Extracellular volume fraction determined by equilibrium contrast-enhanced multidetector computed tomography as a prognostic factor in unresectable pancreatic adenocarcinoma treated with chemotherapy
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To assess whether extracellular volume (ECV) fraction with equilibrium contrast-enhanced multidetector computed tomography (MDCT) predicts outcomes for unresectable pancreatic adenocarcinoma patients treated with chemotherapy
Sixty-seven patients (42 men, 25 women; mean age, 67.5 years; range, 45–83 years) with histologically confirmed surgically unresectable pancreatic adenocarcinoma underwent contrast-enhanced MDCT before systemic chemotherapy. Tumour contrast enhancement (CE) and ECV fraction were calculated using region-of-interest measurement within the pancreatic adenocarcinoma and aorta on unenhanced and equilibrium phase-enhanced CT. The effect on survival variables including age, sex, tumour location, tumour size, TNM stage, carbohydrate antigen (CA) 19-9, carcinoembryonic antigen (CEA), tumour CE and tumour ECV fraction was determined on univariate and multivariate analyses using Cox proportional hazards regression model.
Median overall survival was 10.5 months. On univariate analysis, elevated serum CA19-9 (hazard ratio (HR), 1.00; p = 0.006) and CEA (HR, 1.02; p = 0.011) levels were found to be associated with a negative effect on overall survival. Increasing tumour CE (HR, 0.98; p < 0.001) and ECV fraction (HR, 0.97; p = 0.001) were associated with a positive effect. Multivariate analysis revealed that only tumour ECV fraction was an independent predictor of overall survival (HR, 0.97; p = 0.012).
ECV fraction with equilibrium contrast-enhanced MDCT could be a useful imaging biomarker for predicting patient survival after chemotherapy for unresectable pancreatic adenocarcinoma.
• Tumour aggressiveness and response to therapy are influenced by the extravascular extracellular space.
• Extracellular volume (ECV) fraction can be quantified with equilibrium contrast-enhanced CT.
• Patients with higher tumour ECV fraction had better prognosis after chemotherapy.
KeywordsPancreas cancer Multidetector computed tomography Contrast media Extracellular space Treatment outcome
18F-Fluorodeoxyglucose positron emission tomography
Intraclass correlation coefficient
Multidetector computed tomography
Regions of interest
International Union Against Cancer
We thank Dr. Chihaya Koriyama for help with statistical analysis.
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Yoshihiko Fukukura MD, PhD.
Conflict of interest
The authors of this article declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was waived by the Institutional Review Board.
Institutional Review Board approval was obtained.
• diagnostic or prognostic study
• performed at one institution
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