利用术前对比增强磁共振成像和临床特征识别SMAD4突变型胰腺导管腺癌

Identification of SMAD4-mutated pancreatic ductal adenocarcinoma using preoperative contrast-enhanced MRI and clinical characteristics.

作者信息

Li Zhina, Wang Cheng, Li Jianbo, Wang Xingxing, Li Xiang, Yu Tianzhu, Zhou Jianjun, Wang Xiaolin, Zeng Mengsu, Sun Haitao

机构信息

Department of Radiology, Zhongshan Hospital, Shanghai Institute of Medical Imaging, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.

Department of Radiology, Linyi Centra Hospital, No.17 Jiankang Road, Linyi City, Shandong Province, 276400, China.

出版信息

BMC Med Imaging. 2024 Dec 23;24(1):349. doi: 10.1186/s12880-024-01539-3.

DOI:10.1186/s12880-024-01539-3

PMID:39716095

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11667844/

Abstract

AIM

To assess the value of preoperatively contrast-enhanced MRI and clinical characteristics for identification of SMAD4-mutated pancreatic ductal adenocarcinoma (PDAC) patients.

MATERIALS AND METHODS

This retrospective study included patients with surgically confirmed PDAC from January 2016 to December 2022. Based on immunostaining results indicating the mutation of SMAD4, the enrolled participants were grouped into SMAD4-mutated PDAC and non-SMAD4-mutated PDAC. Contrast-enhanced MRI findings, clinical-pathological characteristics, and prognosis were recorded and reviewed. The pathological findings and clinical prognosis were compared between the two groups. Uni- and multivariable logistic regression analyses were further performed to determine the radiological and clinical predictive factors for the mutation of SMAD4.

RESULTS

In total, 428 PDAC patients were enrolled and analyzed, who were grouped as SMAD4-mutated PDAC (n = 224) and non-SMAD4-mutated PDAC (n = 204). SMAD4-mutated PDAC demonstrated higher frequency of pathological fatty infiltration (83.4% vs. 74.2%, P = 0.016), peripheral nerve infiltration (84.4% vs. 76.5%, P = 0.039). and higher recurrence rates (43.6% vs. 58.9%, P = 0.045) than non-SMAD4-mutated PDAC. The 3-year recurrence-free survival rates were worse for SMAD4-mutated PDAC (28.7% vs. 39.1%). In multivariable logistic regression analyses, CA19-9 > 100 U/mL (odds ratio [OR] = 1.519, P = 0.041), CBD dilation (OR = 1.564, P = 0.036), and rim enhancement (OR = 1.631, P = 0.025) were independent predictive factors.

CONCLUSION

Rim enhancement, CBD dilation on contrast-enhanced MRI and higher CA19-9 level are promising radiological and clinical factors for identifying SMAD4-mutated PDAC.

摘要

目的

评估术前对比增强磁共振成像（MRI）及临床特征在识别SMAD4基因变异的胰腺导管腺癌（PDAC）患者中的价值。

材料与方法

本回顾性研究纳入了2016年1月至2022年12月期间手术确诊的PDAC患者。根据免疫染色结果是否显示SMAD4基因变异，将纳入的参与者分为SMAD4基因变异的PDAC组和非SMAD4基因变异的PDAC组。记录并回顾对比增强MRI表现、临床病理特征及预后情况。比较两组之间的病理结果及临床预后。进一步进行单因素和多因素逻辑回归分析，以确定SMAD4基因变异的影像学及临床预测因素。

结果

共纳入并分析了428例PDAC患者，分为SMAD4基因变异的PDAC组（n = 224）和非SMAD4基因变异的PDAC组（n = 204）。SMAD4基因变异的PDAC患者病理脂肪浸润发生率更高（83.4% 对74.2%，P = 0.016），周围神经浸润发生率更高（84.4% 对76.5%，P = 0.039），复发率也更高（43.6% 对58.9%，P = 0.045）。SMAD4基因变异的PDAC患者3年无复发生存率更差（28.7% 对39.1%）。在多因素逻辑回归分析中，CA19-9 > 100 U/mL（比值比[OR]=1.519，P = 0.041）、胆总管扩张（OR = 1.564，P = 0.036）及边缘强化（OR = 1.631，P = 0.025）是独立预测因素。