Abstract
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Objectives To evaluate the prognostic value of preoperative F-18 FDG PET in patients with pancreatic ductal adenocarcinoma.
Methods From Aug 2006 to Dec 2014, patients with pancreatic ductal adenocarcinoma who underwent initial F-18 FDG PET/CT and subsequent curative surgical resection without neoadjuvant therapy were retrospectively enrolled. Metabolic parameters were measured as the tumor-to-normal liver standardized uptake value ratio (TLR) and the metabolic tumor volume (MTV) of the primary tumor. MTV2.5 was defined was defined as total tumor volume with an SUV of 2.5 or greater. TLR, MTV2.5, age, sex, serum CA19-9, tumor location, histology (tumor size, differentiation, lymphovascular invasion, perineural invasion, resection margin status, and pathologic T stage), regional lymph node (LN) metastasis, and adjuvant treatment were included as independent variables. The prognostic significance of the clinicopathologic and imaging variables for DMFS, LRFS, RFS and OS was assessed.
Results Of the 74 patients (44 male, 30 female, median age 64; range 40-82 years old) enrolled in this study, 43 experienced recurrence and 34 experienced disease-related death. For OS, MTV2.5 and regional LN metastasis were independent prognostic factors (P<0.05). TLR, MTV2.5, regional LN metastasis, and serum CA19-9 level were independent prognostic factors (P<0.05) for both RFS and DMFS. However, for LRFS, TLR (P=0.5) and MTV (P=0.3) showed no statistical prognostic significance whereas serum CA 19-9 level was an independent prognostic factor (P1.8, MTV2.5>4.4) showed significantly worse RFS, DMFS and OS than those with low FDG uptake (TLR≤1.8, MTVliver≤4.4).
Conclusions Pretreatment values of F-18 FDG PET/CT parameters are independent prognostic factors for RFS, DMFS and OS and not for LRFS in pancreatic ductal adenocarcinoma patients who underwent curative surgical resection. The possibility of distant metastasis during follow-up should be considered in patients with high F-18 FDG uptake.