Development and validation of a radiomics nomogram to discriminate advanced pancreatic cancer with liver metastases or other metastatic patterns

2021 ◽  
pp. 1-10
Author(s):  
Tianliang Zhang ◽  
Xiao Dong ◽  
Yang Zhou ◽  
Muhan Liu ◽  
Junjie Hang ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Liver Metastases ◽  
Advanced Pancreatic Cancer ◽  
Region Of Interest ◽  
Random Forest Classifier ◽  
Calibration Plot ◽  
Good Discrimination ◽  
Kaplan Meier ◽  
Metastatic Patterns ◽  
Development And Validation

BACKGROUND: Patients with advanced pancreatic cancer (APC) and liver metastases have much poorer prognoses than patients with other metastatic patterns. OBJECTIVE: This study aimed to develop and validate a radiomics model to discriminate patients with pancreatic cancer and liver metastases from those with other metastatic patterns. METHODS: We evaluated 77 patients who had APC and performed texture analysis on the region of interest. 58 patients and 19 patients were allocated randomly into the training and validation cohorts with almost the same proportion of liver metastases. An independentsamples t-test was used for feature selection in the training cohort. Random forest classifier was used to construct models based on these features and a radiomics signature (RS) was derived. A nomogram was constructed based on RS and CA19-9, and was validated with calibration plot and decision curve. The prognostic value of RS was evaluated by Kaplan-Meier methods. RESULTS: The constructed nomogram demonstrated good discrimination in the training (AUC = 0.93) and validation (AUC = 0.81) cohorts. In both cohorts, patients with RS > 0.61 had much poorer overall survival than patients with RS < 0.61. CONCLUSIONS: This study presents a radiomics nomogram incorporating RS and CA19-9 to discriminate patients who have APC with liver metastases from patients with other metastatic patterns.

Development and validation of a radiomics nomogram to discriminate advanced pancreatic cancer patients with liver metastases or other metastatic patterns.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 435-435
Author(s):  
Junjie Hang ◽  
Lixia Wu
Keyword(s):  
Pancreatic Cancer ◽  
Liver Metastases ◽  
Cancer Patients ◽  
Validation Cohort ◽  
Advanced Pancreatic Cancer ◽  
Region Of Interest ◽  
Calibration Plot ◽  
Training Cohort ◽  
Kaplan Meier ◽  
Metastatic Patterns

435 Background: Pancreatic cancer patients with liver metastases had much poorer prognosis than those with other metastatic patterns. This study aimed to develop and validate a radiomics model to discriminate pancreatic cancer patients with liver metastases from patients with other metastatic patterns. Methods: We evaluated 77 patients advanced pancreatic cancer (APC) with different metastatic patterns and performed texture analysis on the region of interest (ROI). 58 patients and 19 patients were allocated randomly into the training cohort and the validation cohort with almost the same proportion of patients with liver metastases. An independent samples t-test was used for initial feature selection in the training cohort. Random Forest Classifier (RFC) was used to construct models based on these features in both cohorts and a radiomics signature (RS) was derived from the model. Then a nomogram was constructed based on RS and CA19-9, and validated with calibration plot and decision curve. The prognostic value of RS was evaluated by Kaplan-Meier methods. Results: A nomogram based on the RS and CA19-9 was constructed and it demonstrated good discrimination in the training cohort (AUC = 0.93) and validation cohort (AUC = 0.81). Kaplan-meier methods showed that patients with RS>0.61 had much poorer OS than patients with RS < 0.61 in both cohorts. Conclusions:This study presents a radiomics nomogram incorporating both RS and CA19-9, which can be used to discriminate advanced pancreatic cancer patients with liver metastases from patients with other metastatic patterns.

scholarly journals Failure patterns and outcomes of dose escalation of stereotactic body radiotherapy for locally advanced pancreatic cancer: a multicenter cohort study

2020 ◽  
Vol 12 ◽  
pp. 175883592097715
Author(s):  
Xiaofei Zhu ◽  
Yangsen Cao ◽  
Tingshi Su ◽  
Xixu Zhu ◽  
Xiaoping Ju ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Progression Free Survival ◽  
Locally Advanced Pancreatic Cancer ◽  
Multicenter Cohort Study ◽  
Failure Patterns ◽  
Kaplan Meier ◽  
Prescription Dose ◽  
Contrast Ct

