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Clinical Implications of FDG-PET in Pancreatic Ductal Adenocarcinoma Patients Treated with Neoadjuvant Therapy

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Purpose

To evaluate the clinical significance of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with pancreatic ductal adenocarcinoma who underwent neoadjuvant therapy.

Methods

Among 285 consecutive patients who underwent pancreatic resection for pancreatic ductal adenocarcinoma between 2015 and 2021, 86 who underwent preoperative 18F-fluorodeoxyglucose positron emission tomography/computed tomography after completion of neoadjuvant treatment were reviewed. Among preoperative factors, including post-treatment maximum standardized uptake value, predictors of early recurrence and poor prognosis were identified using multivariate analysis for decision making in surgery.

Results

Nineteen (22%) patients with pancreatic ductal adenocarcinoma demonstrated high maximum standardized uptake (≥ 4.5). High post-treatment maximum standardized uptake (≥ 4.5) predicted early recurrence within 6 months after surgery and correlated with shorter recurrence-free survival. Elevated post-treatment CA19-9 level (> 37 U/ml) and maximum standardized uptake ≥ 4.5 were independent prognostic factors. Post-treatment, a high maximum standardized uptake value indicated a poorer prognosis than a low maximum standardized uptake value in both patients with elevated CA19-9 and normal CA19-9 levels. The median overall survival in patients with elevated post-treatment CA19-9 and high maximum standardized uptake was only 17 months; 67% experienced early recurrence. Dynamic changes in maximum standardized uptake during neoadjuvant therapy were correlated with pathological response to neoadjuvant therapy, but not with radiological response or change in CA19-9 level.

Conclusions

Post-treatment assessment using maximum standardized uptake value is useful for stratifying patients with pancreatic ductal adenocarcinoma who will benefit from surgery. Instead of subsequent curative resection, additional neoadjuvant therapy should be considered in patients with a persistently high maximum standardized uptake value.

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Acknowledgements

We would like to thank Editage (www.editage.com) for the English language editing.

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Authors and Affiliations

  1. Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Fukuoka, 812-8582, Japan

    Naoki Ikenaga, Kohei Nakata, Masataka Hayashi, So Nakamura, Toshiya Abe, Noboru Ideno & Masafumi Nakamura

  2. Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Masatoshi Murakami & Nao Fujimori

  3. Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Nobuhiro Fujita, Takuro Isoda, Shingo Baba & Kousei Ishigami

  4. Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Yoshinao Oda

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  1. Naoki Ikenaga
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Contributions

Protocol/project development: NI.

Data collection or management: SN, TA, NI, MM, NF, NF, TI, and SB.

Statistical analysis and interpretation of data: NI, KN, SB, KI, YO, and MN.

Manuscript writing/editing: NI, KN, and MN.

Supervision: MN.

Critical revision of the article for important intellectual content: all authors.

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Correspondence to Masafumi Nakamura.

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Supplemental Figure 1

Kaplan–Meier survival curves of responders and non-responders to neoadjuvant therapy determined by the change in SUVmax of the pre- and post-treatment PET/CT. SUVmax, maximum standardized uptake value; PET/CT, positron emission tomography/computed tomography. (PNG 336 kb)

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Ikenaga, N., Nakata, K., Hayashi, M. et al. Clinical Implications of FDG-PET in Pancreatic Ductal Adenocarcinoma Patients Treated with Neoadjuvant Therapy. J Gastrointest Surg 27, 337–346 (2023). https://doi.org/10.1007/s11605-023-05591-2

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