Computed tomography-based embryologic compartment classification provides prognostic stratification in pancreatic head ductal adenocarcinoma
In brief
Dorsal-confined tumors had 61-month median survival versus 25 months after resection
In a retrospective study of 173 patients with resected pancreatic head cancer, CT-classified dorsal-confined tumors had a median overall survival of 61.5 months, compared with 25.2 months for other tumor locations. The association persisted after adjustment and in anatomically resectable cases, but the single-center findings need validation before this classification guides care.
- Journal
- Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] (Q1)
- Published
- 28 October 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Shingo Kozono, Atsushi Fujii, Takaaki Tatsuguchi, Hirotaka Kuga, Keisuke Hirahata, Yuzo Shimokawa, et al.
- PMID
- 42957554
- DOI
- 10.1016/j.pan.2026.10.029
Why clinicians should know about it
- Picked for Anatomy (top studies of the week, 1 November 2026): CT maps pancreatic embryologic compartments and tumor location
Abstract
BACKGROUND/OBJECTIVES: Pancreatic head PDAC arises within embryologically distinct dorsal and ventral compartments. We investigated whether CT-based embryologic compartment classification identifies prognostically distinct subgroups after curative-intent resection. METHODS: We retrospectively analyzed 173 patients who underwent curative-intent resection for pancreatic head PDAC between 2009 and 2024. On preoperative contrast-enhanced CT, the embryologic boundary was approximated by a line connecting the anterior edge of the intrapancreatic common bile duct and the center of the portal vein-superior mesenteric vein axis. Tumors were classified as dorsal-confined (DC), dorsal-predominant (DP), ventral-predominant (VP), or ventral-confined (VC). RESULTS: The cohort comprised 44 DC, 64 DP, 53 VP, and 12 VC tumors. Overall survival differed significantly among the four groups (p = 0.0078), with DC tumors showing better survival than DP, VP, and VC tumors. Because survival did not differ significantly among DP, VP, and VC tumors, these were combined as non-DC tumors. Median overall survival was 61.5 months in DC and 25.2 months in non-DC tumors (p = 0.0016). DC location remained independently associated with favorable overall survival in the preoperative model (HR, 0.546; 95% CI, 0.323-0.920; p = 0.0178) and in the model including selected postoperative clinicopathological and treatment factors (HR, 0.578; 95% CI, 0.341-0.980; p = 0.0345). This association remained significant in analyses restricted to anatomically resectable disease. CONCLUSIONS: CT-based embryologic compartment classification identified DC tumors as a favorable subgroup and may provide complementary information for preoperative risk stratification.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.