Comparison of the different versions of NCCN guidelines for predicting margin-negative resection of pancreatic cancer in patients undergoing upfront surgery

Eun Joo Park ^1,2, Jong Keon Jang ¹, Jae Ho Byun ³

⁰Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa- gu, Seoul, 05505, Republic of Korea.

Abdominal Radiology (new York) +

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May 27, 2024

View abstract on PubMed

Summary

The 2020 National Comprehensive Cancer Network (NCCN) guidelines demonstrated superior sensitivity in predicting margin-negative (R0) resection for pancreatic cancer compared to earlier versions. Inter-reader agreement remained strong across all guideline versions evaluated.

Area Of Science

Oncology
Radiology
Surgical Oncology

Background

Pancreatic ductal adenocarcinoma (PDAC) resectability is crucial for patient outcomes.
National Comprehensive Cancer Network (NCCN) guidelines evolve to improve surgical planning.
Accurate prediction of margin-negative (R0) resection impacts treatment strategies.

Purpose Of The Study

To compare NCCN guideline versions (2017, 2019, 2020) for PDAC resectability assessment.
To evaluate the predictive accuracy of these guidelines for achieving R0 resection.
To assess inter-reader agreement among radiologists using different NCCN guideline versions.

Main Methods

Retrospective analysis of 283 patients undergoing upfront pancreatectomy for PDAC (2017-2019).
Independent radiologist assessment of resectability on preoperative CT using 2017, 2019, and 2020 NCCN guidelines.
Sensitivity, specificity, and inter-reader agreement (kappa statistics) were calculated for R0 resection prediction.

Main Results

R0 resection was achieved in 84.5% of patients.
The 2020 NCCN guidelines showed the highest sensitivity (76.6%) for predicting R0 resection.
While sensitivity increased with newer guidelines, specificity was highest with the 2017 guidelines (34.1%).
Inter-reader agreement was strong (kappa ≥ 0.83) for all guideline versions, highest with the 2020 version (kappa = 0.91).

Conclusions

The 2020 NCCN guidelines offer improved sensitivity for predicting R0 resection in PDAC compared to 2017 and 2019 versions.
Radiologists demonstrated strong agreement in assessing PDAC resectability across guideline versions.
Updated NCCN guidelines may enhance preoperative planning for pancreatic cancer surgery.

Keywords:

Computed tomography Pancreatectomy Pancreatic ductal carcinoma Tumor staging