Prognostic value of 18F-FDG-PET/CT parameters in patients with pancreatic carcinoma

Abstract

Background:The identification of pancreatic carcinoma (PC) patients with poor prognosis is a priority in clinical oncology because of their high 5-year mortality. However, the prognostic value of pretreatment 18F-fluorodeoxyglucose (18F-FDG)- positron emission tomography (PET)/computed tomography (CT) parameters in PC patients is controversial and no consensus exists as to its predictive capability. This meta-analysis was performed to comprehensively explore the prognostic significance of 18F-FDG-PET/CT parameters in patients with pancreatic carcinoma.Methods:Extensive literature searches of the PubMed, Embase, Web of Science, and Cochrane Library databases were conducted to identify literature published until March 5, 2017. Comparative analyses of the pooled hazard ratios (HRs) for event-free survival (EFS) and overall survival (OS) were performed to assess their correlations with pretreatment maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG). Either the fixed- or the random-effects model was adopted, depending on the heterogeneity observed across studies. Subgroup and sensitivity analyses were performed to assess the robustness of the results.Results:Sixteen studies including 1146 patients were identified. The pooled HRs for the probability of EFS were 1.90 (95% confidential interval (CI): 1.48–2.45) for SUVmax, 1.76 (95% CI: 1.20–2.58) for MTV, and 1.81 (95% CI: 1.27–2.58) for TLG. The pooled HRs for the probability of OS were 1.21 (95% CI: 1.12–1.31) for SUVmax, 1.56 (95% CI: 1.13–2.16) for MTV, and 1.70 (95% CI: 1.25–2.30) for TLG. A slight publication bias was detected using Begg test. After adjustment using the trim and fill procedure, the corrected HRs were not significantly different. The results of the subgroup analyses by SUVmax, MTV, and TLG showed that these factors may have similar prognostic significance.Conclusion:18F-FDG-PET/CT parameters, such as SUVmax, MTV, and TLG, may be significant prognostic factors in patients with pancreatic carcinoma. 18F-FDG-PET/CT imaging could be a promising tool to provide prognostic information for these patients.

How new technologies could impact on radiology diagnosis and assessment of pancreatic lesions: Future perspectives

“…Glucose analog 18 F-fluorodeoxyglucose as metabolic tracer enables to recognize active metabolic areas such as in tumors or in infections. [ 17 ]…”

“…PET/CT is extensively used in diagnosing, staging, and post-therapy follow-up of PDAC. [ 16 17 ] A recent meta-analysis performed by Zhu et al . emerges the role of PET/CT as a prognostic factor to predict overall survival and event-free survival in PDAC.…”

“…emerges the role of PET/CT as a prognostic factor to predict overall survival and event-free survival in PDAC. [ 17 ] However, large heterogeneity of the studies decreases the statistical power of the analysis, and the authors concluded that larger and multicenter studies are necessary to strengthen the results and clinical applications.…”

High Metabolic Tumor Volume and Total Lesion Glycolysis Derived from Baseline 18 F-FDG PET/CT may Predict the Metabolic Abnormalities in Newly Diagnosed Cancer Patients

“…Currently, it was shown that MTV (metabolic tumor volume) and TLG (total lesion glycolysis) values, measurable by FDG PET/CT, could be better than SUVmax alone for assessing and predicting entire tumor burden, overall metabolic activity and prognosis of several malignancies. [8][9][10] Recently, the correction of metabolic disorders and external replacement of decreased essential vitamins and minerals in patients before receiving chemotherapy and radiotherapy is considered as an adjunct to cancer treatment and thus, therapeutic response can be improved, the adverse effects of chemotherapy and radiotherapy can be better tolerated, and as a result patient's quality-of-life be improved. 3,4,11,12 However, measurement and evaluation of most of the specific vitamins and minerals are non-cost-effective and cause intensive labor and time loss.…”

Utilidad pronóstica del PET/CT en cáncer de páncreas

“…Para medir esta captación, se han utilizado índices semicuantitativos que traducen la intensidad de captación de FDG en el tumor primario (valor de captación estándar: SUV), la masa tumoral activa (volumen tumoral metabólico: VTM), o una combinación de ambos (masa tumoral glicolítica: MTG) 8,12,13,14 . En un reciente metaanálisis sobre la utilidad pronóstica del PET/CT en cáncer pancreático, Zhu et al 15 recopilan la experiencia de 16 estudios en un total de 1.146 pacientes, y a pesar de la heterogeneidad de los resultados encontrados, concluyen que el valor de captación estándar máximo (SUVmax), VTM y MTG pudieran ser factores pronósticos significativos en estos pacientes. En nuestra revisión bibliográfica, no encontramos publicaciones referentes a la experiencia local ni regional en la evaluación de la utilidad pronóstica del PET/CT en cáncer pancreático.…”