Three-dimensional remnant pancreatic volumetry as an indicator of poor prognosis in pancreatic cancer patients after pancreatoduodenectomy

Date 24 November 2018
Event ESMO Asia 2018 Congress
Session Poster display - Cocktail
Topics Imaging
Surgical Oncology
Pancreatic Cancer
Presenter Ryoichi Miyamoto
Citation Annals of Oncology (2018) 29 (suppl_9): ix46-ix66. 10.1093/annonc/mdy432
Authors R. Miyamoto1, N. Sano2, M. Maeda2, S. Inagawa2
  • 1Department Of Gastroenterological Surgery, Tsukuba Medical Center Hospital, 305-8558 - Tsukuba/JP
  • 2Department Of Gastroenterological Surgery, Tsukuba Medical Center Hospital, 3058558 - Tsukuba/JP

Abstract

Background

Pancreatic cancer is still refractory to treatment, which has a 5-year survival rate of 5-7%. Recent studies suggest that remnant pancreatic volume (RPV) values from preoperative multidetector computed tomography (MDCT) are highly prognosis factors for resectable pancreatic cancer patients. We performed three-dimensional (3D) surgical simulation of pancreatoduodenectomy (PD) including measurement of the RPV value. Here, we address whether 3D-measured RPV is a prognostic marker in pancreatic cancer patients after PD by comparing various patient-, pancreas- and surgery-related prognostic factors in a retrospective cohort.

Methods

We used the SYNAPSE VINCENT® medical imaging system (Fujifilm Medical Co., Ltd., Tokyo, Japan) to construct 3D images from integrating MDCT and magnetic Resonance cholangiopancreatography (MRCP) images. The RPV value was measured by this 3D image which simulated actual intraoperative pancreatic parenchymal remnant volume. Ninety-one patients who underwent PD were retrospectively enrolled. We divided the cohort into high- and low-RPV groups based on receiver operating characteristic curve analysis cut-off values (> 34.5cm3, n = 35 and ≤ 34.5cm3, n = 56, respectively). The patient characteristics and median survival times (MSTs) were respectively compared between the two groups. Using multivariate analysis, the RPV value and other well-known prognostic factors were independently assessed.

Results

MSTs (days) significantly differed according to the RPV value (high, 816 vs. low, 484, p < 0.01). Multivariate analysis identified the RPV value (hazard ratio [HR], 3.01; p = 0.04), Glasgow Prognostic Score (GPS) (HR, 1.53; p = 0.01), and presence of stage III/IV disease (HR, 8.48; p < 0.01), or postoperative complications (HR, 2.69; p < 0.01) as independent prognostic factors.

Conclusions

The preoperative 3D-measured RPV is an additional useful prognostic marker in pancreatic cancer patients after PD.

Editorial acknowledgement

Clinical trial identification

Legal entity responsible for the study

The Ethics Committee of the Tsukuba Medical Center Hospital approved this study (#2018-010).

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.