18-FDG pet as factor in predicting survival of patients with pancreatic carcinoma

The prognosis of patients with pancreatic adenocarcinoma is usually very poor; the prediction of survival by clmicopathologic features is often difficult. Recently, the uptake of 18-FDG in PET scan has been found to be correlated with survival in patients with pancreatic cancer. Aim of this study was to evaluate the role of 18-FDG PET as prognostic factor for the patients with pancreatic adenocarcinoma. From 1996 to 2001 48 out of 106 patients who had a PET scan in the preoperative work-up for pancreatic cancer, received also an additional abdominal PET scan .'~ith semiqnantitative analysis of the uptake. The standardized uptake value (SUV: n.v 4. Patients were evaluated according to TNM (UICC) classification, gradig of the tumor, and type of operation. Survival curves were prepared using the Kaplan-Meier method, and statistical comparisons were made by log-rank test. A Cox proportional-hazards analysis was used to determine the independent variables that influenced survival. Significance was considered as p 4. Survival was significantly influenced by tumor stage (p <: 0.001) when divided in two groups (stage IVb vs. stage Iva, III and I), grading (p = 0.007) and by SUV value (p = 0.01). Multivariate analysis showed that stage (p = 0.004), grading (p = 0.005), and SUV (p = 0.032) were independent predictors of survival. When the patients analyzed for SUV value, were stratified according to TNM stage, FDG uptake was related to survival (p = 0.023) only in those patients without distant metastases. Conclusions: SUV determination in abdominal FDG-PET provides informations of prognostic relevance in patients with pancreatic cancer before surgery or medical treatment, and may therefore be useful in the selection of patients for therapeutic management.