title: Metabolic Activity by 18F-FDG-PET/CT Is Prognostic for Stage I and II Pancreatic Cancer.
abstract: OBJECTIVE
  Metabolic activity, as defined by F-FDG uptake on PET, is a prognostic marker for multiple malignancies; however, no study has examined the prognostic value of imaging with FDG PET in stage I and II pancreatic cancer. We examined the value of PET FDG uptake in early-stage pancreatic cancer patients.
  
  
  METHODS
  We identified patients with early-stage pancreatic cancer (I-II) who had FDG PET scan performed as part of their preoperative evaluation. The patients were divided into either high or low FDG uptake according to the median primary tumor standard uptake value (SUVmax). Our primary end points were overall survival (OS) and recurrence-free survival (RFS). Kaplan-Meier estimate was used for survival analysis. Pathologic data were compared using the Fisher exact and χ tests.
  
  
  RESULTS
  One hundred five patients were identified: 51 patients with low FDG uptake and 54 patients with high FDG uptake. Eighty-five patients (81%) had PET avid tumors, whereas 20 (19%) patients did not. High FDG uptake correlated with pathologic stage (P = 0.012). Patients with low FDG uptake had significantly better median OS than patients with high FDG uptake (28 vs. 16 months; P = 0.036). Patients with low-FDG uptake had significantly longer median RFS than patients with high FDG uptake (14 vs. 12 months; P = 0.049).
  
  
  CONCLUSIONS
  Low FDG uptake in PET scans in patients with stage I and II pancreatic cancer correlates with improved OS and RFS. This supports the concept that glucose metabolic pathways are important in pancreatic cancer biology and that PET scan activity can be used as a prognostic biomarker after pancreatectomy.
authors.affiliation: From the *Surgical Oncology, H. Lee Moffitt Cancer Center and Research Institute; and †Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Pimiento
authors.forename: Ashley H
authors.initials: AH
authors.lastname: Davis-Yadley
authors.forename: Richard D
authors.initials: RD
authors.lastname: Kim
authors.forename: Dung-Tsa
authors.initials: DT
authors.lastname: Chen
authors.forename: Edward A
authors.initials: EA
authors.lastname: Eikman
authors.forename: Claudia G
authors.initials: CG
authors.lastname: Berman
authors.forename: Mokenge P
authors.initials: MP
authors.lastname: Malafa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18