CT imaging biomarkers predict clinical outcomes after pancreatic cancer surgery

This study aimed to determine whether changes in contrastenhanced computed tomography (CT) parameters could predict postsurgery overall and progression-free survival (PFS) in pancreatic cancer patients. Seventy-nine patients with a final pathological diagnosis of pancreatic adenocarcinoma were included in this study from June 2008 to August 2012. Dynamic contrast-enhanced (DCE) CT of tumors was obtained before curative-intent surgery. Absolute enhancement change (AEC) and relative enhancement change (REC) were evaluated on DCE-CT. PFS and overall survival (OS) were compared based on CT enhancement patterns. The markers of fibrogenic alpha-smooth muscle antigen (a-SMA) and periostin in tumor specimens were evaluated by immunohistochemical staining. The x2 test was performed to determine whether CT enhancement patterns were associated with a-SMA-periostin expression levels (recorded as positive or negative). Lower REC (<0.9) was associated with shorter PFS (HR 0.51, 95% CI: 0.31-0.89) and OS (HR 0.44, 95% CI: 0.25-0.78). The a-SMA and periostin expression level were negatively correlated with REC (both P1/40). Among several CT enhancement parameters, REC was the best predictor of patient postsurgery survival. Low REC was associated with a short progression-free time and poor survival. The pathological studies suggested that REC might be a reflection of cancer fibrogenic potential.