Work

MRI-based risk stratification for predicting overall survival in pancreatic ductal adenocarcinoma

Year: 2025

Type: article

Abstract: Purpose To develop and validate a magnetic resonance imaging (MRI)-based pancreatic risk stratification model (M-PRiSM) for prognosis prediction and therapy guidance in pancreatic ductal adenocarcinoma (PDAC). Materials and methods In this retrospective multicenter study, a total of 540 patients with PDAC were enrolled. A Cox proportional hazards model was used to identify significant clinical-radiological predictors and develop an M-PRiSM risk score system. The performance of the model was assessed using Harrell’s C-index, time-dependent area under the curve (AUC), and calibration curves, and was compared with existing clinical prediction metrics, including the 8th American Joint Committee on Cancer (AJCC) staging and CA19-9 levels. Results 540 PDAC patients were split into a development cohort (n = 282) and an internal validation cohort (n = 122), with 136 patients forming external cohort A (n = 80) and B (n = 56). The model, incorporating CA19-9 (hazard ratio (HR), 1.604, p = 0.047), margin (HR, 1.918, p = 0.001), tumor size (HR, 1.308, p = 0.003), and venous enhancement ratio (VER) (HR, 0.605, p = 0.047), was developed, showing superior predictive accuracy for OS with C-indexes of 0.73, 0.70, and 0.70, and 0.68 across four cohorts. The model outperformed the 8th AJCC staging and CA19-9 alone across validation cohorts (p < 0.001). High-risk patients exhibit the worst overall survival (OS) and a higher frequency of adverse pathological features, but benefited significantly from adjuvant therapy, with improved survival outcomes. Conclusion The M-PRiSM model effectively predicts postoperative OS and identifies PDAC patients likely to benefit from adjuvant treatment. Critical relevance statement The M-PRiSM model, utilizing MRI and clinical features, enables preoperative risk stratification for overall survival in pancreatic ductal adenocarcinoma, offering a generalizable tool to guide personalized adjuvant therapy and enhance prognostic assessment. Key Points The M-PRiSM model can effectively predict pancreatic ductal adenocarcinoma survival. The M-PRiSM model showed strong generalizability in external validations. The M-PRiSM model stratifies patients for guiding adjuvant therapy for improved outcomes. Graphical Abstract

Source: Insights into Imaging

DOI: 10.1186/s13244-025-02088-1