Dynamic contrast-enhanced CT-derived extracellular volume fraction for predicting postoperative oncologic outcomes in pancreatic ductal adenocarcinoma

To evaluate the prognostic value of the extracellular volume fraction (fECV) derived from contrast-enhanced computed tomography (CE-CT) for recurrence-free survival (RFS) and overall survival (OS) rates after pancreatic ductal adenocarcinoma (PDAC) surgery. This retrospective study evaluated 71 patients diagnosed with PDAC postsurgery who underwent CE-CT with precontrast and equilibrium phases before neoadjuvant chemotherapy (35 males, 36 females; mean age, 70.3 years; 95 % CI, 68.1-72.6; SD, 9.8; range, 45-89 years), were enrolled. Noncancerous pancreatic parenchyma and pancreatic tumors were automatically segmented from nonenhanced and equilibrium-phase images, excluding focal lesions, major-vessel, and ducts. Uni- and multivariate analyses (Cox proportional hazards model) were performed to evaluate fECV [=(100 - hematocrit) × (ΔPancreas/ΔAorta] in the nonaffected pancreas and tumor, with age, sex, chemotherapeutic scheme, tumor marker/location/size, stage, histological type, RFS, and OS as factors. Time-dependent receiver-operating characteristic curves showed the optimal fECV cutoff values for predicting RFS and OS. Adjuvant chemotherapy regimen, histological type, and fECV of noncancerous pancreatic parenchyma were independent prognostic factors of OS (p < 0.001, 0.049, and 0.018, respectively), and TNM stage (IB) was an independent predictor of RFS (p = 0.025). RFS and OS were worse in patients with noncancerous pancreatic tissue with higher fECV than in those with lower fECV (optimal cutoffs: 40.32 % for RFS, p = 0.036; 43.65 % for OS, p < 0.001). The fECV of noncancerous pancreatic parenchyma from CE-CT was a significant predictor of survival outcomes in PDAC.