Prognostic Significance of Portal Vein Tumor Thrombus in Pancreatic Ductal Adenocarcinoma Treated With Chemoradiotherapy

ABSTRACT Aim To examine the significance of portal vein tumor thrombus (PVTT) as a prognostic factor for patients with pancreatic ductal adenocarcinoma (PDAC) treated with chemoradiotherapy (CRT) followed by surgery. Methods The study retrospectively examined 313 patients with borderline resectable (BR) or locally advanced (LA) PDAC who underwent CRT between November 2008 and December 2023. PVTT was evaluated on computed tomography. Disease‐specific survival (DSS) and overall survival (OS) were compared between patients with and without PVTT. Multivariate Cox analysis was conducted to examine the significance of PVTT as a prognostic factor. Subgroup analysis of patients who underwent resection ( n  = 153) was also performed. Results The PVTT and no PVTT groups comprised 25 (8.0%) and 288 (92.0%) patients, respectively. Median DSS (23.5 vs. 12.3 months) and OS (21.6 vs. 12.2 months) were significantly longer in the no PVTT group ( p   Conclusion The presence of PVTT on computed tomography before CRT was an independent adverse prognostic factor in BR and LA PDAC patients enrolled in CRT.