Objective: This study aims to compare recurrence patterns and outcomes of biologically effective dose (BED10, α/β = 10) of 60–70 Gy with those of a BED10 >70 Gy for locally advanced pancreatic cancer (LAPC). Methods: Patients from three centers with a biopsy and a radiographically proven LAPC were retrospectively included and data were prospectively collected from June 2012 to June 2019. Radiotherapy was delivered by stereotactic body radiation therapy. Recurrences were categorized as in-field, marginal, and outside-the-field recurrence. Patients in two groups were required to receive abdominal enhanced contrast CT or MRI every 2–3 months and CA19-9 examinations every month during follow-up. Treatment-related toxicities were evaluated every month. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan–Meier method. Results: After propensity score matching, there were 486 patients in each group. The median prescription dose of the two groups was 37 Gy/5–8 f (range: 36–40.8 Gy/5–8 f) and 42 Gy/5–8 f (range: 40–49.6 Gy/5–8 f), respectively. The median OS of patients with a BED10 >70 Gy and a BED10 60–70 Gy was 20.3 months (95% CI: 19.1–21.5 months) and 18.2 months (95% CI: 17.8–18.6 months) respectively ( p < 0.001). The median PFS of the two cohorts was 15.4 months (95% CI: 14.2–16.6 months) and 13.3 months (95% CI: 12.9–13.7 months) respectively ( p < 0.001). A higher incidence of in-field and marginal recurrence was found in patients with BED10 of 60–70 Gy (in-field: 97/486 versus 72/486, p = 0.034; marginal: 109/486 versus 84/486, p = 0.044). However, more patients with BED10 >70 Gy had grade 2 or 3 acute (87/486 versus 64/486, p = 0.042) and late gastrointestinal toxicities (77/486 versus 55/486, p = 0.039) than those with BED10 of 60–70 Gy. Conclusion: BED10 >70 Gy was found to have the best survival benefits along with a higher incidence of acute and late gastrointestinal toxicities. Therefore, a higher dose may be required in the case of patients’ good tolerance.

scholarly journals Intensity-Modulated and Image-Guided Radiotherapy in Patients with Locally Advanced Inoperable Pancreatic Cancer after Preradiation Chemotherapy

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
M. Sinn ◽  
R. Ganeshan ◽  
R. Graf ◽  
U. Pelzer ◽  
J. M. Stieler ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Intensity Modulated Radiotherapy ◽  
Image Guided Radiotherapy ◽  
Image Guided ◽  
Intensity Modulated ◽  
Kaplan Meier ◽  
Median Dosage

Background. Radiotherapy (RT) in patients with pancreatic cancer is still a controversial subject and its benefit in inoperable stages of locally advanced pancreatic cancer (LAPC), even after induction chemotherapy, remains unclear. Modern radiation techniques such as image-guided radiotherapy (IGRT) and intensity-modulated radiotherapy (IMRT) may improve effectiveness and reduce radiotherapy-related toxicities.Methods. Patients with LAPC who underwent radiotherapy after chemotherapy between 09/2004 and 05/2013 were retrospectively analyzed with regard to preradiation chemotherapy (PRCT), modalities of radiotherapy, and toxicities. Progression-free (PFS) and overall survival (OS) were estimated by Kaplan-Meier curves.Results. 15 (68%) women and 7 men (median age 64 years; range 40–77) were identified. Median duration of PRCT was 11.1 months (range 4.3–33.0). Six patients (27%) underwent conventional RT and 16 patients (73%) advanced IMRT and IGRT; median dosage was 50.4 (range 9–54) Gray. No grade III or IV toxicities occurred. Median PFS (estimated from the beginning of RT) was 5.8 months, 2.6 months in the conventional RT group (conv-RT), and 7.1 months in the IMRT/IGRT group (P=0.029); median OS was 11.0 months, 4.2 months (conv-RT), and 14.0 months (IMRT/IGRT);P=0.141. Median RT-specific PFS for patients with prolonged PRCT>9 months was 8.5 months compared to 5.6 months for PRCT<9 months (P=0.293). This effect was translated into a significantly better median RT-specific overall survival of patients in the PRCT>9 months group, with 19.0 months compared to 8.5 months in the PRCT  <  9 months group (P=0.049).Conclusions. IGRT and IMRT after PRCT are feasible and effective options for patients with LAPC after prolonged preradiation chemotherapy.

scholarly journals Multicenter Retrospective Analysis of Second-Line Therapy after Gemcitabine Plus Nab-Paclitaxel in Advanced Pancreatic Cancer Patients

Cancers ◽  
2020 ◽  
Vol 12 (5) ◽  
pp. 1131 ◽  
Author(s):  
Valeria Merz ◽  
Alessandro Cavaliere ◽  
Carlo Messina ◽  
Massimiliano Salati ◽  
Camilla Zecchetto ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Cancer Patients ◽  
Advanced Pancreatic Cancer ◽  
Rank Test ◽  
Second Line ◽  
Second Line Therapy ◽  
Clear Trend ◽  
Line Therapy ◽  
Kaplan Meier ◽  
Number Of Patients

