Total lesion glycolysis is a promising predictor of chemo-response in pancreatic cancer patients treated with neoadjuvant chemotherapy prior to surgery

Sooin Byeon; Bridget Abbott; Paul Roach; Dale L Bailey; Angela Chou; Sarah Maloney; Anthony J Gill; Jaswinder Samra; Anubhav Mittal; Sumit Sahni

doi:10.1111/eci.70046

Total lesion glycolysis is a promising predictor of chemo-response in pancreatic cancer patients treated with neoadjuvant chemotherapy prior to surgery

Eur J Clin Invest. 2025 Sep;55(9):e70046. doi: 10.1111/eci.70046. Epub 2025 Apr 8.

Authors

Sooin Byeon^{1

2}, Bridget Abbott³, Paul Roach³, Dale L Bailey^{1

3}, Angela Chou^{1

4}, Sarah Maloney^{1

2}, Anthony J Gill^{1

4}, Jaswinder Samra^{5

6}, Anubhav Mittal^{1

5

6

7}, Sumit Sahni^{1

2}

Affiliations

¹ Northern Clinical School, Faculty of Medicine and Health, University of Sydney, St Leonards, New South Wales, Australia.
² Kolling Institute of Medical Research, University of Sydney, St Leonards, New South Wales, Australia.
³ Department of Nuclear Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia.
⁴ NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, New South Wales, Australia.
⁵ Australian Pancreatic Centre, St Leonards, Sydney, New South Wales, Australia.
⁶ Upper GI Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, St Leonards, New South Wales, Australia.
⁷ The University of Notre Dame Australia, Sydney, New South Wales, Australia.

Abstract

Background: There has been increased use of neoadjuvant chemotherapy (NAC) in resectable pancreatic ductal adenocarcinoma (PDAC) patients. [¹⁸F]fluoro-2-deoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) scan is being frequently used to determine treatment response in PDAC patients undergoing NAC. Maximum standardized uptake value (SUV_max) is conventionally used as an FDG-PET/CT parameter, but there are emerging parameters, such as total lesion glycolysis (TLG), which take into account mean standardized uptake (SUV_mean) and metabolic tumour volume (MTV). This study compared the ability of emerging FDG-PET/CT parameters (i.e. SUV_mean, MTV and TLG) to predict chemo-response compared to SUV_max.

Methods: In this single centre, retrospective study, NAC-treated PDAC patients (n = 74) for whom both pre- and post-NAC FDG-PET/CT scans were available were recruited. All scans were imported to a single analysis platform and reanalysed. Chemo-response was determined by the assessment of percentage viable tumour cells in the tumour bed. Statistical analysis was performed on the data.

Results: A significant correlation was observed between post-treatment FDG-PET/CT scan parameters and viable cancer cells in the tumour bed, with TLG showing a higher degree of correlation (r = .3131) compared to all other parameters (r = .2722-.3008). The percentage decrease in the TLG (post-NAC scan vs. pre-NAC scan) demonstrated the highest degree of correlation with viable cancer cells in the tumour bed (r = -.3444) and had a statistically significant (p = .0157) effect between NAC responders (Median = 80.57) and non-responders (Median = 65.16). The difference between TLG (post-NAC scan vs. pre-NAC scan) was shown to be an independent prognostic indicator for overall survival (hazard ratio = .5033, p = .0361).

Conclusion: TLG was shown to be a superior predictor of chemo-response and patient prognosis compared to all other FDG-PET/CT parameters in PDAC patients treated with NAC.

Keywords: PET scan; SUVmax; imaging biomarkers; pancreatic ductal adenocarcinoma; total lesion glycolysis.

MeSH terms

Adult
Aged
Antineoplastic Combined Chemotherapy Protocols* / therapeutic use
Carcinoma, Pancreatic Ductal* / diagnostic imaging
Carcinoma, Pancreatic Ductal* / drug therapy
Carcinoma, Pancreatic Ductal* / metabolism
Chemotherapy, Adjuvant
Female
Fluorodeoxyglucose F18
Glycolysis*
Humans
Male
Middle Aged
Neoadjuvant Therapy
Pancreatic Neoplasms* / diagnostic imaging
Pancreatic Neoplasms* / drug therapy
Pancreatic Neoplasms* / metabolism
Positron Emission Tomography Computed Tomography
Radiopharmaceuticals
Retrospective Studies
Treatment Outcome
Tumor Burden

Substances

Fluorodeoxyglucose F18
Radiopharmaceuticals

Grants and funding

Philanthropic Donations