Prognostic value of SUVmax measured by Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography with Computed Tomography in Patients with Pancreatic Cancer

Hwang, Jae Pil; Lim, Ilhan; Chang, Kyoung Jin; Kim, Byung Il; Choi, Chang Woon; Lim, Sang Moo

Abstract

PURPOSE
Recent studies have been conducted on the relationship between fluorodeoxyglucose (FDG) uptake in F-18 FDG PET/CT and prognosis in patients with pancreatic cancer, but these studies have been carried out in small numbers of patients. The aim of this retrospective study was to determine in a large number of patients whether glucose metabolism as assessed by F-18 FDG PET/CT provides prognostic information independent of established prognostic factors in patients with pancreatic cancer.
METHODS
We reviewed retrospectively the medical records of 165 patients (men 105, women 60, mean age 67+/-10 years) with a diagnosis of pancreatic cancer that had undergone F-18 FDG PET/CT as part of a pretreatment workup from January 2004 to December 2009. Subsequently, all patients underwent surgery, cyberknife, radiotherapy, and/or chemotherapy. For the analysis, patients were classified by age, demographic data, maximum standardized uptake value (SUVmax), size, location, serum level of CA19-9, type of treatment, and AJCC stage. The relationship between FDG uptake and survival was analyzed using the Kaplan-Meier with log-Rank test and Cox's proportional-hazard regression methods.
RESULTS
Median survival for all 165 study subjects was 290 days and median SUV by PET/CT was 5.8 (range: 0-25.1). Patients were allocated to high (>4.1) and low (< or =4.1) SUV groups, and median survivals of these patients were 229 days and 610 days, respectively, which were significantly different (p<0.0001). Furthermore, SUVmax was found to be significantly related to survival in each stage, i.e., there were 1267 days in stage I, 440 days in stage II, 299 days in stage III, and 143 days in stage IV (p<0.0001). The median survival was also found to be significantly related to tumor size (p=0.001), site (p=0.0298), serum level of CA19-9 (p=0.0017), distant metastasis (p<0.0001), and type of treatment (p<0.0001). Multivariate analysis study revealed that the patients with a low SUV (p=0.0298), a lower serum level of CA19-9 (p=0.0071), a lower stage (p=0.0017), and no distant metastasis (p<0.0001) had longer survivals. In addition, SUVmax values were found to have a similar hazard ratio of distant metastasis; it was well known predictor. Furthermore, SUVmax values showed a higher hazard ratio than that of other clinicopathologic predictors.
CONCLUSION
The present study shows that SUVmax on F-18 FDG PET/CT can provide a prognostic information in patients with pancreatic cancer.