Preoperative FDG-PET predicts early recurrence and a poor prognosis after resection of pancreatic adenocarcinoma

Ann Surg Oncol. 2015 Feb;22(2):677-84. doi: 10.1245/s10434-014-4046-2. Epub 2014 Sep 5.

Abstract

Objective: The aim of this study was to evaluate the clinical utility of preoperative 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) as a prognostic predictor of resectable pancreatic adenocarcinoma.

Methods: A total of 128 patients with resected pancreatic adenocarcinoma who preoperatively underwent FDG-PET examinations were studied. The maximum standard uptake value (SUVmax) was calculated for each primary lesion. A receiver operating characteristics (ROC) curve was constructed to estimate the optimal cutoff value of the SUVmax. In order to determine which outcomes of interest were appropriately demonstrated, ROC curve analyses were conducted for six outcomes: 6-, 12-, and 24-month disease-free survival (DFS), and 6-, 12-, and 24-month overall survival (OS). A multivariate analysis was conducted to identify prognostic factors.

Results: The ROC curves revealed that the SUVmax predicted the 6-month DFS most optimally (area under the curve 0.757), with a cutoff value of 6.0. Of the 69 patients with an SUVmax ≥ 6.0, 34 (49 %) developed recurrence within 6 months. In contrast, only 3 of 59 (5 %) patients with an SUVmax < 6.0 exhibited early recurrence (p < 0.001). The median OS time was 37 months in patients with an SUVmax < 6.0 and 18 months in patients with an SUVmax ≥ 6.0 (p < 0.001). The multivariate analysis revealed lymph node metastasis (hazard ratio [HR] 2.31; p = 0.001) and an SUVmax ≥ 6.0 (HR 2.05; p = 0.002) to be significantly correlated with a poor survival.

Conclusions: An SUVmax ≥ 6.0 was a significant predictor of early postoperative recurrence and subsequent poor survival following resection of pancreatic adenocarcinoma.

MeSH terms

  • Adenocarcinoma / diagnostic imaging*
  • Adenocarcinoma / surgery
  • Aged
  • Female
  • Fluorodeoxyglucose F18
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / diagnostic imaging*
  • Neoplasm Recurrence, Local / surgery
  • Pancreatic Neoplasms / diagnostic imaging*
  • Pancreatic Neoplasms / surgery
  • Positron-Emission Tomography*
  • Preoperative Care
  • Prognosis
  • ROC Curve
  • Radiopharmaceuticals
  • Survival Analysis

Substances

  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18