD]；男性 155 例）。两名放射科医生根据 2017 年、2019 年和 2020 年 NCCN 指南，独立在术前 CT 上判断可切除性。采用广义估计方程的多变量逻辑回归分析评估 R0 切除的敏感性和特异性。采用 Kappa 统计评估读者间的一致性。
239 例（84.5%）患者达到了 R0 切除。两位读者的平均敏感性和特异性分别为 2020 年指南的 76.6%和 29.5%、2019 年指南的 74.1%和 32.9%以及 2017 年指南的 72.6%和 34.1%。与 2020 年指南相比，2019 年和 2017 年指南的 R0 切除敏感性显著降低（p≤.009）。2017 年指南的特异性显著高于 2020 年指南（p=0.043）。所有指南的 PDCA 可切除性判断的读者间一致性均较强（k≥0.83），其中以 2020 年指南最高（k=0.91）。
与 2017 年和 2019 年指南相比，2020 年 NCCN 指南对 R0 切除的预测具有更高的敏感性。
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