Prognostic Impact of Portal System Invasion in Pancreatic Cancer Based on Image Classification

Area of Science:

• Oncology
• Radiology
• Surgical Pathology

Background:

• Pancreatic cancer (PC) prognosis is significantly influenced by the extent of portal system invasion (PSI).
• Accurate assessment of PSI is crucial for treatment planning and predicting outcomes in PC patients undergoing surgery.

Purpose of the Study:

• To determine the correlation between imaging-based classification of portal system invasion and its pathological grade in pancreatic cancer.
• To evaluate the prognostic significance of imaging-defined portal vein (PV) and splenic vein (SPV) invasion for patient survival.

Main Methods:

• Retrospective analysis of 244 pancreatic head and 80 body/tail cancer resections.
• Classification of PV invasion (types A-D) and SPV invasion (types α-γ) based on imaging findings.
• Correlation of imaging classification with pathological venous invasion grades (0-3).

Main Results:

• Significant correlation observed between imaging classification and pathological grade for both PV (ρ = 0.696) and SPV (ρ = 0.681) invasion.
• Patients with PV invasion beyond type B showed significantly poorer survival (P < 0.0001) compared to type A.
• No significant survival difference was found among SPV invasion types α, β, and γ.

Conclusions:

• Imaging classification of PSI aligns well with pathological staging in pancreatic cancer.
• Imaging-based classification of portal vein invasion serves as a reliable prognostic marker for pancreatic cancer survival.
• The prognostic value of imaging classification for splenic vein invasion requires further investigation.