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A pilot study of the diagnostic and prognostic values of FLT-PET/CT for pancreatic cancer: comparison with FDG-PET/CT

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Abstract

Purpose

The purpose of the study was to examine the diagnostic and prognostic values of 18F-fluorothymidine (FLT)-PET/CT for pancreatic cancer by comparing with 18F-fluorodeoxyglucose (FDG)-PET/CT.

Methods

Fifteen patients with newly diagnosed pancreatic cancer underwent both FLT and FDG-PET/CT scans before treatment. The sensitivity, specificity, and accuracy in detecting nodal and distant metastases were compared between both scans using McNemar exact or χ 2 test. Progression-free survival (PFS) and overall survival (OS) were calculated by Kaplan–Meier method. Prognostic significance was assessed by Cox proportional hazards analysis.

Results

Both scans visualized all primary cancers. The sensitivity, specificity, and accuracy per patient basis for detecting nodal metastasis were equal and 63.6% (7/11), 100% (4/4), and 73.3% (11/15) for both scans, and for detecting distant metastasis were 100% (6/6), 88.9% (8/9), and 93.3% (14/15) for FDG-PET/CT, and 50.0% (3/6), 100% (9/9), and 80.0% (12/15) for FLT-PET/CT, respectively, without significant difference in each of them between both scans (p > 0.05). However, of 4 patients with multiple liver metastases, FDG-PET/CT was positive in all, but FLT-PET/CT was negative in three patients. At univariate analysis, only FLT-SUVmax correlated with PFS (hazard ratio, 1.306, p = 0.048), and FDG total lesion glycolysis (TLG), FLT-SUVmax, and FLT-total lesion proliferation (TLP) correlated with OS (p = 0.021, p = 0.005, and p = 0.022, respectively). At bivariate analysis, FLT-SUVmax was superior to FDG-TLG or FLT-TLP for prediction of OS [HR (adjusted for FDG-TLG), 1.491, p = 0.034, HR (adjusted for FLT-TLP), 1.542, p = 0.023].

Conclusion

FLT-PET/CT may have a potential equivalent to FDG-PET/CT for detecting primary and metastatic cancers except liver metastasis. FLT-SUVmax can provide the most significant prognostic information.

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Authors and Affiliations

  1. Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan

    Masatoyo Nakajo, Atsushi Tani, Megumi Jinguji, Yoshihiko Fukukura & Takashi Yoshiura

  2. Department of Radiology, Nanpuh Hospital, 14-3 Nagata, Kagoshima, 892-8512, Japan

    Masatoyo Nakajo, Yoriko Kajiya & Masayuki Nakajo

  3. Department of Gastroenterology, Nanpuh Hospital, 14-3 Nagata, Kagoshima, 892-8512, Japan

    Tohru Nihara

Authors
  1. Masatoyo Nakajo
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  2. Yoriko Kajiya
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  3. Atsushi Tani
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  4. Megumi Jinguji
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  5. Masayuki Nakajo
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Correspondence to Masatoyo Nakajo.

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No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individuals participants included in the study.

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Nakajo, M., Kajiya, Y., Tani, A. et al. A pilot study of the diagnostic and prognostic values of FLT-PET/CT for pancreatic cancer: comparison with FDG-PET/CT. Abdom Radiol 42, 1210–1221 (2017). https://doi.org/10.1007/s00261-016-0987-1

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