Development of pancreatic cancer is predictable well in advance using contrast-enhanced CT: a case–cohort study
Tóm tắt
To investigate the radiological findings prognostic for the development of pancreatic adenocarcinoma in a cohort of patients with hepatocellular carcinoma, using multiphasic computed tomography (CT). A case–cohort study performed in a single university hospital. A database of patients who received hepatocellular carcinoma (HCC) treatment and trimonthly follow-up with four-phase dynamic CT was used (n = 1848). The cohort group was randomly extracted from the database (n = 103). The case group comprised nine patients from the database who developed pancreatic adenocarcinoma. The radiological findings were assessed during follow-up (average, 32 months). The incidence of pancreatic mass, inhomogeneous parenchyma, loss of fatty marbling and main pancreatic duct dilatation gradually increased from 4 to 13 months before the diagnosis of pancreatic adenocarcinoma. There was a significantly higher incidence of pancreatic mass, inhomogeneous parenchyma and loss of fatty marbling on CT at baseline (average, 34 months before diagnosis) in the case group compared with the cohort group (P values < 0.01) and those findings at baseline were revealed as prognostic factors for pancreatic carcinogenesis, respectively (log-rank test, P values < 0.001). Several radiological findings observed on multiphasic CT can assist in predicting pancreatic carcinogenesis well in advance. • Pancreatic findings in multiphasic CT help predict development of pancreatic adenocarcinoma.
• Key findings are mass, inhomogeneous parenchyma and loss of fatty marbling.
• Those findings were observed 34 months before confirmed diagnosis of adenocarcinoma.
• Those findings were prognostic factors for pancreatic carcinogenesis.
Tài liệu tham khảo
Siegel R, Ma J, Zou Z, Jemal A (2014) Cancer statistics, 2014. CA Cancer J Clin 64:9–29
Takayama S (2015) Cancer statistics in Japan '14. Foundation for Promotion of Cancer Research, Tsukiji, Japan. http://ganjoho.jp/en/professional/statistics/brochure/2014_en.html. Accessed 3 Jul 2015
Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A (2015) Global cancer statistics, 2012. CA Cancer J Clin 65:87–108
Bilimoria KY, Bentrem DJ, Ko CY et al (2007) Validation of the 6th edition AJCC Pancreatic Cancer Staging System: report from the National Cancer Database. Cancer 110:738–744
Sachs T, Pratt WB, Callery MP, Vollmer CM Jr (2009) The incidental asymptomatic pancreatic lesion: nuisance or threat? J Gastrointest Surg 13:405–415
Paspulati RM (2005) Multidetector CT of the pancreas. Radiol Clin North Am 43:999-1020, viii
Verslype C, Van Cutsem E, Dicato M et al (2007) The management of pancreatic cancer. Current expert opinion and recommendations derived from the 8th World Congress on Gastrointestinal Cancer, Barcelona, 2006. Ann Oncol 18(Suppl 7):vii1–vii10
Somers I, Bipat S (2017) Contrast-enhanced CT in determining resectability in patients with pancreatic carcinoma: a meta-analysis of the positive predictive values of CT. Eur Radiol. doi:10.1007/s00330-016-4708-5
Pelaez-Luna M, Takahashi N, Fletcher JG, Chari ST (2007) Resectability of presymptomatic pancreatic cancer and its relationship to onset of diabetes: a retrospective review of CT scans and fasting glucose values prior to diagnosis. Am J Gastroenterol 102:2157–2163
Gangi S, Fletcher JG, Nathan MA et al (2004) Time interval between abnormalities seen on CT and the clinical diagnosis of pancreatic cancer: retrospective review of CT scans obtained before diagnosis. AJR Am J Roentgenol 182:897–903
Yoon SH, Lee JM, Cho JY et al (2011) Small (</= 20 mm) pancreatic adenocarcinomas: analysis of enhancement patterns and secondary signs with multiphasic multidetector CT. Radiology 259:442–452
Ahn SS, Kim MJ, Choi JY, Hong HS, Chung YE, Lim JS (2009) Indicative findings of pancreatic cancer in prediagnostic CT. Eur Radiol 19:2448–2455
