Survival Prediction after Curative Resection of Pancreatic Ductal Adenocarcinoma by Imaging-Based Intratumoral Necrosis

SIMPLE SUMMARY: The histopathological characteristics and prognostic effects of intratumoral necrosis in pancreatic ductal adenocarcinoma (PDAC) observed on computed tomography (CT) or magnetic resonance imaging (MRI) are not well known.

This study aimed to determine the histopathological characteristics and prognosis of curatively resected PDAC showing intratumoral necrosis on preoperative CT or MRI.

This study consecutively included 102 patients who underwent upfront surgery with margin-negative resection from 2012 to 2020.

All patients underwent both pancreatic CT and MRI within 1 month before surgery.

PDACs with CT- or MRI-detected necrosis demonstrated a significantly higher degree of histopathological necrosis than those without.

Moreover, PDACs with CT- or MRI-detected necrosis were characterized by aggressive histologic tumor grades, higher tumor cellularity, and less frequent remaining acini.

Multivariable analysis revealed that only MRI-detected necrosis was significantly associated with overall survival, and therefore MRI-detected necrosis might be a potential imaging predictor of poor survival after curative resection of PDAC.

ABSTRACT: We aimed to determine the histopathological characteristics and prognosis of curatively resected pancreatic ductal adenocarcinoma (PDAC) showing intratumoral necrosis on preoperative CT or MRI.

This study consecutively included 102 patients who underwent upfront surgery with margin-negative resection from 2012 to 2020.

All patients underwent both pancreatic CT and MRI within 1 month before surgery.

Two radiologists independently assessed CT/MRI findings, including the presence of CT- and MRI-detected necrosis.

Histopathological characteristics of PDACs according to CT or MRI detection of necrosis were evaluated.

Disease-free survival (DFS) and overall survival (OS) were assessed by the Kaplan–Meier method and the Cox proportional hazards model.

Among the 102 PDAC patients, 14 patients (13.7%) had CT-detected necrosis, and 16 patients (15.7%) had MRI-detected necrosis, of which 9 showed both CT- and MRI-detected necrosis.

PDACs with CT- or MRI-detected necrosis demonstrated a significantly higher degree of histopathological necrosis than those without (p < 0.001).

Multivariable analysis revealed that tumor size (hazard ratio [HR], 1.19; p = 0.040), tumor location (HR, 0.46; p = 0.009), and MRI-detected necrosis (HR, 2.64; p = 0.002) had independent associations with DFS.

Only MRI-detected necrosis was significantly associated with OS (HR, 2.59; p = 0.004).

Therefore, MRI-detected necrosis might be a potential imaging predictor of poor survival after curative resection of PDAC.