Liu Wei, Chen Yi, Xie Tiansong, Zhang Zehua, Wang Yu, Xie Xuebin, Chen Lei, Zhou Zhengrong
Department of Radiology, Fudan University Shanghai Cancer Center & Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
Shanghai Institute of Medical Imaging, Shanghai, 200032, China.
Eur Radiol. 2025 Mar;35(3):1451-1463. doi: 10.1007/s00330-024-11330-1. Epub 2025 Feb 8.
Tumor collagen is vital in chemotherapy resistance of pancreatic cancer (PC), but its non-invasive evaluation remains challenging. This study aims to investigate the association of variables derived from dual-energy CT with the collagen ratio (CR) of PC and to determine the prognostic value of CR in unresectable diseases.
A total of 83 patients with resected PC and 71 patients with unresectable PC were enrolled. In the resected group, the correlation between the tumor CR and variables of dual-energy CT was analyzed. In the unresectable group, Cox regression analyses were conducted to investigate the prognostic value of dual-energy CT-predicted CR and other clinicoradiological indicators.
The patients with resected PC were divided into low and high-CR sets with a threshold of 55%. In the resected group, the extracellular volume fraction calculated by the iodine concentration (ECV_IC) was the only predictor of tumor CR according to univariate and multivariate analysis (hazard ratio [HR] (95% confidence interval [CI]):1.19 [1.03-1.37]). The correlation coefficient r was 0.26 (p = 0.02) between ECV_IC and specific CR values. In the training set of unresectable PC group, ECV_IC (HR (95% CI): 0.94 (0.89-0.99), p = 0.03) and contrast-enhanced pattern (CEP) (HR (95% CI): 3.20 (1.41-7.27), p = 0.01) were independent prognostic factors for overall survival. The nomogram model was constructed and showed a good performance.
The ECV_IC is a non-invasive indicator of tumor CR in PC. The ECV_IC and CEP have the potential to predict the prognosis of unresectable PC.
Question Non-invasive evaluation of tumor collagen, a vital determinant of chemotherapy resistance of pancreatic cancer, remains challenging. Findings Tumor collagen ratio can be noninvasively predicted by extracellular volume fraction based on iodine concentration. Clinical relevance The nomogram model composed of extracellular volume fraction and contrast-enhanced pattern can serve as an effective and convenient tool for stratifying the prognosis of patients with unresectable pancreatic cancer.
肿瘤胶原蛋白在胰腺癌（PC）的化疗耐药中至关重要，但其非侵入性评估仍具有挑战性。本研究旨在探讨双能CT衍生变量与PC胶原蛋白比率（CR）之间的关联，并确定CR在不可切除疾病中的预后价值。
共纳入83例接受手术切除的PC患者和71例不可切除的PC患者。在手术切除组中，分析肿瘤CR与双能CT变量之间的相关性。在不可切除组中，进行Cox回归分析以研究双能CT预测的CR和其他临床放射学指标的预后价值。
接受手术切除的PC患者根据阈值55%分为低CR组和高CR组。在手术切除组中，根据单因素和多因素分析，由碘浓度计算的细胞外体积分数（ECV_IC）是肿瘤CR的唯一预测因子（风险比[HR]（95%置信区间[CI]）：1.19[1.03 - 1.37]）。ECV_IC与特定CR值之间的相关系数r为0.26（p = 0.02）。在不可切除PC组的训练集中，ECV_IC（HR（95%CI）：0.94（0.89 - 0.99），p = 0.03）和增强模式（CEP）（HR（95%CI）：3.20（1.41 - 7.27），p = 0.01）是总生存的独立预后因素。构建了列线图模型并显示出良好的性能。
ECV_IC是PC中肿瘤CR的非侵入性指标。ECV_IC和CEP有预测不可切除PC预后的潜力。
问题 肿瘤胶原蛋白的非侵入性评估是胰腺癌化疗耐药的重要决定因素，仍然具有挑战性。发现 肿瘤胶原蛋白比率可通过基于碘浓度的细胞外体积分数进行非侵入性预测。临床意义 由细胞外体积分数和增强模式组成的列线图模型可作为对不可切除胰腺癌患者预后分层的有效且便捷的工具。
