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Eur J Nucl Med Mol Imaging. 2017 Nov;44(12):1995-2003. doi: 10.1007/s00259-017-3755-8. Epub 2017 Jun 20.

Heterogeneity index evaluated by slope of linear regression on 18F-FDG PET/CT as a prognostic marker for predicting tumor recurrence in pancreatic ductal adenocarcinoma.

Author information

1
Department of Nuclear Medicine, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.
2
Department of Nuclear Medicine, Seoul National University Hospital, Seoul, South Korea.
3
Veterans Health Service Medical Center, Seoul, South Korea.
4
Cancer Research Institute, Seoul National University, Seoul, South Korea.
5
Department of Nuclear Medicine, Seoul National University Hospital, Seoul, South Korea. kangkw@snu.ac.kr.
6
Cancer Research Institute, Seoul National University, Seoul, South Korea. kangkw@snu.ac.kr.
7
Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea. kangkw@snu.ac.kr.
8
Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 03080, South Korea. kangkw@snu.ac.kr.

Abstract

PURPOSE:

18F-Fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) has been investigated as a method to predict pancreatic cancer recurrence after pancreatic surgery. We evaluated the recently introduced heterogeneity indices of 18F-FDG PET/CT used for predicting pancreatic cancer recurrence after surgery and compared them with current clinicopathologic and 18F-FDG PET/CT parameters.

METHODS:

A total of 93 pancreatic ductal adenocarcinoma patients (M:F = 60:33, mean age = 64.2 ± 9.1 years) who underwent preoperative 18F-FDG PET/CT following pancreatic surgery were retrospectively enrolled. The standardized uptake values (SUVs) and tumor-to-background ratios (TBR) were measured on each 18F-FDG PET/CT, as metabolic parameters. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were examined as volumetric parameters. The coefficient of variance (heterogeneity index-1; SUVmean divided by the standard deviation) and linear regression slopes (heterogeneity index-2) of the MTV, according to SUV thresholds of 2.0, 2.5 and 3.0, were evaluated as heterogeneity indices. Predictive values of clinicopathologic and 18F-FDG PET/CT parameters and heterogeneity indices were compared in terms of pancreatic cancer recurrence.

RESULTS:

Seventy patients (75.3%) showed recurrence after pancreatic cancer surgery (mean recurrence = 9.4 ± 8.4 months). Comparing the recurrence and no recurrence patients, all of the 18F-FDG PET/CT parameters and heterogeneity indices demonstrated significant differences. In univariate Cox-regression analyses, MTV (P = 0.013), TLG (P = 0.007), and heterogeneity index-2 (P = 0.027) were significant. Among the clinicopathologic parameters, CA19-9 (P = 0.025) and venous invasion (P = 0.002) were selected as significant parameters. In multivariate Cox-regression analyses, MTV (P = 0.005), TLG (P = 0.004), and heterogeneity index-2 (P = 0.016) with venous invasion (P < 0.001, 0.001, and 0.001, respectively) demonstrated significant results.

CONCLUSIONS:

The heterogeneity index obtained using the linear regression slope, could be an effective predictor of pancreatic cancer recurrence after pancreatic cancer surgery, in addition to 18F-FDG PET/CT volumetric parameters and clinicopathologic parameters.

KEYWORDS:

Heterogeneity; Metabolic tumor volume; Pancreatic cancer; Recurrence; Total lesion glycolysis

PMID:
28634684
DOI:
10.1007/s00259-017-3755-8
[Indexed for MEDLINE]

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