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Preoperative 18-FDG PET Predicts Survival in Resectable Pancreatic Cancer
Mario Gruppo*1, Valentina Beltrame1, Enrico Dalla Bona1, Sergio Bissoli2, Sergio Pedrazzoli1, Stefano Merigliano1, Cosimo Sperti1
1Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Padova, Italy; 2Department of Nuclear Medicine, Castelfranco General Hospital, Castelfranco Veneto, Italy
Context
The identification of prognostic factors useful in selecting patients with pancreatic cancer who will benefit from surgery or other treatments, is still debating. Preliminary reports showed that 18-Fluorodeoxyglucose Positron Emission Tomography (18-FDG PET) was predictive of prognosis in patients resected on for pancreatic adenocarcinoma (Sperti et al , J.Gastrointest Surg., 2003).
Objective
The aim of this study is to evaluate the role of 18 FDG PET as a prognostic factor for patients who underwent resection for pancreatic cancer.
Methods
From January 2004 to July 2011, a total of 110 patients who underwent resection for pancreatic cancer, were examined with 18-FDG PET (with-CT acquisition) in their preoperative work-up. The standardized uptake value (SUV) of 18 FDG was calculated and the patients were divided into high (> 4.0) and low (≤ 4.0) SUV groups. They were also evaluated according to the tumor node status, stage (TNM), tumor grade, radicality of resection, and serum CA 19-9 levels .
Results
Fifty-four cancers showed low and 56 high SUVs. Disease free survival (DFS) was significantly influenced by tumor stage (p=0.003), node status (p=0.003), radicality of resection (p=0.004), SUV (p=0.0001), CA 19-9 (p=0.001) and grading (p=0.04). Multivariate analysis showed that only stage (p=0.02) and CA 19-9 (p=0.008) were independent predictors of DFS. Overall survival was significantly influenced by node status (p=0.001), radicality of resection (p=0.001), stage (p=0.0001), SUV (p=0.001), CA 19-9 (p=0.0001) and grading (p=0.008). Multivariate analysis showed that stage (p=0.004), CA 19-9 (p=0.001), SUV (p=0.004) and radicality (p=0.02) were independent predictors of survival. When patients analyzed for SUV were stratified according to stage, FDG uptake was related to DFS (p=0.01) and overall survival (p=0.001) in tumor's stage I-II. Stratification for CA 19-9 levels, showed that SUV was related to DFS (P=0.01) and overall survival (p=0.002) in patients with high tumor marker levels. In these patients, multivariate analysis confirmed that SUV was independent predictor of survival.
Conclusion
This study confirm that tumor stage and CA 19-9 serum levels are the strongest independent factors influencing disease-free and overall survival after resection for pancreatic cancer. SUV, calculated with 18 FDG PET, is an independent predictor of overall survival, and an important prognostic parameter in stage I-II pancreatic carcinoma and may be useful in selecting patients for neo-adjuvant therapy.
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