| Purpose:The aim of this study was to evaluate the significance of baseline computed tomography(CT)imaging features and carbohydrate antigen 19-9(CA19-9)in predicting prognosis of LAPC receiving IORT and to establish a progression risk nomogram that could identify the potential beneficiary of IORT.Methods:A total of 88 LAPC patients with IORT as their initial treatment were enrolled retrospectively.Clinical data and CT imaging features,including quantitative parameters and semantic features were analyzed.Cox regression analyses were performed to identify the independent risk factors for progression-free survival(PFS)and to establish a nomogram.A risk-score was calculated by the coefficients of the regression model to stratify the risk of progression.Results:Multivariate analyses revealed that relative enhanced value in portal-venous phase(REV-PVP),peripancreatic fat infiltration,necrosis,and CA19-9 were significantly associated with PFS(all p<0.05).The nomogram was constructed according to the above variables and showed a good performance in predicting the risk of progression with a concordance index(C-index)of 0.779.Our nomogram stratified patients with LAPC into low-and high-risk groups with distinct differences for progression after IORT(p<0.001).Conclusion:The integrated nomogram could help clinicians to identify appropriate patients who might benefit from IORT before treatment and to adapt an individualized treatment strategy in advanced.Objectives:The aim of this study was to evaluate the role of CT quantitative parameters in predicting overall survival(OS)and progression-free survival(PFS)in locally advanced pancreatic cancer after intraoperative radiotherapy(IORT),and to establish a more effective treatment plan for LAPC patients after IORT,helping patients establish individualized clinical diagnosis and treatment plans.Methods:LAPC patients who underwent contrast-enhanced CT before and after IORT and were predicted to be at low risk of progression after IORT were retrospectively enrolled.The quantitative CT parameters,semantic features,and treatment responses were evaluated.Cox regression analysis was used to determine independent risk factors for overall survival(OS).The outcome-based optimal cut-off value for quantitative CT parameters was determined and stratified patients into high-risk and low-risk groups,PFS was compared using Kaplan-Meier analysis.Results:Among the 76 patients(mean age,58.52 ± 10.09 years,47 men and 29 women)receiving IORT,the relative enhanced value(REV)in the portal-venous phase increased significantly after IORT(p=0.018).Change in REV(delta-REV)was an independent risk factor for OS and PFS(hazard ratio[HR],0.974;p=0.003)and PFS(HR,0.953;p=0.012).A 3-HU threshold in delta-REV was used to stratify patients into high-(delta-REV ≤3 HU;31/76,40.8%)and low-risk groups(delta-REV>3 HU;45/76,59.2%).The difference in progression between the two groups was significant,with a median PFS of 12.53 months and 10.76 months,respectively(p=0.028).Median OS was longer in patients receiving chemoradiotherapy than those receiving chemotherapy in responders(14.3 months vs 10.4 months)(p=0.034),while median PFS was longer in patients receiving chemotherapy than in those receiving radiotherapy in non-responders(13.0 months VS 9.2 months)(p=0.046).Conclusion:Delta-REV could be used as an imaging biomarker in terms of prognostic prediction in LAPC patients receiving IORT.It could also assist clinicians in identifying a more suitable adjuvant treatment after IORT,which mights to achieve individualized precision treatment to improve patient outcomes. |
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