Tumor conspicuity significantly correlates with postoperative recurrence in patients with pancreatic cancer: a retrospective observational study

BACKGROUND: There has been scanty data regarding the clinical significance of tumor conspicuity in pancreatic cancer. In this study, we attempted to investigate the prognostic significance of pancreatic tumor conspicuity and determine prognostic factors for postoperative recurrence in patients with surgically resected pancreatic cancer. METHODS: Between January 2011 and September 2019, 62 patients who underwent preoperative computed tomography (CT) for pancreatic cancer were retrospectively included. Two reviewers evaluated various clinical, imaging, and pathologic variables and reviewed all available medical records to determine patient outcomes after surgery. Tumor conspicuity was defined as the attenuation ratio between normal parenchyma and tumor lesions on dynamic-enhanced CT images and represented the conspicuity score. Recurrence-free survival and overall survival were investigated using Cox regression analysis. RESULTS: Patient mean age was 65.9 (±11.6) years, and 56.5% were male. The median follow-up period was 11 months (range 2–138). Forty patients (64.5%) experienced postoperative recurrence, and the median time to recurrence was 6 months (range 1–101). Tumor conspicuity scores were positively correlated with both radiologic and pathologic tumor sizes (r = 0.252, 0.321, p < 0.01). Conspicuity score ≥ 2 (HR 3.8, 95% CI 1.73–8.47), elevated preoperative (HR 1.15, 95% CI; 1.02–1.28) and postoperative CA19–9 (HR 1.11, 95% CI 1.01–1.23), pathologic tumor size (HR 1.61, 95% CI 1.06–2.45), and lymphatic invasion (HR 2.76, 95% CI 1.22–6.21) were significant factors for recurrence-free survival in the multivariate analysis. CONCLUSIONS: Over half of the patients with pancreatic cancer experienced postoperative recurrence (64.5%). Increased tumor conspicuity correlated with larger tumor size and postoperative recurrence.