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Published on: February 1, 2020
MRI-based risk stratification for predicting overall survival in pancreatic ductal adenocarcinoma
Haitao Sun1,2, Jianbo Li1, Lei Li3
1Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
Purpose:
To develop and validate a magnetic resonance imaging (MRI)-based pancreatic risk stratification model (M-PRiSM) for prognosis prediction and therapy guidance in pancreatic ductal adenocarcinoma (PDAC).
Materials And Methods:
In this retrospective multicenter study, a total of 540 patients with PDAC were enrolled. A Cox proportional hazards model was used to identify significant clinical-radiological predictors and develop an M-PRiSM risk score system. The performance of the model was assessed using Harrell's C-index, time-dependent area under the curve (AUC), and calibration curves, and was compared with existing clinical prediction metrics, including the 8th American Joint Committee on Cancer (AJCC) staging and CA19-9 levels.
Results:
540 PDAC patients were split into a development cohort (n = 282) and an internal validation cohort (n = 122), with 136 patients forming external cohort A (n = 80) and B (n = 56). The model, incorporating CA19-9 (hazard ratio (HR), 1.604, p = 0.047), margin (HR, 1.918, p = 0.001), tumor size (HR, 1.308, p = 0.003), and venous enhancement ratio (VER) (HR, 0.605, p = 0.047), was developed, showing superior predictive accuracy for OS with C-indexes of 0.73, 0.70, and 0.70, and 0.68 across four cohorts. The model outperformed the 8th AJCC staging and CA19-9 alone across validation cohorts (p < 0.001). High-risk patients exhibit the worst overall survival (OS) and a higher frequency of adverse pathological features, but benefited significantly from adjuvant therapy, with improved survival outcomes.
Conclusion:
The M-PRiSM model effectively predicts postoperative OS and identifies PDAC patients likely to benefit from adjuvant treatment.
Critical Relevance Statement:
The M-PRiSM model, utilizing MRI and clinical features, enables preoperative risk stratification for overall survival in pancreatic ductal adenocarcinoma, offering a generalizable tool to guide personalized adjuvant therapy and enhance prognostic assessment.
Key Points:
The M-PRiSM model can effectively predict pancreatic ductal adenocarcinoma survival. The M-PRiSM model showed strong generalizability in external validations. The M-PRiSM model stratifies patients for guiding adjuvant therapy for improved outcomes.
