title: Maximum Standard Uptake Value as a Clinical Biomarker for Detecting Loss of SMAD4 Expression and Early Systemic Tumor Recurrence in Resected Left-Sided Pancreatic Cancer.
abstract: This study investigated the oncologic impact of loss of SMAD4 expression in resected left-sided pancreatic cancer and its correlation with tumor metabolism.From 2005 to 2011, the medical records of patients who underwent radical distal pancreatectomy for resectable pancreatic cancer were retrospectively reviewed. Formalin-fixed, paraffin embedded tissue from 32 patients was investigated. Clinicopathological characteristics, immunostaining of SMAD4, and positron emission tomography-based parameters were analyzed in relation to oncologic outcomes.Thirteen patients were women and 19 were men, with a mean age of 63 ± 9.4 years. Mean resected tumor size was 3.3 ± 1.5 cm. Ten patients (31.3%) showed loss of SMAD4 expression. No significant clinicopathological differences were noted according to SMAD4 expression (P > 0.05); however, patients with loss of SMAD4 showed significantly poorer disease-free survival (mean 57.4 months vs mean 17.6 months, P = 0.006). As a cut-off value, a SUVmax of 4.5 was found to be predictive of loss of SMAD4 with a sensitivity of 75% and a specificity of 84.6%. In logistic regression analysis, SUVmax>4.5 was found to infer a 16-fold higher risk for loss of SMAD4 in resected left-sided pancreatic cancers (Exp[β] = 16.5, P = 0.012, 95% confidence interval: 1.832-148.606).Loss of SMAD4 is associated with poor oncologic outcomes. SUVmax can predict loss of SMAD4 in resected left-sided pancreatic cancer. SUVmax may be a clinical biomarker for detecting loss of SMAD4 expression and predicting early systemic metastasis.
authors.affiliation: From the Department of Surgery (CMK, HKH, JP, WJL); Nuclear Medicine (MY); Medical Informatics and Biostatistics (CK, S-KC), Yonsei University College of Medicine; and Pancreaticobiliary Cancer Clinic (CMK, HKH, JP, MY, WJL), Institute of Gastroenterology, Severance Hospital, Seoul, Korea.
authors.forename: Chang Moo
authors.initials: CM
authors.lastname: Kang
authors.forename: Ho Kyoung
authors.initials: HK
authors.lastname: Hwang
authors.forename: Jiae
authors.initials: J
authors.lastname: Park
authors.forename: Changsoo
authors.initials: C
authors.lastname: Kim
authors.forename: Seong-Kyoung
authors.initials: SK
authors.lastname: Cho
authors.forename: Mijin
authors.initials: M
authors.lastname: Yun
authors.forename: Woo Jung
authors.initials: WJ
authors.lastname: Lee
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000235:genetics*; D005260:Female; D019788:Fluorodeoxyglucose F18; D020868:Gene Silencing; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000235:genetics* / Q000401:mortality / Q000473:pathology; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000235:genetics* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D011379:Prognosis; D051901:Smad4 Protein / Q000235:genetics*; D013223:Statistics as Topic; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed
chemical_list: D014408:Biomarkers, Tumor; C497796:SMAD4 protein, human; D051901:Smad4 Protein; D019788:Fluorodeoxyglucose F18