ABSTRACT Aim To examine the significance of portal vein tumor thrombus (PVTT) as a prognostic factor for patients with pancreatic ductal adenocarcinoma (PDAC) treated with chemoradiotherapy (CRT) followed by surgery. Methods The study retrospectively examined 313 patients with borderline resectable (BR) or locally advanced (LA) PDAC who underwent CRT between November 2008 and December 2023. PVTT was evaluated on computed tomography. Disease‐specific survival (DSS) and overall survival (OS) were compared between patients with and without PVTT. Multivariate Cox analysis was conducted to examine the significance of PVTT as a prognostic factor. Subgroup analysis of patients who underwent resection ( n = 153) was also performed. Results The PVTT and no PVTT groups comprised 25 (8.0%) and 288 (92.0%) patients, respectively. Median DSS (23.5 vs. 12.3 months) and OS (21.6 vs. 12.2 months) were significantly longer in the no PVTT group ( p < 0.001). In multivariate analysis, independent predictors of worse OS were older age, poor performance status, ≥ 180° celiac artery contact/invasion before CRT, ≥ 180° superior mesenteric artery contact/invasion before CRT, presence of PVTT before CRT, and chemotherapy using gemcitabine alone. Among the patients who underwent resection, there were no significant differences in DSS, OS, and RFS between the PVTT and no PVTT groups; multivariate analysis identified PVTT before CRT, poor performance status, contact/invasion of the celiac/superior mesenteric arteries, and no adjuvant chemotherapy as independent predictors of worse OS. Conclusion The presence of PVTT on computed tomography before CRT was an independent adverse prognostic factor in BR and LA PDAC patients enrolled in CRT.
Hayasaki et al. (Wed,) studied this question.