Prognostic value of preoperative fluorodeoxyglucose positron emission tomography/computed tomography in patients with potentially resectable pancreatic cancer

Abdom Radiol (NY). 2018 Dec;43(12):3381-3389. doi: 10.1007/s00261-018-1647-4.


Purpose: To evaluate the prognostic value of preoperative 18-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) in patients with potentially resectable pancreatic cancer.

Methods: The study included 103 consecutive patients with potentially resectable pancreatic cancer who underwent preoperative FDG-PET/CT. Age, sex, blood glucose level, tumor marker levels (carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9)), PET-related parameters (maximum standardized uptake value (SUVmax)), and contrast-enhanced CT-related factors (tumor size, location, enhancement pattern, and CT-based T and N factors by tumor nodes metastasis (TNM) classification) were assessed for their ability to independently predict postoperative tumor recurrence using Cox proportional hazards model.

Results: Median follow-up was 23.1 months. Univariate analyses revealed that SUVmax (P = 0.0004), tumor size (P = 0.0002), T factor (P = 0.0102), N factor (P = 0.0049), and CA19-9 levels (P = 0.0059) were significantly associated with disease-free survival (DFS). In multivariate analysis, SUVmax (P = 0.0163) and CA19-9 levels (P = 0.0364) independently predicted DFS. Kaplan-Meier analysis revealed that patients with low (< 2.5) SUVmax had a significantly better prognosis than those with higher SUVmax (P = 0.0006). The DFS in patients with SUVmax < 2.5 (n = 23) and SUVmax ≥ 2.5 (n = 80) was 61.9% and 9.7%, respectively, 3 years postoperatively.

Conclusions: SUVmax can predict DFS in patients with resectable pancreatic cancer. A SUVmax < 2.5 heralds a better prognosis.

Keywords: 18-Fluorodeoxyglucose positron emission tomography/computed tomography; Disease-free survival; Maximum standardized uptake value; Pancreatic cancer; Potentially resectable.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Female
  • Fluorodeoxyglucose F18*
  • Humans
  • Image Enhancement / methods*
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Pancreas / diagnostic imaging
  • Pancreatic Neoplasms / diagnostic imaging*
  • Positron Emission Tomography Computed Tomography / methods*
  • Preoperative Care / methods*
  • Prognosis
  • Radiopharmaceuticals*
  • Reproducibility of Results
  • Retrospective Studies


  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18

Supplementary concepts

  • Pancreatic Carcinoma