Abstract
ObjectivesMetabolic tumor volume (MTV) on 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) is a promising prognostic predictor in pancreatic ductal adenocarcinoma (PDAC). However, the optimal segmentation method and threshold value to determine MTV for PDAC are still unclear. We explored the optimal method and threshold value for the prognostic value of MTV measured on pre-treatment 18F-FDG-PET/CT.MethodsSeventy-three patients with resected PDAC who underwent 18F FDG-PET/CT before surgical resection were enrolled. MTV values of the tumor were measured on FDG-PET/CT by the two fixed-threshold methods using threshold values as 2.0, 2.5, 3.0, and 3.5 for the absolute method and 35%, 40%, 42%, 45%, and 50% for the relative method. Receiver operating characteristic curve analysis for prediction of 1-year survival rates was conducted for determining the optimal threshold values, and we selected the optimal method and threshold value considering area under the curve. The prognostic values of each FDG-PET/CT parameter for disease-specific survival and recurrence-free survival were assessed with Kaplan–Meier method and Cox proportional hazard models.ResultsIn receiver operating characteristic curve analysis, MTV by the fixed-absolute threshold method based on a threshold value of 3.5 (MTV3.5) performed best in our study with area under the curve 0.724, sensitivity of 65%, and specificity of 75%. In univariate and multivariate analyses, MTV3.5 was significantly associated with disease-specific and recurrence-free survival.ConclusionsMTV3.5 by absolute threshold on pre-treatment FDG-PET/CT was the best independent prognostic predictor in resectable PDAC compared with other absolute threshold values and relative threshold values.
Highlights
Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal carcinomas and the fourth leading cause of cancer-related death in Japan [1]
We evaluated the prognostic value of metabolic tumor volume (MTV) measured on pretreatment 18F-FDG-PET/CT for resected patients with
Our study demonstrated that the fixed-absolute threshold method is superior to the fixed-relative threshold method for determining MTV and that the optimal threshold value is standardized uptake value (SUV) > 3.5
Summary
Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal carcinomas and the fourth leading cause of cancer-related death in Japan [1]. The volumetric parameters associated with 18F-FDG PET/CT such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were reported to be effective prognostic factors in patients with PDAC [9,10,11,12,13,14]. These parameters have been considered more reliable for predicting prognosis than SUVmax because they reflect tumor glucose metabolism level and whole tumor burden [15]
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