The role of <sup>18</sup>F-fluorodeoxyglucose positron emission tomography/computed tomography-derived parameters as prognostic factors in patients undergoing resection for pancreatic ductal adenocarcinoma.

Lancellotti, Francesco; Patel, Agastya; Tsaramanidis, Savvas; Edy, Elbert; Satyadas, Thomas; Filobbos, Rafik; Jamdar, Saurabh; Barker, Sharon et al. · Surgery · 2025

retrospective_cohort · Level III

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Abstract

The aim of this study is to investigate the role of maximum standardized uptake and tumor-to-liver ratio derived from preoperative <sup>18</sup>F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with pancreatic ductal adenocarcinoma. Patients who underwent pancreatic resection from January 2015 to December 2022 were reviewed. Patients were grouped based on disease-free survival of 1 year, disease-free survival of 6 months, overall survival of 1 year, and resectability. A total of 133 patients were included in the study. The median maximum standardized uptake was significantly greater in patients with shorter survival than in those with longer survival (disease-free survival <1 year vs >1 year: 7.1 [4.3-9.1] vs 4.9 [3.3-6.5], P < .001; disease-free survival <6 months vs >6 months: 8 [4.5-9.7] vs 5.2 [3.4-6.8], P = .001; overall survival <1 year vs >1 year: 6.9 [4.4-8.8] vs 5 [3.4-6.9], P = .01). Median maximum standardized uptake was significantly greater in patients with intraoperative findings of unresectable disease than in those who underwent surgical resection (7.4 [5.5-9.5] vs 5.5 [3.8-7.8], P = .02). These findings were consistent for tumor-to-liver ratio for all groupings. The area under the curve based on receiver operating characteristic analysis was 0.7 for both maximum standardized uptake and tumor-to-liver ratio for predicting disease-free survival, overall survival, and resectability. Preoperative <sup>18</sup>F-fluorodeoxyglucose positron emission tomography/computed tomography maximum standardized uptake and tumor-to-liver ratio are indicators of resectability, early recurrence, and poor prognosis in patients with pancreatic ductal adenocarcinoma. A maximum standardized uptake value between 5 and 7 is a potential red flag, and further investigations should be considered before proceeding to a pancreatic resection.

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