Pancreatic cancer is one of the most lethal solid tumors. In many European countries gemcitabine plus nab-paclitaxel is the preferred first-line treatment. An increasing number of patients are eligible for second-line therapy, but the best regimen is still controversial. This study aimed to evaluate the efficacy of oxaliplatin-based compared to irinotecan-based therapies in this setting. 181 advanced pancreatic cancer patients consecutively treated in three centers with a second-line therapy progressed on gemcitabine plus nab-paclitaxel were retrospectively enrolled. OS and PFS were calculated using the Kaplan-Meier method and survival of the two groups was compared using the log-rank test. The median PFS and OS were respectively 3.5 (95%CI 3.2–3.8) and 8.8 months (95%CI 7.9–9.8) from second-line therapy in the overall population. The median PFS and OS were respectively 3.3 (95%CI 3.1–3.5) and 8.2 months (95%CI 7.24–9.34) with an irinotecan-based combination compared to 4.0 (95%CI 2.4–5.7) and 10.3 months (95%CI 8.62–12.02) in patients receiving an oxaliplatin-based combination. We observed a clear trend for longer survival outcomes with platinum-based doublet compared to regimens including irinotecan or nal-IRI. Head-to-head trials are still lacking. The neutrophil-to-lymphocyte ratio and the presence of liver metastases could drive physicians in tailoring the treatment strategy.

scholarly journals A case of long survival in advanced pancreatic cancer with multiple liver metastases successfully treated by combined chemotherapy of S-1 and gemcitabine

Suizo ◽  
2008 ◽  
Vol 23 (4) ◽  
pp. 510-518
Author(s):  
Shun-ichi ISHIGAMI ◽  
Nobuo BABA ◽  
Kazuhiko KITAGUCHI ◽  
Morito SAKIKUBO ◽  
Ryou KAMIMURA ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Liver Metastases ◽  
Advanced Pancreatic Cancer ◽  
Combined Chemotherapy ◽  
Long Survival ◽  
Multiple Liver Metastases

Beneficial trends of second-line chemotherapy in advanced pancreatic cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14680-e14680
Author(s):  
Milton Jose B. Silva ◽  
Joyce Maria L. Maia ◽  
Adriana Regina G. Ribeiro ◽  
Ludmilla T. D. Chinen ◽  
Tadeu Ferreira Paiva Jr ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Advanced Pancreatic Cancer ◽  
Control Analysis ◽  
Line Treatment ◽  
Second Line ◽  
First Line ◽  
Second Line Chemotherapy ◽  
Kaplan Meier ◽  
Line Chemotherapy

e14680 Background: Despite the lack of high-quality clinical trial data suggesting that second-line chemotherapy (SLC) may affect survival on metastatic pancreatic cancer (mPC), most of centers utilizes them after the failure of initial treatment in patients who maintain a good performance status. The aim of the present study was to review our institutional experience with SLC and estimate its role in overall survival (OS). Methods: We performed a retrospective matched case-control analysis based on search of medical records in 106 consecutive patients with mPC at our institution. Patients received first line chemotherapy (FLC) and SLC (n = 49) or FLC only (n =57) from September 2005 to December 2010. Case matching was performed with respect to age (< 60y versus ≥ 60y), topography (head of the pancreas versus body or tail), sites of metastasis. Overall survival was analyzed by Kaplan-Meier method. Results: Median age was 63 (32-86) and 60 (38-85) for SLC group and FLC group respectively. There was no significant difference between the two groups regarding topography, TNM stage at diagnosis, and sites of metastasis. The main site of metastasis was the liver (24,4%), followed by peritoneum (2,8%).Median follow-up of both groups was 8.4 months (0.23m-54.93m). First line treatment consisted of Gemcitabine (55.1% x 49.1%) and gemcitabine + cisplatin (18.4%x14%) in SLC and FLC group respectively. The most used second line treatment was Capecitabine (32.7%), followed by Folfox (16.3%), and Fluoracil (10.2%). The Kaplan-Meier estimate of the overall median survival, 1-year and 2-years survival rate was 15.72 months versus 7.2 months (p:0.021), and 60% vs. 32%, and 30% vs. 19% in SLC and FLC group, respectively. Conclusions: Our result suggests that second-line chemotherapy may be beneficial to improve overall survival in patients with advanced pancreatic cancer. It’s important that new and ongoing clinical trials clarify which is the best chemotherapy scheme in this setting.

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