Value of PET/CT texture analysis in predicting the efficacy and prognosis of neoadjuvant radiochemotherapy for pancreatic ductal adenocarcinoma
Objective To investigate the value of positron emission tomography/computed tomography(PET/CT)texture analysis in predicting the efficacy and prognosis of neoadjuvant radiochemotherapy for pancreatic ductal adenocarcinoma(PDAC).Methods Seventy-eight patients with PDAC in the First Affiliated Hospital of Henan University of Science and Technology from October 2020 to October 2022 were enrolled.Preoperative neoadjuvant radiochemotherapy was administered in 10-day cycles for a total of 3 cycles.After the radiochemotherapy,the pathological responses were evaluated using the tumor regression grade(TRG),and patients were classified into response group and non-response group;the patients were re-divided into good prognosis group and poor-prognosis group according to the lesion status.All patients underwent PET/CT scanning before and at the end of neoadjuvant radiochemotherapy,and the parameters including maximum standardized uptake value(SUVmax),metabolic tumor volume(MTV),energy,entropy,contrast,and correlation were obtained,then the value of those parameters in predicting the efficacy and prognosis of neoadjuvant radiochemotherapy for PDAC was assessed.Results After neoadjuvant radiochemotherapy in 78 PDAC patients,TRG evaluations showed that 46 cases(58.98％)were classified as pathological nonresponders(TRG 0-2),whereas 32 cases(41.03％)were classified as pathological responders(TRG 3-4).The prognostic assessment yielded 52 cases(66.67％)with good prognosis and 26 cases(33.33％)with poor prognosis.PET/CT after surgery showed that the response group had higher SUVmax and MTV that those of the non-response group,with significant differences(P＜0.05).While the energy,entropy,contrast and correlation demonstrated no significant difference(all P＞0.05).Receiver operating characteristic(ROC)curve suggested that the AUCs of separate and combined test of SUVmax and MTV in predicting the effect of neoadjuvant radiochemotherapy in PDAC patients were 0.698,0.778 and 0.903,and the combined test had better predictive efficacy than the separate test.PET/CT after neoadjuvant radiochemotherapy showed that good prognosis group had larger energy and lower entropy than those of poor prognosis group,with significant differences(P＜0.05),while no significant difference was found in contrast,correlation,SUVmax,and MTV between good prognosis group and poor prognosis group(P＞0.05).ROC curve suggested that the AUCs of separate and combined test of entropy and energy in predicting the prognosis of patients with PDAC after neoadjuvant radiochemotherapy were 0.721,0.707 and 0.862,and the predictive value was the highest under combined test.Conclusions PET/CT texture analysis is of great value in predicting the efficacy and prognosis of neoadjuvant radiochemotherapy for PDAC patients.
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