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

BackgroundThe 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. MethodsPatients who underwent pancreatic resection from January 2015 to December 2022 were reviewed. Patients were grouped based on disease-free survival of 1year, disease-free survival of 6months, overall survival of 1year, and resectability. ResultsA total of 133 patients were included in the study. The median maximum standardized uptake wassignificantly greater in patients with shorter survival than in those with longer survival (disease-free survival 1year: 7.1 [4.3-9.1] vs 4.9 [3.3-6.5],[italic]P[/italic]< .001; disease-free survival 6months: 8 [4.5-9.7] vs 5.2 [3.4-6.8],[italic]P[/italic]= .001; overall survival 1year: 6.9 [4.4-8.8] vs 5 [3.4-6.9],[italic]P[/italic]= .01). Median maximum standardized uptake was significantly greater in patients withintraoperative findings of unresectable disease than in those who underwent surgical resection (7.4[5.5-9.5] vs 5.5 [3.8-7.8],[italic]P[/italic]= .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. ConclusionPreoperative[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.