Regional lymph node metastasis detected on preoperative CT and/or FDG-PET may predict early recurrence of pancreatic adenocarcinoma after curative resection

Abstract

The objective of this study was to evaluate the role of regional lymph node (LN) metastasis detected on preoperative CT and/or 18F-fluoro-2-deoxyglucose-positron emission tomography (FDG-PET) scans in the prediction of early tumor recurrence after curative surgical resection of pancreatic ductal adenocarcinoma (PDAC). This retrospective study included 137 patients who underwent upfront surgery with R0 resection of PDAC between 2013 and 2016. Regional LN metastasis was identified using two criteria: positive findings for regional LN metastasis on either preoperative CT or FDG-PET scans (LNOR), or on both preoperative CT and FDG-PET scans (LNAND). A total of 55 patients had early tumor recurrence within 12 months after curative resection. Univariable and multivariable Cox proportional hazard regression analysis showed that preoperative carbohydrate antigen 19–9 (CA19-9) levels, preoperative locally advanced status, and regional LN metastasis (both LNOR and LNAND criteria) were significant risk factors for early recurrence. Positive LNOR and LNAND showed significantly poorer recurrence-free survival compared to negative regional LN metastasis groups (p = 0.048 and p = 0.020, respectively). Compared with the LNAND criteria, the LNOR criteria provided higher sensitivity (22.4% vs. 15.5%, p = 0.046) and a higher negative predictive value (61.9% vs. 59.8%, p = 0.046). The LNOR definition provided more sensitive and accurate performance in diagnosing preoperative regional LN metastasis.

A deep-learning radiomics-based lymph node metastasis predictive model for pancreatic cancer: a diagnostic study

“…The PET examination relies on the metabolic characteristic of tissues, and it is proposed to be able to precisely diagnose LN metastasis. However, the sensitivity of PET is reported as unsatisfactory previously as well 24 . Also, considering the radioactivity and high price, the PET examination was actually not commonly used in clinical.…”

Predicting Recurrence-Free Survival After Upfront Surgery in Resectable Pancreatic Ductal Adenocarcinoma: A Preoperative Risk Score Based on CA 19-9, CT, and 18F-FDG PET/CT

“…To address the low sensitivity of both modalities, we combined the findings of 18 F-FDG PET/CT and CT to identify suspicious regional LNs, resulting in a modest improvement in sensitivity (32.0%) and a slight reduction in specificity (84.8%). Despite the low sensitivity of both modalities, the prognostic value of suspicious regional LNs detected using 18 F-FDG PET/CT or CT was also recently reported [ 38 ]. Taken together, the presence of suspicious regional LN detected using 18 F-FDG PET/CT or CT suggests the presence of pathological LN metastasis and a high risk of recurrence in patients with resectable PDAC.…”

Development and Validation of a Nomogram for Preoperative Prediction of Early Recurrence after Upfront Surgery in Pancreatic Ductal Adenocarcinoma by Integrating Deep Learning and Radiological Variables

“…PDAC with artery involvement has been reported in association with advanced tumor characteristics, lower R0 resection rate, and higher recurrence rate [27][28][29]. With respect to the cN stage, a number of studies [14,21,30] reported that the detection of lymph node metastasis preoperative CT scans (cN1/2) was a useful predicter of ER. The nomogram integrating the deep learning model outputs and these two radiological variables showed an improved predictive performance over the clinical model.…”