Metabolic activity by FDG-PET/CT after neoadjuvant chemotherapy in borderline resectable and locally advanced pancreatic cancer and association with survival
- 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)
- 권재우; 김규표; 김송철; 김재승; 류백렬; 박서영; 박예종; 송기병; 오민영; 유창훈; 이우형; 이재훈; 장흥문; 전은성; 정재호; 황대욱
- Issued Date
- 2021
- Type
- Article
- Keyword
- chemotherapy regimenneoadjuvant therapysurgical procedures; operativeneoplasmssurgery specialtypancreatic cancercomputed tomography/positron emission tomography imagingfluorodeoxyglucose positron emission tomographyprognostic factorschemotherapy; neoadjuvant
- 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&context=PC&vid=ULSAN&lang=ko_KR&search_scope=default_scope&adaptor=primo_central_multiple_fe&tab=default_tab&query=any,contains,Metabolic%20activity%20by%20FDG-PET%2FCT%20after%20neoadjuvant%20chemotherapy%20in%20borderline%20resectable%20and%20locally%20advanced%20pancreatic%20cancer%20and%20association%20with%20survival&offset=0&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
-
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