A Preoperative Model for Predicting Lymphovascular Invasion in Pancreatic Ductal Adenocarcinoma

Introduction: Lymphovascular invasion (LVI) is a pathological feature associated with poor prognosis in patients with pancreatic ductal adenocarcinoma (PDAC). The objective of this study is to develop a preoperative model for predicting LVI in PDAC patients. Methods: One Thousand and Nine patients from three tertiary hospitals were enrolled in this study. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of LVI. A nomogram was constructed based on the results of the multivariate analysis. Results: The present study identified age <65, cachexia, preoperatively assessed CA19-9 levels, lymph node metastasis reported in imaging, and increased tumor size as independent high-risk predictors of LVI in PDAC. The nomogram, incorporating these predictors, demonstrated good predictive performance in both the development and validation cohorts. The high-LVI-risk patients experienced worse recurrence-free survival and overall survival compared to their low-LVI risk counterparts. Notably, patients with high LVI risk demonstrated prolonged survival following neoadjuvant chemotherapy, whereas survival in patients with low LVI risk did not show significant extension after neoadjuvant chemotherapy. Conclusions: A successful establishment and evaluation of a preoperative model predicting LVI in PDAC was achieved. The application of this model holds potential benefits for guiding clinical decisions regarding the utilization of neoadjuvant therapy. (c) 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.