Validation of intratumoral necrosis as a prognostic marker in PDAC: Correlation with pathological findings and preoperative MDCT assessment.

PURPOSE: To validate the prognostic significance of intratumoral necrosis in patients with pancreatic ductal adenocarcinoma (PDAC) and evaluate the diagnostic accuracy of preoperative multidetector computed tomography (MDCT) in detecting necrosis. METHODS: The study included eighty-nine PDAC patients who underwent curative-intent R0 resection without neoadjuvant therapy. Patients were stratified into two groups based on pathologically confirmed necrosis. Clinical, pathological, and MDCT features were systematically analyzed and compared between groups. RESULTS: Multivariate Cox regression adjusted for age and tumor differentiation demonstrated that pathologically confirmed necrosis was independently associated with reduced overall survival in PDAC patients (HR = 2.094, 95% confidence interval [CI]: 1.080-4.060, P = 0.029). Using pathologically confirmed necrosis as the gold standard, MDCT-detected necrosis by visual assessment achieved an area under the curve (AUC) 0.709 (95% CI: 0.603-0.801), sensitivity 74.1%, specificity 67.7%, and negative predictive value (NPV) 85.7%. Delta in venous phase [AUC 0.764 (95% CI: 0.660-0.869), sensitivity 70.4%, specificity 71.0%, NPV 84.6%] and delayed phases showed comparable performance [AUC 0.760 (95% CI: 0.651-0.868), sensitivity 70.4%, specificity 80.6%, NPV 86.2%]. CONCLUSION: Intratumoral necrosis serves as an independent prognostic indicator in PDAC. Preoperative MDCT features provide clinically actionable identification of necrosis with moderate sensitivity and NPV, enabling risk stratification to guide personalized therapeutic strategies.