18 F-fluordeoxyglucose PET/CT metabolic parameters in predicting the pathological response and prognosis of patients with borderline resectable and locally advanced pancreatic cancer after receiving neoadjuvant chemotherapy
Objective To explore the value of 18F-fluorodeoxyglucose(18F-FDG)PET/CT metabolic parameters in predicting the path-ological response and prognosis of patients with borderline resectable and locally advanced pancreatic cancer after receiving neoadju-vant chemotherapy(NACT).Methods Clinical data of 39 patients with pancreatic cancer who underwent 18F-FDG PET/CT examina-tion and NACT at Chinese PLA General Hospital from November 2021 to December 2023 were retrospectively analyzed.The patients were divided into treatment response group(n =12)and treatment non-response group(n =27)according to their pathological reactions after receiving NACT.The 18F-FDG PET/CT metabolic parameters of the two groups were compared,including the maximum standard uptake value(SUVmax)and the average standard uptake value(SUVmean),and the metabolic tumor volume(MTV)and total glucose glycolysis(TLG)were calculated using 40%of the pathological SUVmax as the threshold value.The difference of 18F-FDG PET/CT metabolic parameters before and after treatment(ΔSUVmax,ΔSUVmean,ΔTLG,ΔMTV)and the percentage difference of metabolic pa-rameters(ΔSUVmax%,ΔSUVmean%,ΔTLG%,ΔMTV%)were compared between the two groups before and after treatment.The prognosis of the patients was collected and Kaplan-Meier analysis was performed.Results There were significant differences in SUVmax,SUVmean and ΔSUVmax%of 18F-FDG PET/CT metabolic parameters between the two groups after treatment(P<0.05).SUVmax and ΔSUVmax%showed good area under the curve(AUC)after treatment,where the AUC of SUVmax after treatment was 0.790(95%confidence interval:0.641-0.939),the optimal diagnostic threshold was 3.09,the sensitivity and specificity were 0.917(0.598-0.996)and 0.667(0.460-0.828),respectively.The AUC of ΔSUVmax%was 0.753(95%confidence interval:0.593-0.913),the optimal diagnostic threshold was 51.5%,and the sensitivity and specificity were 0.917(0.598-0.996)and 0.703(0.497-0.855),respectively.When TLG =17.94 after treatment was taken as the threshold,patients with TLG<17.94 after treatment had better overall survival(log-rank χ2 =7.793,P =0.005)compared with patients with TLG>17.94 after treatment,but the difference in progression-free survival was not statistically significant(χ2 =3.450,P =0.063).Conclusion 18F-FDG PET/CT metabolic parame-ters have high clinical value in predicting the pathological response and prognosis of borderline resectable and lacally alvanced pancre-atic cancer patients receiving NACT,and can provide more nuclear medicine help for the treatment of borderline resectable and locally advanced pancreatic cancer patients receiving NACT to a certain extent.
18F-fluorodeoxyglucose PET/CTMetabolic parametersBorderline resectable and locally advanced pancreatic cancerPathological reactionPrognosis
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