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Metabolic tumour burden assessed by 18F-FDG PET/CT associated with serum CA19-9 predicts pancreatic cancer outcome after resection

European Journal of Nuclear Medicine and Molecular Imaging volume 41, pages 1093–1102 (2014)Cite this article

Abstract

Purpose

Tumour burden is one of the most important prognosticators for pancreatic ductal adenocarcinoma (PDAC). The aim of this study was to investigate the predictive significance of metabolic tumour burden measured by 18F-FDG PET/CT in patients with resectable PDAC.

Methods

Included in the study were 122 PDAC patients who received preoperative 18F-FDG PET/CT examination and radical pancreatectomy. Metabolic tumour burden in terms of metabolic tumour volume (MTV) and total lesion glycolysis (TLG), pathological tumour burden (tumour size), serum tumour burden (baseline serum CA19-9 level), and metabolic activity (maximum standard uptake value, SUVmax) were determined, and compared for their performance in predicting overall survival (OS) and recurrence-free survival (RFS).

Results

MTV and TLG were significantly associated with baseline serum CA19-9 level (P = 0.001 for MTV, P < 0.001 for TLG) and tumour size (P < 0.001 for MTV, P = 0.001 for TLG). Multivariate analysis showed that MTV, TLG and baseline serum CA19-9 level as either categorical or continuous variables, but not tumour size or SUVmax, were independent risk predictors for both OS and RFS. Time-dependent receiving operating characteristics analysis further indicated that better predictive performances for OS and RFS were achieved by MTV and TLG compared to baseline serum CA19-9 level, SUVmax and tumour size (P < 0.001 for all).

Conclusion

MTV and TLG showed strong consistency with baseline serum CA19-9 level in better predicting OS and RFS, and might serve as surrogate markers for prediction of outcome in patients with resectable PDAC.

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Acknowledgments

This work was supported by grants from the National Natural Science Foundation of China (81172005 and 81172276), the National Natural Science Foundation of Shanghai (11ZR1407000), and the Ph.D. Program Foundation of Ministry of Education of China (20110071120096).

We thank Huanyu Xia for assistance in data collection and follow-up of patients, and professor Si-Long Hu for help in the analysis of 18F-FDG PET/CT images.

There are no financial disclosures from any authors.

Conflicts on interest

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Author information

Affiliations

  1. Pancreatic Cancer Institute and Department of Pancreatic and Hepatobiliary Surgery, Fudan University, Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032, China

    Hua-Xiang Xu, Tao Chen, Wen-Quan Wang, Chun-Tao Wu, Chen Liu, Jiang Long, Jin Xu, Liang Liu & Xian-Jun Yu

  2. Department of Nuclear Medicine, Fudan University, Shanghai Cancer Center, Shanghai, China

    Ying-Jian Zhang

  3. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

    Hua-Xiang Xu, Tao Chen, Wen-Quan Wang, Chun-Tao Wu, Chen Liu, Jiang Long, Jin Xu, Ying-Jian Zhang, Liang Liu & Xian-Jun Yu

  4. Department of General Surgery, Jinshan Hospital, Fudan University, Shanghai, China

    Run-Hao Chen

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  1. Hua-Xiang Xu
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  2. Tao Chen
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Correspondence to Liang Liu or Xian-Jun Yu.

Additional information

Hua-Xiang Xu, Tao Chen, Wen-Quan Wang and Chun-Tao Wu contributed equally to this work.

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Supplementary Fig. 1
figure 5

Subgroup analysis of overall survival (OS) and recurrence-free survival (RFS) stratified by MTV and TLG according to whether patients received postoperative chemotherapy or chemoradiotherapy. MTV and TLG predict OS (a, c without postoperative chemotherapy; b, d with postoperative chemotherapy) and RFS (e, g without postoperative chemotherapy; f, h with postoperative chemotherapy) regardless of whether patients received postoperative chemotherapy. Consistently, MTV and TLG predict OS (i, k) and RFS (m, o) in patients who did not receive postoperative chemoradiotherapy, and a similar tendency (j, l for OS; n, p for RFS) was observed in those who received postoperative chemoradiotherapy, although the difference in survival between patients with high and low MTV and TLG was not significant. (JPEG 97 kb)

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Xu, HX., Chen, T., Wang, WQ. et al. Metabolic tumour burden assessed by 18F-FDG PET/CT associated with serum CA19-9 predicts pancreatic cancer outcome after resection. Eur J Nucl Med Mol Imaging 41, 1093–1102 (2014). https://doi.org/10.1007/s00259-014-2688-8

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  • DOI: https://doi.org/10.1007/s00259-014-2688-8

Keywords

  • Metabolic tumour burden
  • Metabolic tumour volume
  • Total lesion glycolysis
  • Carbohydrate antigen 19-9
  • Pancreatic ductal adenocarcinoma