18-Fluorodeoxyglucose Positron Emission Tomography Predicts Recurrence in Resected Pancreatic Ductal Adenocarcinoma

Kyohei Ariake, Fuyuhiko Motoi, Hideo Shimomura, Masamichi Mizuma, Shimpei Maeda, Chiaki Terao, Yasuko Tatewaki, Hideo Ohtsuka, Koji Fukase, Kunihiro Masuda, Hiroki Hayashi, Tatsuyuki Takadate, Takeshi Naitoh, Yasuyuki Taki, Michiaki Unno

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22 Citations (Scopus)


Background: We aimed to determine whether treatment should be stratified according to 18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) maximum standardized uptake values (SUVmax) in pancreatic ductal adenocarcinoma. Methods: Patients who underwent preoperative 18F-FDG PET/CT between 2006 and 2014 (n = 138) were stratified into high (≥ 4.85) and low (< 4.85) PET groups. The clinicopathological characteristics and prognostic outcomes were analyzed retrospectively. Results: The primary tumor SUVmax was positively correlated with preoperative CA19-9 levels (P < 0.001). The high PET group failed to achieve postoperative CA19-9 normalization (P = 0.014). Disease-specific (P < 0.001), recurrence-free (P < 0.001), liver recurrence-free (P < 0.001), and peritoneal recurrence-free (P = 0.020) survivals were significantly shorter in the high PET group. The primary tumor SUVmax was an independent predictive risk factor for liver metastasis (hazard ratio 3.46, 95% confidence interval 1.61–7.87; P = 0.001) and peritoneal recurrence (hazard ratio 3.36, 95% confidence interval 1.18–10.89; P = 0.023). Conclusions: Surgical resection failed to achieve CA19-9 normalization in the high PET group and distant recurrence was frequent. This suggests the potential for residual cancer at distant sites, even after curative resection. Stronger preoperative systemic chemotherapy is preferred for the high PET group patients.

Original languageEnglish
Pages (from-to)279-287
Number of pages9
JournalJournal of Gastrointestinal Surgery
Issue number2
Publication statusPublished - 2018 Feb 1


  • Pancreatic neoplasm
  • Positron emission tomography
  • Prognosis
  • Recurrence


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