目的:开发并验证结合糖类抗原(CA)19-9、CT、和氟-18-氟脱氧葡萄糖(18F-FDG)PET/CT变量可预测可切除的胰腺导管腺癌(PDAC)患者的前期手术后的无复发生存率(RFS)。
方法:回顾性评估2014年至2017年(开发集)或2018年至2019年(测试集)接受前期手术的可切除PDAC患者。在开发集中,使用多变量Cox比例风险模型开发了风险评分系统,包括与RFS相关的变量。在测试集中,使用HarrellC指数评估风险评分的表现,并与术后病理肿瘤分期进行比较。
结果:共有529名患者,包括335(198名男性;平均年龄±标准差,64±9岁)和194(103名男性;平均年龄,66±9岁)开发和测试集中的患者,分别,进行了评估。风险评分包括预测RFS的五个变量:肿瘤大小(风险比[HR],每1厘米增加1.29;P<0.001),肿瘤的最大标准化摄取值≥5.2(HR,1.29;P=0.06),可疑区域淋巴结(HR,1.43;P=0.02),18F-FDGPET/CT可能的远处转移(HR,2.32;P=0.03),和CA19-9(HR,每100U/mL增量1.02;P=0.002)。在测试集中,风险评分在预测RFS方面表现良好(C指数,0.61),与病理肿瘤分期相似(C指数,0.64;P=0.17)。
结论:基于术前CA19-9,CT,和18F-FDGPET/CT变量在选择可切除PDAC的高危患者中可能具有临床实用性。
OBJECTIVE: To develop and validate a preoperative risk score incorporating carbohydrate antigen (CA) 19-9, CT, and fluorine-18-fluorodeoxyglucose (18F-FDG) PET/CT variables to predict recurrence-free survival (RFS) after upfront surgery in patients with resectable pancreatic ductal adenocarcinoma (PDAC).
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 on 18F-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).
CONCLUSIONS: The proposed risk score based on preoperative CA 19-9, CT, and 18F-FDG PET/CT variables may have clinical utility in selecting high-risk patients with resectable PDAC.