Prognostic Value of Metabolic Tumor Volume and Total Lesion Glycolysis on Preoperative ¹⁸F-FDG PET/CT in Patients with Pancreatic Cancer

Abstract

In this study, we aimed to assess the prognostic value of metabolic tumor volume (MTV) and total lesion glycolysis (TLG) measured on 18 F-FDG PET/CT in pancreatic cancer patients who underwent resection with curative intent. Methods: Eighty-seven patients with pancreatic ductal adenocarcinoma who underwent 18 F-FDG PET/ CT and subsequent surgical resection with curative intent with (30 patients) or without (57 patients) neoadjuvant therapy were retrospectively enrolled. The maximum standardized uptake value (SUVmax), MTV, and TLG were measured on 18 F-FDG PET/CT in all patients. The prognostic significances of PET/CT parameters and tumor factors for recurrence-free survival (RFS) and overall survival (OS) were evaluated by univariate and multivariate analyses. Results: Of the 87 patients, 57 (64%) experienced recurrence during the follow-up period. The tumor size, pathologic T (pT) stage, SUVmax, MTV, and TLG were significant prognostic factors for both RFS and OS (P , 0.05) on univariate analyses, and the presence of lymph node metastasis showed significance only for predicting RFS (P , 0.05). On multivariate analyses, the tumor size, MTV, and TLG were independent prognostic factors for RFS, and pT stage, MTV, and TLG were independent prognostic factors for OS. For the 57 patients who did not undergo neoadjuvant treatment, MTV and TLG remained significant predictive factors for tumor recurrence, along with tumor size and SUVmax. Conclusion: MTV and TLG are independent prognostic factors for predicting RFS and OS in patients with pancreatic cancer. Thus, 18 F-FDG PET/CT can provide useful prognostic information for patients undergoing resection of pancreatic cancer with curative intent irrespective of neoadjuvant treatment.

Quantitative 18F‑FDG PET analysis in survival rate prediction of patients with non‑small cell lung cancer

“…Results from recent studies demonstrate that MTV and TLG were computed using a maximum percentage threshold of 40-50% (30,31). However, other studies used a fixed SUV threshold, most commonly SUV2.5, where SUV>2.5 is the absolute threshold (TLG2.5 or MTV2.5), particularly for segmentation of lung tumors (32–34). Increasing interest in volumetric indices has led to the development of commercially available tools, for example PETVCAR, which enables the rapid and simple measurement of numerous indices for tumor analysis, including various threshold values of MTV and TLG (typically, 41-70% of SUV max within the tumor) (35).…”

Changes in Total Lesion Glycolysis Evaluated by Repeated F-18 FDG PET/CT as Prognostic Factor in Locally Advanced Esophageal Cancer Patients Treated with Preoperative Chemoradiotherapy

“…However, the current study showed the prognostic roles of OS and RFS in MTV only in univariate analysis. It is well known that pretreatment MTV and TLG are potent prognostic factors in various cancers [29,30,31]. Nevertheless, conflicting results regarding the prognostic role of sequential F-18 FDG PET/CT still exist in LAEC patients treated with preoperative CRT.…”

Advancement in treatment and diagnosis of pancreatic cancer with radiopharmaceuticals

“…Results revealed that metabolic tumor volume and total lesion glycolysis are independent prognostic factors for predicting RFS and OS. Thus, 18 F-FDG PET/CT can provide useful prognostic information for patients undergoing resection of PC with curative intent irrespective of neoadjuvant treatment [46] . Choi et al [47] evaluated the prognostic value of 18 F-FDG PET in patients with resectable PC.…”