Background:Total tumor volume (TTV), derived from imaging data, has emerged as a potential prognostic biomarker in various cancers. This study aimed to evaluate the impact of TTV on outcomes in advanced pancreatic ductal adenocarcinoma (PDAC) and to validate a survival prediction model combining TTV with baseline clinico-biological markers.Materials and Methods:We conducted a retrospective analysis of 150 patients with locally advanced or metastatic PDAC treated with first-line FOLFIRINOX from 2010 to 2021. TTV was calculated by manually segmenting all visible lesions on baseline CT scans. Progression-free survival (PFS) and overall survival (OS) were the primary endpoints. A cut-off value for TTV predicting 6-month PFS was determined in 140 patients using AUC and Youden’s Index and then applied to OS analysis. A multivariate Cox regression model incorporating TTV, CA 19-9, and neutrophil-to-lymphocyte ratio (NLR) was developed in 94 patients to establish a survival risk score.Results:12,028 lesions were annotated. OS was slightly but significantly different between TTV above and below the median value of 69.60 cm3(12.4 vs. 13.5 months,p= 0.0269). A cut-off of 400 cm3distinguished two groups: patients with TTV > 400 cm3had significantly shorter OS (9.4 months) compared to those with TTV ≤ 400 cm3(13.0 months,p= 0.0056). A similar trend was observed for PFS, though not statistically significant (7.4 months for TTV > 400 cm3vs. 8.2 months for TTV ≤ 400 cm3,p= 0.0735). The combined model achieved a mean c-index of 0.62 for PFS and 0.64 for OS. Based on the risk score, high-risk patients had significantly worse median PFS (5.5 vs. 9.2 months,p= 0.0008) and median OS (7.2 vs. 13.5 months,p< 0.0001).Conclusions:TTV is a valuable prognostic marker in advanced PDAC. A model integrating TTV with biological markers enhances survival prediction and supports risk stratification in clinical practice.
背景：基于影像数据计算的总肿瘤体积（TTV）已成为多种癌症的潜在预后生物标志物。本研究旨在评估TTV对晚期胰腺导管腺癌（PDAC）患者预后的影响，并验证结合TTV与基线临床生物学标志物的生存预测模型。 材料与方法：我们对2010年至2021年间接受一线FOLFIRINOX方案治疗的150例局部晚期或转移性PDAC患者进行回顾性分析。通过在基线CT图像上手动分割所有可见病灶计算TTV。研究主要终点为无进展生存期（PFS）和总生存期（OS）。在140例患者中采用受试者工作特征曲线下面积和约登指数确定预测6个月PFS的TTV截断值，并将其应用于OS分析。在94例患者中建立包含TTV、CA19-9和中性粒细胞与淋巴细胞比值（NLR）的多变量Cox回归模型，以构建生存风险评分。 结果：共标注12,028个病灶。TTV高于与低于中位值69.60 cm³的患者OS存在轻微但显著差异（12.4个月 vs. 13.5个月，p=0.0269）。以400 cm³为截断值可区分两组患者：TTV＞400 cm³组OS（9.4个月）显著短于TTV≤400 cm³组（13.0个月，p=0.0056）。PFS呈现相似趋势但未达统计学显著性（7.4个月 vs. 8.2个月，p=0.0735）。联合模型预测PFS和OS的平均C指数分别为0.62和0.64。基于风险评分，高风险患者的中位PFS（5.5个月 vs. 9.2个月，p=0.0008）和中位OS（7.2个月 vs. 13.5个月，p＜0.0001）均显著更差。 结论：TTV是晚期PDAC的重要预后标志物。整合TTV与生物学标志物的模型可提升生存预测效能，为临床实践中的风险分层提供支持。
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