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Toesca DAS, Susko M, von Eyben R, Baclay JRM, Pollom EL, Jeffrey RB, Poullos PD, Poultsides GA, Fisher GA, Visser BC, Koong AC, Feng M, Chang DT. Validation of a Resectability Scoring System for Prediction of Pancreatic Adenocarcinoma Surgical Outcomes. Ann Surg Oncol 2023; 30:3479-3488. [PMID: 36792768 DOI: 10.1245/s10434-023-13120-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/02/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND The most used pancreatic cancer (PC) resectability criteria are descriptive in nature or based solely on dichotomous degree of involvement (< 180° or > 180°) of vessels, which allows for a high degree of subjectivity and inconsistency. METHODS Radiographic measurements of the circumferential degree and length of tumor contact with major peripancreatic vessels were retrospectively obtained from pre-treatment multi-detector computed tomography (MDCT) images from PC patients treated between 2001 and 2015 at two large academic institutions. Arterial and venous scores were calculated for each patient, then tested for a correlation with tumor resection and R0 resection. RESULTS The analysis included 466 patients. Arterial and venous scores were highly predictive of resection and R0 resection in both the training (n = 294) and validation (n = 172) cohorts. A recursive partitioning tree based on arterial and venous score cutoffs developed with the training cohort was able to stratify patients of the validation cohort into discrete groups with distinct resectability probabilities. A refined recursive partitioning tree composed of three resectability groups was generated, with probabilities of resection and R0 resection of respectively 94 and 73% for group A, 61 and 35% for group B, and 4 and 2% for group C. This resectability scoring system (RSS) was highly prognostic, predicting median overall survival times of 27, 18.9, and 13.5 months respectively for patients in RSS groups A, B, and C (p < 0.001). CONCLUSIONS The proposed RSS was highly predictive of resection, R0 resection, and prognosis for patients with PC when tested against an external dataset.
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Affiliation(s)
- Diego A S Toesca
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Matthew Susko
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Rie von Eyben
- Department of Radiation Oncology, Stanford Cancer Institute, 875 Blake Wilbur Drive MC5847, Stanford, CA, 94305, USA
| | - J Richelsyn M Baclay
- Department of Radiation Oncology, Stanford Cancer Institute, 875 Blake Wilbur Drive MC5847, Stanford, CA, 94305, USA
| | - Erqi L Pollom
- Department of Radiation Oncology, Stanford Cancer Institute, 875 Blake Wilbur Drive MC5847, Stanford, CA, 94305, USA
| | - R Brooke Jeffrey
- Department of Radiology, Stanford Cancer Institute, Stanford, CA, USA
| | - Peter D Poullos
- Department of Radiology, Stanford Cancer Institute, Stanford, CA, USA
| | | | - George A Fisher
- Department of Medical Oncology, Stanford Cancer Institute, Stanford, CA, USA
| | - Brendan C Visser
- Department of Surgery, Stanford Cancer Institute, Stanford, CA, USA
| | - Albert C Koong
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mary Feng
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Daniel T Chang
- Department of Radiation Oncology, Stanford Cancer Institute, 875 Blake Wilbur Drive MC5847, Stanford, CA, 94305, USA. .,Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
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