Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Brain Korea 21 Project, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Eur J Surg Oncol. 2024 Sep;50(9):108494. doi: 10.1016/j.ejso.2024.108494. Epub 2024 Jun 20.
Determination of vessel resection in patients with pancreatectomy after neo-adjuvant chemotherapy remains controversial. The recently introduced computed tomography-based vascular burden index presents a potential solution to this challenge. This study aimed to evaluate the model performance for the prediction of vascular resection and pathological invasion.
Patients who underwent surgery after neo-adjuvant chemotherapy were included. Two independent reviewers measured the vascular tumour burden index around the adjacent artery (AVBI), and vein (VVBI). The area under the curve was compared to assess the predictive capacity of vascular burden index values and their changes for vascular resection and pathological vascular invasion.
Among 252 patients, 179 and 73 had borderline resectable and locally advanced pancreatic cancer, respectively. Concurrent vessel resection and pathological vascular invasion were observed in 121 (48.0 %) and 42 (16.6 %) patients, respectively. In all patients, the VVBI (area under the curve: 0.872) and AVBI (0.911) after neo-adjuvant therapy significantly predicted vessel resection. In patients with vascular resection, the VVBI after neo-adjuvant chemotherapy (0.752) and delta value of the AVBI (0.706) demonstrated better performance for predicting pathological invasion of the resected vein. The regression of the AVBI and VVBI was an independent prognostic factor for survival (hazard ratio: 0.54, 95 % confidence interval: 0.34-0.85; P = 0.009) CONCLUSIONS: Regressed VVBI on serial computed tomography scans is useful for predicting vein resection and pathological venous invasion before surgery. The delta value of the AVBI may therefore be helpful for predicting pathological arterial invasion after neo-adjuvant chemotherapy.
新辅助化疗后行胰切除术时确定血管切除范围仍存在争议。最近提出的基于 CT 的血管负荷指数为解决这一挑战提供了一种潜在的解决方案。本研究旨在评估该模型预测血管切除和病理侵犯的性能。
纳入接受新辅助化疗后手术的患者。两名独立的评估者测量了毗邻动脉（AVBI）和静脉（VVBI）周围的血管肿瘤负荷指数。比较曲线下面积以评估血管负荷指数值及其变化对血管切除和病理血管侵犯的预测能力。
在 252 例患者中，179 例和 73 例分别为边界可切除和局部晚期胰腺癌。121 例（48.0%）和 42 例（16.6%）患者同时行血管切除和病理血管侵犯。在所有患者中，新辅助治疗后的 VVBI（曲线下面积：0.872）和 AVBI（0.911）均能显著预测血管切除。在接受血管切除的患者中，新辅助化疗后 VVBI（0.752）和 AVBI 差值（0.706）在预测切除静脉的病理侵犯方面表现更好。AVBI 和 VVBI 的消退是生存的独立预后因素（风险比：0.54，95%置信区间：0.34-0.85；P=0.009）。
系列 CT 扫描上的 VVBI 消退可用于预测手术前静脉切除和病理静脉侵犯。因此，AVBI 的差值可能有助于预测新辅助化疗后动脉侵犯的病理情况。