Shiina S, Tateishi R, Arano T et al (2012) Radiofrequency ablation for hepatocellular carcinoma: 10-year outcome and prognostic factors. Am J Gastroenterol 107:569–577, quiz 578
Kanda Y (2013) Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transplant 48:452–458
Ishikawa O, Ohigashi H, Imaoka S et al (1999) Minute carcinoma of the pancreas measuring 1 cm or less in diameter–collective review of Japanese case reports. Hepatogastroenterology 46:8–15
Goodman M, Willmann JK, Jeffrey RB (2012) Incidentally discovered solid pancreatic masses: imaging and clinical observations. Abdom Imaging 37:91–97
Tamada T, Ito K, Kanomata N et al (2016) Pancreatic adenocarcinomas without secondary signs on multiphasic multidetector CT: association with clinical and histopathologic features. Eur Radiol 26:646–655
Fitzgerald TL, Smith AJ, Ryan M et al (2003) Surgical treatment of incidentally identified pancreatic masses. Can J Surg 46:413–418
Loizou L, Albiin N, Leidner B et al (2016) Multidetector CT of pancreatic ductal adenocarcinoma: effect of tube voltage and iodine load on tumour conspicuity and image quality. Eur Radiol 26:4021–4029
Harinck F, Konings IC, Kluijt I et al (2015) A multicentre comparative prospective blinded analysis of EUS and MRI for screening of pancreatic cancer in high-risk individuals. Gut. doi:10.1136/gutjnl-2014-308008
Lu C, Xu CF, Wan XY, Zhu HT, Yu CH, Li YM (2015) Screening for pancreatic cancer in familial high-risk individuals: a systematic review. World J Gastroenterol 21:8678–8686
Lu DS, Vedantham S, Krasny RM, Kadell B, Berger WL, Reber HA (1996) Two-phase helical CT for pancreatic tumors: pancreatic versus hepatic phase enhancement of tumor, pancreas, and vascular structures. Radiology 199:697–701
Feig C, Gopinathan A, Neesse A, Chan DS, Cook N, Tuveson DA (2012) The pancreas cancer microenvironment. Clin Cancer Res 18:4266–4276
Tada M, Kawabe T, Arizumi M et al (2006) Pancreatic cancer in patients with pancreatic cystic lesions: a prospective study in 197 patients. Clin Gastroenterol Hepatol 4:1265–1270
Ryan DP, Hong TS, Bardeesy N (2014) Pancreatic adenocarcinoma. N Engl J Med 371:1039–1049
Berthelemy P, Bouisson M, Escourrou J, Vaysse N, Rumeau JL, Pradayrol L (1995) Identification of K-ras mutations in pancreatic juice in the early diagnosis of pancreatic cancer. Ann Intern Med 123:188–191
Hruban RH, Wilentz RE, Kern SE (2000) Genetic progression in the pancreatic ducts. Am J Pathol 156:1821–1825
Brat DJ, Lillemoe KD, Yeo CJ, Warfield PB, Hruban RH (1998) Progression of pancreatic intraductal neoplasias to infiltrating adenocarcinoma of the pancreas. Am J Surg Pathol 22:163–169
Konstantinidis IT, Warshaw AL, Allen JN et al (2013) Pancreatic ductal adenocarcinoma: is there a survival difference for R1 resections versus locally advanced unresectable tumors? What is a "true" R0 resection? Ann Surg 257:731–736
Matsumoto S, Mori H, Miyake H et al (1995) Uneven fatty replacement of the pancreas: evaluation with CT. Radiology 194:453–458
Heuck A, Maubach PA, Reiser M et al (1987) Age-related morphology of the normal pancreas on computed tomography. Gastrointest Radiol 12:18–22
Gonoi W, Akahane M, Akai H et al (2011) Retroportal main pancreatic duct with circumportal pancreas: radiographic visualization. Clin Imaging 35:442–446
Seo N, Byun JH, Kim JH et al (2015) Validation of the 2012 international consensus guidelines using computed tomography and magnetic resonance imaging: branch duct and main duct intraductal papillary mucinous neoplasms of the pancreas. Ann Surg. doi:10.1097/SLA.0000000000001217
Gonoi W, Akai H, Hagiwara K et al (2011) Pancreas divisum as a predisposing factor for chronic and recurrent idiopathic pancreatitis: initial in vivo survey. Gut 60:1103–1108
Gonoi W, Akai H, Hagiwara K et al (2012) Meandering main pancreatic duct as a relevant factor to the onset of idiopathic recurrent acute pancreatitis. PLoS One 7, e37652
Gonoi W, Akai H, Hagiwara K et al (2013) Santorinicele without pancreas divisum pathophysiology: initial clinical and radiographic investigations. BMC Gastroenterol 13:62