Association Between Radiography And Pathology Of Peripancreatic Veins Invasion And Prognostic Value Assessment In Pancreatic Cancer

ObjectiveA retrospective study was performed to clarify the association between radiographic manifestation and pathology of portal vein(PV)and superior mesenteric vein(SMV)wall invasion,and their correlation with postoperative prognosis.Materials and methodsPatients who had undergone radical resection of pancreatic cancer,including pancreaticoduodenectomy,distal pancreatectomy and total pancreatectomy,combined with vascular resection and reconstruction,between January 2012 and August 2016 in The Second Affiliated Hospital,Zhejiang University School of Medicine,Hepatobiliary&Pancreatic Surgery,were analyzed.These patients all undergone a multislice computed tomography angiography(MSCTA)examination before surgery.And clinical,imaging and pathological data of these patients were recorded.Imaging data includes tumour involvement of the vein,length of tumor contact with vein and circumferential involvement.Tumour involvement of the vein were classified into type ?(without contact,contact with vein wall regular or irregular),type ?(contact and the points of contact form a convexity),type?(contact and the points of contact form a concavity),typeIV(stenosis>1/2)and type ?(obstruction or embolus).Pathological grades of PV/SMV wall invasion were classified as A(no invasion),B(tunica adventitia invasion),C(tunica media invasion),D(tunica intima invasion).ResultsThere were 69 cases with detailed clinical,imaging and pathological data underwent radical resection of pancreatic cancer combined with vascular resection and reconstruction,with a median age of 65(35-85)years,and the male-to-female ratio was 37:32.A total of 66 cases underwent preoperative neoadjuvant chemotherapy were classified into type ?(n= 17),?(n= 17),?(n= 14),?(n= 12),?(n=6).All the 17 cases of type ? were without invasion.Of 17 cases of type ?,9(52.9%)cases were with vein invasion,among which 7(41.2%)cases were with tunica adventitia invasion,2(11.7%)cases were with tunica media invasion.Of 14 cases of type ?,12(85.7%)cases were with vein invasion,among which 4(28.6%)cases were with tunica adventitia invasion,5(35.7%)cases were with tunica media invasion and 3(21.4%)cases were with tunica intima invasion.Of 12 cases of type ?,11(91.7%)cases were with vein invasion,among which 2(16.7%)case were with tunica adventitia invasion,7(58.3%)cases were with tunica media invasion and 2(16.7%)cases were with tunica intima invasion.All the 6 cases of type ? were with vein invasion,among which 2(33.3%)cases were with tunica media invasion and 4(66.7%)cases were with tunica intima invasion.Of 3 cases who underwent preoperative neoadjuvant chemotherapy,1 case presented with typeIV and 2 cases presented with type V.While the pathological grades of vein wall invasion were classified as A(no invasion).We achieved sensitivity of 0.763,specificity of 0.893,positive predictive value of 0.906 and negative predictive value of 0.735 for evaluating PV/SMV invasion with the radiographic type of tumour involvement of the vein.And the area under receiver operating characteristic curve is 0.913(p<0.001).Meanwhile,we achieved sensitivity of 0.921,specificity of 0.893,positive predictive value of 0.921 and negative predictive value of 0.893 for evaluating PV/SMV invasion with the criterion of radiographic type combined with length of tumor contact and circumferential involvement.And the area under receiver operating characteristic curve is 0.944(p<0.001).Two patients died within one month after surgery due to multiple organ dysfunction syndrome(MODS).Overall survival rates were estimated using the Kaplan-Meier method,patients without PV/SMV invasion had a significantly higher cumulative survival rate than those with vein invasion(p=0.001).Patients with tunica adventitia invasion had better prognosis than those with tunica media or tunica intima invasion(p=0.046).Cumulative survival rate was significantly different among patients with different radiographic types(p=0.001).Patients with imaging score less than 7 had a significantly higher cumulative survival rate than those with score higher than or equal to 7(p=0.004).Conclusion1.Radiographic type and the imaging score of radiographic type combined with length of tumor contact and circumferential involvement has a high value in evaluating PV/SMV invasion.And a new radiographic evaluation system for vein invasion in pancreatic cancer was established.2.There's a strong correlation between PV/SMV wall invasion of the radiography type and pathological grade.The incidence and grade of pathological PV/SMV wall invasion increased according to the radiographic type of PV/SMV invasion.3.PV/SMV invasion and the degree of vascular invasion is prognostic factors of patients undergo radical resection of pancreatic cancer combined with vascular resection and reconstruction.And the radiographic type and the imaging score are also correlated with prognoses.