Combination of imaging features on pancreatic CT for predicting early recurrence after upfront pancreatoduodenectomy of pancreatic ductal adenocarcinoma.

Purpose: This study aimed to identify preoperative computed tomography (CT) imaging features for predicting early recurrence after upfront pancreatoduodenectomy of pancreatic ductal adenocarcinoma (PDAC), and to assess the diagnostic performance and prognostic relevance of their combination. Methods: This study retrospectively included PDAC patients who underwent pancreatoduodenectomy and preoperative pancreatic CT between January 2016 and December 2023. Early recurrence is defined based on imaging evidence or pathology within 12 months after surgery. Significant imaging features for early recurrence were identified using univariate and multivariate analyses. Disease-free survival (DFS) and overall survival (OS) were analyzed in relation to these significant imaging features. Results: A total of 149 patients were evaluated (median age: 67 years; interquartile range: 41-89 years; 82 men), among whom 70 (47.0 %) experienced early recurrence. Rim enhancement, tumor necrosis, peripancreatic tumor infiltration, and suspicious metastatic lymph nodes, were independently associated with early recurrence. When any two or more of these four significant imaging features were combined, the specificity was 86.1 % (68/79) and the sensitivity was 88.6 % (60/70). DFS and OS were significantly worse in PDAC patients with two or more of these features compared to those with none or only one (all log-rank Conclusion: A combination of two or more imaging features such as rim enhancement, tumor necrosis, peripancreatic tumor infiltration, and suspicious metastatic lymph nodes, could be used as a prognostic imaging marker for early recurrence, demonstrating effective diagnostic performance and an association with DFS and OS after pancreatoduodenectomy of PDAC.