1. Predicting Recurrence-Free Survival After Upfront Surgery in Resectable Pancreatic Ductal Adenocarcinoma: A Preoperative Risk Score Based on CA 19-9, CT, and 18 F-FDG PET/CT.
- Author
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Jeong B, Oh M, Lee SS, Kim N, Kim JS, Lee W, Kim SC, Kim HJ, Kim JH, and Byun JH
- Subjects
- Humans, Male, Female, Middle Aged, Aged, Retrospective Studies, Tomography, X-Ray Computed methods, Neoplasm Recurrence, Local diagnostic imaging, Risk Assessment, Disease-Free Survival, Predictive Value of Tests, Fluorodeoxyglucose F18, Positron Emission Tomography Computed Tomography methods, Carcinoma, Pancreatic Ductal diagnostic imaging, Carcinoma, Pancreatic Ductal surgery, Carcinoma, Pancreatic Ductal pathology, Carcinoma, Pancreatic Ductal mortality, Pancreatic Neoplasms diagnostic imaging, Pancreatic Neoplasms surgery, Pancreatic Neoplasms pathology, Pancreatic Neoplasms mortality, Radiopharmaceuticals, CA-19-9 Antigen blood
- Abstract
Objective: To develop and validate a preoperative risk score incorporating carbohydrate antigen (CA) 19-9, CT, and fluorine-18-fluorodeoxyglucose (
18 F-FDG) PET/CT variables to predict recurrence-free survival (RFS) after upfront surgery in patients with resectable pancreatic ductal adenocarcinoma (PDAC)., Materials and Methods: Patients with resectable PDAC who underwent upfront surgery between 2014 and 2017 (development set) or between 2018 and 2019 (test set) were retrospectively evaluated. In the development set, a risk-scoring system was developed using the multivariable Cox proportional hazards model, including variables associated with RFS. In the test set, the performance of the risk score was evaluated using the Harrell C-index and compared with that of the postoperative pathological tumor stage., Results: A total of 529 patients, including 335 (198 male; mean age ± standard deviation, 64 ± 9 years) and 194 (103 male; mean age, 66 ± 9 years) patients in the development and test sets, respectively, were evaluated. The risk score included five variables predicting RFS: tumor size (hazard ratio [HR], 1.29 per 1 cm increment; P < 0.001), maximal standardized uptake values of tumor ≥ 5.2 (HR, 1.29; P = 0.06), suspicious regional lymph nodes (HR, 1.43; P = 0.02), possible distant metastasis on18 F-FDG PET/CT (HR, 2.32; P = 0.03), and CA 19-9 (HR, 1.02 per 100 U/mL increment; P = 0.002). In the test set, the risk score showed good performance in predicting RFS (C-index, 0.61), similar to that of the pathologic tumor stage (C-index, 0.64; P = 0.17)., Conclusion: The proposed risk score based on preoperative CA 19-9, CT, and18 F-FDG PET/CT variables may have clinical utility in selecting high-risk patients with resectable PDAC., Competing Interests: Seung Soo Lee, who holds the respective position of Editorial Board Member of the Korean Journal of Radiology, was not involved in the editorial evaluation or decision to publish this article. The remaining author has declared no conflicts of interest., (Copyright © 2024 The Korean Society of Radiology.)- Published
- 2024
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