title: Noninvasive assessment of tumor vascularity by contrast-enhanced ultrasonography and the prognosis of patients with nonresectable pancreatic carcinoma.
abstract: BACKGROUND
  Studies have shown that angiogenesis is one of the factors that influences the prognosis of patients with solid tumors, including pancreatic carcinomas. However, none have assessed noninvasively the relation between angiogenesis and prognosis in patients with pancreatic carcinoma. Contrast-enhanced ultrasonography (US) not only is a convenient, harmless, and noninvasive imaging modality, but it also provides detailed information on tumor vascularity. The objectives of this study were to assess the vascularity of pancreatic carcinoma noninvasively by contrast-enhanced US and to clarify the prognostic value of tumor vascularity in patients with nonresectable pancreatic carcinoma.
  
  
  METHODS
  Thirty-five consecutive patients with pathologically confirmed, nonresectable pancreatic carcinoma were examined with contrast-enhanced US before systemic chemotherapy. The correlations among tumor vascularity, clinicopathologic factors, and clinical outcomes then were analyzed statistically to investigate prognostic indicators.
  
  
  RESULTS
  The median time to progression (TTP) was longer in patients who had avascular tumors compared with patients who had vascular tumors (110 days vs. 28 days, respectively; P=0.0072; log-rank test). The median survival also was longer in patients who had avascular tumors (267 days vs. 115 days, respectively; P=0.0034; log-rank test). A multivariate analysis using a Cox proportional hazards model revealed that tumor vascularity was a significant, independent factor that influenced TTP (P <0.001) and survival (P=0.022) along with primary tumor size and serum lactate dehydrogenase (LDH) level, which are well known as prognostic factors in patients with pancreatic carcinoma.
  
  
  CONCLUSIONS
  The current results indicated that contrast-enhanced US may be useful in assessing the prognosis of patients with nonresectable pancreatic carcinoma who receive systemic chemotherapy.
authors.affiliation: Department of Gastroenterology, Kanagawa Cancer Center Hospital, Yokohama, Japan. tmasaki@nih.go.jp
authors.forename: Takahiro
authors.initials: T
authors.lastname: Masaki
authors.forename: Shinichi
authors.initials: S
authors.lastname: Ohkawa
authors.forename: Ayumi
authors.initials: A
authors.lastname: Amano
authors.forename: Makoto
authors.initials: M
authors.lastname: Ueno
authors.forename: Kaoru
authors.initials: K
authors.lastname: Miyakawa
authors.forename: Kazuo
authors.initials: K
authors.lastname: Tarao
mesh_terms: D000328:Adult; D000368:Aged; D003287:Contrast Media; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D018572:Disease-Free Survival; D004338:Drug Combinations; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic; D010094:Oxonic Acid / Q000627:therapeutic use; D010190:Pancreatic Neoplasms / Q000098:blood supply* / Q000188:drug therapy; D011134:Polysaccharides; D011379:Prognosis; D011725:Pyridines / Q000627:therapeutic use; D016019:Survival Analysis; D015996:Survival Rate; D005641:Tegafur / Q000627:therapeutic use; D014463:Ultrasonography / Q000379:methods*; D000093542:Gemcitabine
chemical_list: D003287:Contrast Media; D004338:Drug Combinations; D011134:Polysaccharides; D011725:Pyridines; D003841:Deoxycytidine; C059891:SHU 508; C079198:S 1 (combination); D005641:Tegafur; D010094:Oxonic Acid; D000093542:Gemcitabine