Prediction of R0 resectability in pancreatic adenocarcinoma by MRI using NCCN criteria

Abstract

In pancreatic ductal adenocarcinoma, radiologic assessment of vascular involvement is very critical during the presurgical plan. Surgical resection with a negative margin is the main aim for good prognosis after surgery. Therefore, we evaluated the diagnostic performance of magnetic resonance image (MRI) to predict the negative margin known as R0 resectability of pancreatic ductal adenocarcinoma using National Comprehensive Cancer Network criteria. Two radiologists retrospectively reviewed abdominal MRI examinations of 55 patients with non-metastatic pancreatic ductal adenocarcinoma who were operated on between 2018 and 2020 and evaluated resectability (resectable vs borderline resectable) according to National Comprehensive Cancer Network criteria (version 2, 2021). R0 resection rates were assessed based on MRI resectability status in operated patients. Independent predictors of R0 resection were determined using logistic regression analysis. Based on MRI findings, 46 patients were reported as resectable and 9 patients as borderline resectable using National Comprehensive Cancer Network criteria for resectability. R0 resection rates were 63% (29 of 46) and 77.8% (7 of 9) for resectable and borderline resectable disease, respectively (p = 0.473, p > 0.05). At multivariable analysis, superior mesenteric vein invasion (p = 0049) and lymph node ratios (p = 0.004) were significantly associated with margin positive resection in patients with resectable disease at MRI. Applying all National Comprehensive Cancer Network-resectability criteria to the classification of pancreatic ductal adenocarcinoma patients into resectable or borderline resectable categories by MRI is not related with a decreased or increased likelihood for R0 resection overall. However, our study showed that superior mesenteric vein invasion and lymph node ratio emerged as an independent predictor for margin-positive resection in patients with resectable cancer. Pancreatic cancer patients with R0 resection have a better prognostic outcome than patients with R1 resection. Preoperative MRI may identify patients who may benefit from neoadjuvant chemotherapy.