A Bio-Imaging Signature as a Predictor of Clinical Outcomes in Locally Advanced Pancreatic Cancer

Abstract

Purpose: To evaluate the predictive value of 18F-FDG PET/CT semiquantitative parameters of the primary tumour and CA 19-9 levels assessed before treatment in patients with locally advanced pancreatic cancer (LAPC). Methods: Among one-hundred twenty patients with LAPC treated at our institution with initial chemotherapy followed by curative chemoradiotherapy (CRT) from July 2013 to January 2019, a secondary analysis with baseline 18F-FDG PET/CT was conducted in fifty-eight patients. Pre-treatment CA 19-9 level and the maximum standardized uptake value (SUVmax), metabolic tumour volume (MTV) and total lesion glycolysis (TLG) of primary tumour were measured. The receiving operating characteristics (ROC) analysis was performed to define the cut-off point of SUVmax, MTV, TLG and CA 19-9 values to use in prediction of early progression (EP), local progression (LP) and overall survival (OS). Areas under the curve (AUCs) were assessed for all variables. Post-test probability was calculated to evaluate the advantage for parameters combination. Results: For EP, CA 19-9 level > 698 U/mL resulted the best marker to identify patient at higher risk with OR of 5.96 (95% CI, 1.66–19.47; p = 0.005) and a Positive Predictive Value (PPV) of 61%. For LP, the most significant parameter was TLG (OR 9.75, 95% CI, 1.64–57.87, p = 0.012), with PPV of 83%. For OS, the most significant parameter was MTV (OR 3.12, 95% CI, 0.9–10.83, p = 0.07) with PPV of 88%. Adding consecutively each of the other parameters, PPV to identify patients at risk resulted further increased (>90%). Conclusions: Pre-treatment CA 19-9 level, as well as MTV and TLG values of primary tumour at baseline 18F-FDG PET/CT and their combination, may represent significant predictors of EP, LP and OS in LAPC patients.

CA19.9 Serum Level Predicts Lymph-Nodes Status in Resectable Pancreatic Ductal Adenocarcinoma: A Retrospective Single-Center Analysis

“…Fiore et al in their experience, reported that Ca 19.9 levels higher than 698 U/ml were able to identify early progression of pancreatic cancer in patients who had undergone radical resection. In these patients, the odds to develop a recurrence were six times higher (23).…”

“…However, Ca19.9 assessment has been reported to improve patient selection for neoadjuvant therapies or upfront surgery, followed by adjuvant chemotherapy (22). Furthermore, Ca 19.9 demonstrated its efficacy in combination with PET-CT scan in predicting progression and overall survival in locally advanced PDAC submitted to chemotherapy and radiotherapy (23).…”

Role of CA 19.9 in the Management of Resectable Pancreatic Cancer: State of the Art and Future Perspectives

“…Regarding the ability of CA 19.9 to predict the positivity of the lymph node status before surgery, the risk of a resection with positive margins, the need to proceed with a vascular resection, and the analysis of the literature we conducted ( which certainly is not to be considered exhaustive) would seem to confirm the potential of CA 19.9 [ 9 , 17 , 19 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ].…”

“…Using ROC curve analysis to assess the cut-offs for all those variables, they found a significant association between pre-surgical CA 19.9 levels, OS, and early recurrence. Notably, they reported a six-time higher risk of early recurrence in the presence of a preoperative level of CA 19.9 > 698 U/mL [ 32 ].…”

Role of Neoplastic Markers in Pancreatic Adenocarcinoma

“…Notably, in this report, CA 19.9 values were also significantly associated with oncological outcomes such as early local recurrence and overall survival. In detail, a CA 19.9 value above 698 U/mL in pre-operatory measurement is associated with a six-times higher risk of early recurrence [ 16 ].…”