Prognostic value of intratumoral heterogeneity of preoperative 18 F-FDG PET/CT in pancreatic cancer.

Abstract

The purpose of current study was to investigate the value of textural features used fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18 F-FDG PET/CT) in predicting recurrence-free survival (RFS) and overall survival (OS) in patients with pancreatic cancer. Seventy two patients with pancreatic cancer who underwent 18F-FDG PET/CT prior to curative surgical treatment were enrolled. Conventional parameters, such as maximum standardize uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were measured. Twenty-two textural features were extracted from PET images derived from first-order and 4 higher-order matrices: Grey level co-occurrence matrix (GLCM), neighborhood grey-level different matrix (NGLDM), grey-level run length matrix (GLRLM), and grey-level zone length matrix (GLZLM). Independent predictive factors for survival were determined using Cox proportional hazards regression models. The SUVmax did not have prognostic values for RFS and OS. Median values of TLG and intratumoral heterogeneity parameter (kurtosis) were 63.95, and 3.15. High TLG and high kurtosis patients group showed shorter OS. Cox proportional hazards regression analysis revealed differentiation of the tumor, kurtosis and TLG were the significant predictive factors on OS. Besides, kurtosis presented no correlation with the conventional PET parameters, such as SUVmax, MTV and TLG. This study suggests that intratumoral heterogeneity and volumetric parameter induced by 18F-FDG PET/CT could be significant prognostic surrogate markers in patients with pancreatic cancers.