CT-based Node-RADS for evaluating regional lymph node metastasis and postoperative recurrence in patients with pancreatic ductal adenocarcinoma undergoing upfront surgery.

Abstract

To evaluate the diagnostic performance of preoperative CT-based Node-RADS for regional lymph node (LN) metastasis and its prognostic value for postoperative recurrence in pancreatic ductal adenocarcinoma (PDAC). This single-center retrospective study included patients with PDAC undergoing contrast-enhanced CT and surgical resection between January 2017 and July 2023. Node-RADS scores were independently assigned for each resected LN station, with histopathology as the reference standard. Diagnostic performance was evaluated at the patient, LN group, and station levels using sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC). Fine-Gray analysis was performed to assess the prognostic association of Node-RADS on time to recurrence (TTR) after adjustment for clinicopathologic variables. A total of 216 patients (mean age, 66.6 ± 9.1 years; 122 men) were included, with LN metastases in 154 (71.3%). Using a cutoff of Node-RADS ≥ 3, the sensitivity and specificity for detecting LN metastasis were 77.3% (119 of 154) and 83.9% (52 of 62) at the patient level, 74.8% (104 of 139) and 81.8% (63 of 77) for group 1, and 77.3% (34 of 44) and 82.6% (142 of 172) for group 2, with AUCs corresponding of 0.815, 0.791, and 0.814. Per-station analysis showed sensitivity ranging from 60.0% to 84.6% and specificity from 79.1% to 97.7%. Multivariable Fine-Gray analyses confirmed that Node-RADS ≥ 3 independently predicted shorter TTR (subdistribution hazard ratio, 1.68; 95% CI: 1.19-2.36; p = 0.003). Preoperative CT-based Node-RADS enabled promising assessment of regional LN metastasis and prediction of postoperative recurrence in PDAC. Question Accurate preoperative identification of regional LN metastasis in PDAC remains challenging, limiting prognosis assessment and individualized treatment allocation. Findings Node-RADS ≥ 3 on preoperative CT demonstrates robust diagnostic performance across patient, group, and station levels and independently predicts shorter recurrence-free survival in PDAC. Clinical relevance CT-based Node-RADS provides promising preoperative assessment of regional nodal involvement and recurrence prediction in PDAC, facilitating personalized surgical planning and decision-making regarding neoadjuvant therapy.