胰外神经丛影像特征在预测胰头导管腺癌术后早期复发中的应用价值

Value of the imaging features of extrapancreatic nerve plexus in predicting the early postoperative recurrence of ductal adenocarcinoma of pancreatic head

目的探讨术前评估胰外神经丛影像特征对预测胰头导管腺癌术后早期复发的应用价值。方法回顾性分析2014年1月至2022年4月在清华大学附属北京清华长庚医院肝胆胰中心行胰十二指肠切除术的胰头导管腺癌患者的临床、影像及病理资料。共纳入73例胰头导管腺癌患者,其中男性51例,女性22例,年龄(66.1±9.0)岁。采用门诊或电话的方式进行随访,了解复发情况,依据术后6个月内是否复发分为两组:复发组(n=26)和无复发组(n=47)。比较两组胰外神经丛走行区索条或软组织密度影、胰外神经丛走行区门静脉期CT值与动脉期CT值差值、肿瘤最大径以及区域淋巴结肿大情况。结果复发组与无复发组患者胰外神经丛走行区出现索条或软组织密度影者的比例分别为80.8%(21/26)和51.1%(24/47),胰外神经丛走行区门静脉期CT值与动脉期CT值差值≥15 HU者的比例分别为50.0%(13/26)和25.5%(12/47),肿瘤最大径≥25 mm者的比例分别为80.8%(21/26)和57.4%(27/47),区域淋巴结肿大≥3个者的比例分别为例65.4%(17/26)和31.9%(15/47),两组上述指标比较差异均具有统计学意义(均P<0.05)。胰外神经丛走行区门静脉期CT值与动脉期CT值差值≥15 HU(OR=3.609,95%CI:1.099~11.855)、区域淋巴结肿大≥3个(OR=4.665,95%CI:1.400~15.545)的胰头导管腺癌患者术后早期复发的风险升高(均P<0.05),这两个因素联合预测胰头导管腺癌术后早期复发的受试者工作特征曲线下面积为0.748,灵敏度为92.3%,特异度为48.9%(P<0.001)。结论胰外神经丛走行区门静脉期CT值与动脉期CT值差值≥15 HU、区域淋巴结肿大≥3个是预测胰头导管腺癌患者术后早期复发的独立危险因素。基于CT增强图像测量胰外神经丛走行区CT值变化结合区域淋巴结肿大情况,可为胰头导管腺癌患者提供术前预测信息。

Objective To study the value of imaging features of extrapancreatic nerve plexus in predicting early postoperative recurrence of ductal adenocarcinoma of pancreatic head.Methods The clinical,imaging and pathological data of patients with ductal adenocarcinoma of pancreatic head undergoing pancreati-coduodenectomy at the Hepatobiliary Pancreatic Center of Beijing Tsinghua Changgung Hospital,Tsinghua University from January 2014 to April 2022 were retrospectively analyzed.A total of 73 patients were included,including 51 males and 22 females,aged(66.1±9.0)years old.The patients were followed up by telephone or outpatient review,who were divided into two groups according to the recurrence within 6 months after surgery:the recurrence group(n=26)and the non-recurrence group(n=47).Streaks or soft-tissue densities in the distribution area of extrapancreatic nerve plexus,difference in CT values between the portal and arterial phases of the distribution area of extrapancreatic nerve plexus,maximum tumor diameter,and regional lymph node enlargement were compared between the two groups.Results The incidences of streaks or soft-tissue densities showing in the distribution area of extrapancreatic nerve plexus were 80.8%(21/26)in the recurrence group and 51.1%(24/47)in the non-recurrence group,respectively.A CT value difference≥15 HU between the portal and arterial phases of the distribution area of extrapancreatic nerve plexus occurred in 50.0%(13/26)patients of the recurrence group and 25.5%(27/47)of the non-recurrence group,respectively.Maximum tumor diameter≥25 mm were found in 80.8%(21/26)patients of the recurrence group and 57.4%(27/47)of the non-recurrence group,respectively.≥3 reginal lymph node enlargement showed in 65.4%(17/26)patients of the recurrence group and 31.9%(15/47)of the non-recurrence group,respectively(all P<0.05).The risk of early postoperative recurrence increased in patients with a CT value difference≥15 HU between the portal and arterial phases of the distribution area of extrapancreatic nerve plexus(OR=3.609,95%CI:1.099-11.855),and regional lymph node enlargement≥3(OR=4.665,95%CI:1.400-15.545)(all P<0.05).And these two independent risk factors were combined to predict early postoperative recurrence of ductal adenocarcinoma of pancreatic head with an area under receiver operating characteristic curve of 0.748,sensitivity of 92.3%,and specificity of 48.9%(P<0.001).Conclusion≥15 HU CT value difference between the portal and arterial phases of the distribution area of extrapancreatic nerve plexus and≥3 regional lymph node enlargement are independent risk factors for the early postoperative recurrence of pancreatic head ductal adenocarcinoma,which could provide more predictive information preoperatively.