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Metabolic activity by FDG-PET/CT after neoadjuvant chemotherapy in borderline resectable and locally advanced pancreatic cancer and association with survival

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Abstract
Background: The optimal prognostic markers for neoadjuvant chemotherapy in patients with borderline resectable or locally advanced pancreatic cancer are not yet established.

Method: Patients who received neoadjuvant chemotherapy prior to surgery and underwent FDG-PET/CT between July 2012 and December 2017 were included. Metabolic parameters including standardised uptake value (SUV), metabolic tumour volume (MTV), and total lesion glycolysis (TLG) on PET/CT, and response evaluations using PERCIST criteria, were investigated for its impact on survival and recurrence. Cox proportional hazards model was performed. Differences in risk were expressed as hazard ratio [HR] with 95% confidence interval [c.i.].

Results: The patients with borderline resectable (N = 106) or locally advanced pancreatic cancer (N = 82) were identified. The median survival was 33.6 months. Decreased metabolic parameters of PET/CT after neoadjuvant chemotherapy were associated with positive impacts on survival and recurrence such as SUVmax (HR 1.16, 95% c.i. 1.01 to 1.32, P = 0.025), SUVpeak (HR 1.26, 95% c.i. 1.05 to 1.51, P = 0.011), and MTV (HR 1.15, 95% c.i. 1.04 to 1.26, P = 0.005). Large delta values were related to a positive impact on recurrence such as SUVmax (HR 1.21, 95% c.i. 1.06 to 1.38, P = 0.005). Post-neoadjuvant chemotherapy SUVmax ≥3 (HR 3.46, 95% c.i. 1.21 to 9.91; P = 0.036) was an independent prognostic factor for negative impact on survival. Patients with post-neoadjuvant chemotherapy SUVmax <3 showed more chemotherapy cycles (8.7 versus 6.2, P = 0.001), more frequent complete metabolic response (25 vs 2.2%, P = 0.002), smaller tumour size (2.1 vs 3.1 cm, P = 0.002), and less frequent lymphovascular invasion (23.7 vs 51.1%, P = 0.020) than patients with SUVmax ≥3.

Conclusion: Reduction in metabolic tumour parameters of FDG- PET/CT after neoadjuvant chemotherapy indicates improved overall survival and recurrence-free survival.
Author(s)
권재우김규표김송철김재승류백렬박서영박예종송기병오민영유창훈이우형이재훈장흥문전은성정재호황대욱
Issued Date
2021
Type
Article
Keyword
chemotherapy regimenneoadjuvant therapysurgical proceduresoperativeneoplasmssurgery specialtypancreatic cancercomputed tomography/positron emission tomography imagingfluorodeoxyglucose positron emission tomographyprognostic factorschemotherapyneoadjuvant
DOI
10.1093/bjs/znab229
URI
https://oak.ulsan.ac.kr/handle/2021.oak/8557
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_proquest_miscellaneous_2560298915&amp;context=PC&amp;vid=ULSAN&amp;lang=ko_KR&amp;search_scope=default_scope&amp;adaptor=primo_central_multiple_fe&amp;tab=default_tab&amp;query=any,contains,Metabolic%20activity%20by%20FDG-PET%2FCT%20after%20neoadjuvant%20chemotherapy%20in%20borderline%20resectable%20and%20locally%20advanced%20pancreatic%20cancer%20and%20association%20with%20survival&amp;offset=0&amp;pcAvailability=true
Publisher
BRITISH JOURNAL OF SURGERY
Location
미국
Language
영어
ISSN
0007-1323
Citation Volume
109
Citation Number
1
Citation Start Page
61
Citation End Page
70
Appears in Collections:
Medicine > Medicine
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