title: Radiological tumor density and lymph node size correlate with survival in resectable adenocarcinoma of the pancreatic head: A retrospective cohort study.
abstract: BACKGROUND
  Tumors within the pancreatic head show a variable density and enhancement on computerized tomography (CT). The relationship between the radiological appearance of pancreatic adenocarcinoma on CT and survival remains unclear. The aim of this study was to evaluate the relationship between the tumor density on CT and survival. We also evaluated the correlation between lymph node (LN) size and overall survival in patients undergoing pancreaticoduodenectomy for head of pancreas adenocarcinoma.
  
  
  METHODS
  Case records of patients undergoing pancreaticoduodenectomy for the adenocarcinoma of pancreas head, between 2005 and 2009, were evaluated. CT was interpreted to document tumor density - Hounsfield unit (HU) and LN size of enlarged LNs. Histology was analyzed to review tumor differentiation and LN status. Survival was correlated with LN size and tumor density (HU).
  
  
  RESULTS
  Increasing tumor density was significantly associated with an adverse outcome (P = 0.042, hazard ratio [HR] 1.034, 1.002-1.067 95% confidence interval [95% CI]). Patients with well-differentiated tumors had significantly lower tumor density as compared to moderately differentiated tumors (39.00 ± 26.00 vs. 71.31 ± 21.03 HU, P = 0.005). LN size more than 1 cm irrespective of LN status strongly correlated with the survival and was found to be an important prognostic factor (19.37 ± 2.71 months vs. 27.44 ± 2.74 months; P = 0.025; HR 2.70; 1.09-6.68 95% CI).
  
  
  CONCLUSIONS
  Increasing pancreatic tumor density and the lymph nodal size of more than 1 cm are strong predictors of unfavorable overall survival for resectable adenocarcinoma of the pancreatic head. Further studies are required to identify the value of these proposed prognostic factors.
authors.affiliation: Division of HPB and Liver Transplant Surgery, Royal Free Hospital and Medical School, London, NW3 2QG, UK.
authors.forename: Soumil J
authors.initials: SJ
authors.lastname: Vyas
authors.forename: Yogesh S
authors.initials: YS
authors.lastname: Puri
authors.forename: Biku J
authors.initials: BJ
authors.lastname: John
authors.forename: Dominic
authors.initials: D
authors.lastname: Yu
authors.forename: Jennifer
authors.initials: J
authors.lastname: Watkins
authors.forename: Charles
authors.initials: C
authors.lastname: Imber
authors.forename: Guiseppe
authors.initials: G
authors.lastname: Fusai
authors.forename: Shankar
authors.initials: S
authors.lastname: Arjun
authors.forename: Dinesh
authors.initials: D
authors.lastname: Sharma
authors.forename: Brian R
authors.initials: BR
authors.lastname: Davidson
authors.forename: Massimo
authors.initials: M
authors.lastname: Malago
authors.forename: Sakhawat
authors.initials: S
authors.lastname: Rahman
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D010179:Pancreas / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D014057:Tomography, X-Ray Computed