Prognostic significance of extracellular volume fraction with equilibrium contrast-enhanced computed tomography for pancreatic neuroendocrine neoplasms

Hiromichi Iwaya; Yoshihiko Fukukura; Shinichi Hashimoto; Shiroh Tanoue; Machiko Kawahira; Makoto Hinokuchi; Toshihiro Fujita; Yuga Komaki; Shiho Arima; Fumisato Sasaki; Shuji Kanmura; Michiyo Higashi; Kiichi Tamada; Akio Ido

doi:10.1016/j.pan.2021.02.020

Prognostic significance of extracellular volume fraction with equilibrium contrast-enhanced computed tomography for pancreatic neuroendocrine neoplasms

Pancreatology. 2021 Jun;21(4):779-786. doi: 10.1016/j.pan.2021.02.020. Epub 2021 Mar 3.

Affiliations

¹ Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City, 890-8520, Japan; Department of Gastroenterology, Jichi Medical University, 3311-1 Yakushiji, Tochigi, 329-0498, Japan. Electronic address: grentypem32@gmail.com.
² Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City, 890-8544, Japan.
³ Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City, 890-8520, Japan.
⁴ Human Pathology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City, 890-8544, Japan.
⁵ Department of Gastroenterology, Jichi Medical University, 3311-1 Yakushiji, Tochigi, 329-0498, Japan.

PMID: 33714670
DOI: 10.1016/j.pan.2021.02.020

Abstract

Background: /Objectives: Identifying reliable pretreatment imaging biomarkers for pancreatic neuroendocrine neoplasm (PanNEN) is a key imperative. Extracellular volume (ECV) fraction quantified with equilibrium contrast-enhanced CT can be easily integrated into routine examinations. This study aimed to determine whether ECV fraction with equilibrium contrast-enhanced computed tomography (CECT) could predict long-term outcomes in patients with PanNEN.

Methods: This study was a retrospective observational study of 80 patients pathologically diagnosed with PanNEN at a single institution. ECV fraction of the primary lesion was calculated using region-of-interest measurement within PanNEN and the aorta on unenhanced and equilibrium CECT. The impact of clinical factors and tumor ECV fraction on progression-free survival (PFS) and overall survival (OS) was assessed with univariate and multivariate analyses using Cox proportional hazards models. The correlation between WHO classification and tumor ECV fraction was evaluated using Kendall rank correlation coefficients.

Results: PFS and OS rates were estimated as 93.4% and 94.6%, 78.7% and 86.2%, 78.7% and 77.0%, and 78.7% and 66.6% at 1, 3, 5, and 10 years, respectively. Multivariate analysis revealed that Union for International Cancer Control (UICC) stage (hazard ratio [HR] = 3.95, P = 0.003), WHO classification (HR = 12.27, P = 0.003), and tumor ECV fraction (HR = 11.93, P = 0.039) were independent predictors of PFS. Patient age (HR = 1.11, P < 0.001), UICC stage (HR = 3.14, P = 0.001), and tumor ECV fraction (HR = 5.27, P = 0.024) were independent significant variables for predicting OS. Tumor ECV fraction had a weak inverse relationship with WHO classification (P = 0.045, τ = -0.178).

Conclusions: ECV fraction determined by equilibrium CECT and UICC stage may predict survival in patients with PanNEN.

Keywords: Computed tomography; Pancreatic neuroendocrine neoplasms; Treatment outcome; extracellular volume fraction.

Publication types

Observational Study

MeSH terms

Humans
Pancreatic Neoplasms* / diagnostic imaging
Prognosis
Proportional Hazards Models
Retrospective Studies
Tomography, X-Ray Computed*
Tumor Burden