Computed tomography-based embryologic compartment classification provides prognostic stratification in pancreatic head ductal adenocarcinoma
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Published on: February 1, 2020
Shingo Kozono1, Atsushi Fujii1, Takaaki Tatsuguchi1
1Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, Fukuoka, 802-8561, Japan.
Background/Objectives:
Pancreatic head PDAC arises within embryologically distinct dorsal and ventral compartments. We investigated whether CT-based embryologic compartment classification identifies prognostically distinct subgroups after curative-intent resection.
Methods:
We retrospectively analyzed 173 patients who underwent curative-intent resection for pancreatic head PDAC between 2009 and 2024. On preoperative contrast-enhanced CT, the embryologic boundary was approximated by a line connecting the anterior edge of the intrapancreatic common bile duct and the center of the portal vein-superior mesenteric vein axis. Tumors were classified as dorsal-confined (DC), dorsal-predominant (DP), ventral-predominant (VP), or ventral-confined (VC).
Results:
The cohort comprised 44 DC, 64 DP, 53 VP, and 12 VC tumors. Overall survival differed significantly among the four groups (p = 0.0078), with DC tumors showing better survival than DP, VP, and VC tumors. Because survival did not differ significantly among DP, VP, and VC tumors, these were combined as non-DC tumors. Median overall survival was 61.5 months in DC and 25.2 months in non-DC tumors (p = 0.0016). DC location remained independently associated with favorable overall survival in the preoperative model (HR, 0.546; 95% CI, 0.323-0.920; p = 0.0178) and in the model including selected postoperative clinicopathological and treatment factors (HR, 0.578; 95% CI, 0.341-0.980; p = 0.0345). This association remained significant in analyses restricted to anatomically resectable disease.
Conclusions:
CT-based embryologic compartment classification identified DC tumors as a favorable subgroup and may provide complementary information for preoperative risk stratification.
