Impact of EOB-MRI on the outcome of patients with pancreatic cancer in real-world settings.

person Atsushi Oba Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan info_outline Atsushi Oba, Tomoyuki Taguchi, Naoto Fujikawa, Suguru Okami, Takashi Tsuji, Alexander Michel, Yuki Kado, Satoshi Goshima

Authors person Atsushi Oba Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan info_outline Atsushi Oba, Tomoyuki Taguchi, Naoto Fujikawa, Suguru Okami, Takashi Tsuji, Alexander Michel, Yuki Kado, Satoshi Goshima Organizations Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan, Bayer Yakuhin Ltd., Tokyo, Japan, Bayer Yakuhin Ltd., Osaka, Japan, Bayer Consumer Care AG, Basel, Swaziland, IQVIA Solutions Japan G.K., Tokyo, Japan, Hamamatsu University School of Medicine, Shizuoka, Japan Abstract Disclosures Research Funding No funding sources reported Background: Contrast-enhanced computed tomography (CE-CT) is a commonly used imaging modality for the preoperative detection of local extension and distant metastasis in patients (pts) with pancreatic cancer (PaC). There have been cases where surgical treatment was deemed unsuitable due to unexpected distant metastases discovered during surgery, which had not been detected by CE-CT. While studies have reported gadoxetate disodium-enhanced MRI (EOB-MRI) improves the detection of liver metastases, it is not clear whether adding EOB-MRI to CE-CT provides clinical benefits, e.g. improved outcomes through the early access to appropriate treatments by avoiding unnecessary surgery (open-close surgery) in pts with PaC. This study aimed to assess the effectiveness of adding EOB-MRI before surgical or non-surgical treatment on overall survival (OS) in pts with PaC in real world settings. Methods: This was a retrospective cohort study using a nationwide hospital-claims database in Japan. Pts aged ≥18 years diagnosed with PaC with a record of surgery, radiotherapy, or chemotherapy, who had an imaging modality were identified between January 1, 2011 to October 31, 2021. Pts were grouped into EOB-MRI and no EOB-MRI groups, and further grouped into surgery, no surgery and open-close laparotomy. OS was compared between propensity-score matched EOB-MRI and no EOB-MRI groups using the Cox regression model. Results: 39,624 pts were included in the study, of them, 4,477 (11.3%) underwent EOB-MRI prior to the initial treatment. 2,061 (46.0%) pts in EOB-MRI group underwent surgery, 2,346 (52.4%) had no surgery and 70 (1.6%) had open-close laparotomy. In 35,147 (88.7%) pts in no EOB-MRI group, 13,182 (37.5%) underwent surgery, 21,506 (61.2%) had no surgery, and 459 (1.3%) had open-close laparotomy. The OS results in subgroups are shown in the Table. Conclusions: In real-world settings, EOB-MRI performed prior to the initial treatment was associated with significantly higher OS than those without EOB-MRI in pts who did not undergo surgery, but there was no difference in OS in pts who underwent surgery. These results suggest that the early detection of micro hepatic metastases through EOB-MRI and multidisciplinary treatment that enables EOB-MRI may contribute to improved outcomes in pts with PaC. Overall survival. Crude No Surgery Surgery Modality (N) No EOB-MRI (21,506) EOB-MRI (2,346) No EOB-MRI (13,182) EOB-MRI (2,061) Death (%) 10,692 (49.7) 1,014 (43.2) 3,248(24.6) 443 (21.5) Median survival time, days (95% CI) 420 (411–431) 553 (510–602) NR (3,500–NR) 3,225 (2,823–NR) Adjusted No surgery Surgery Modality (N) No EOB-MRI (5,667) EOB-MRI (1,889) No EOB-MRI (5,172) EOB-MRI (1,724) Death (%) 2,579(45.5) 785 (41.6) 1,138 (22.0) 365 (21.2) Median survival time, days (95% CI) 467 (445–491) 595 (528–662) NR (3,500–NR) NR (2,823–NR) Hazard ratio (95% CI) - 0.79 (0.73–0.85) - 0.99 (0.88–1.11) p-value - <.01 - 0.86 CI, confidence interval; NR, not reached.