TY - JOUR
T1 - FDG-PET Predicts Neoadjuvant Therapy Response and Survival in Borderline Resectable/Locally Advanced Pancreatic Adenocarcinoma
AU - Abdelrahman, Amro M.
AU - Goenka, Ajit H.
AU - Alva-Ruiz, Roberto
AU - Yonkus, Jennifer A.
AU - Leiting, Jennifer L.
AU - Graham, Rondell P.
AU - Merrell, Kenneth W.
AU - Thiels, Cornelius A.
AU - Hallemeier, Christopher L.
AU - Warner, Susanne G.
AU - Haddock, Michael G.
AU - Grotz, Travis E.
AU - Tran, Nguyen H.
AU - Smoot, Rory L.
AU - Ma, Wen Wee
AU - Cleary, Sean P.
AU - McWilliams, Robert R.
AU - Nagorney, David M.
AU - Halfdanarson, Thorvardur R.
AU - Kendrick, Michael L.
AU - Truty, Mark J.
N1 - Publisher Copyright:
© 2022 Harborside Press. All rights reserved.
PY - 2022/9
Y1 - 2022/9
N2 - Background: Neoadjuvant therapy (NAT) is used in borderline resectable/ locally advanced (BR/LA) pancreatic ductal adenocarcinoma (PDAC). Anatomic imaging (CT/MRI) poorly predicts response, and biochemical (CA 19-9) markers are not useful (nonsecretors/nonelevated) in many patients. Pathologic response highly predicts survival post- NAT, but is only known postoperatively. Because metabolic imaging (FDG-PET) reveals primary tumor viability, this study aimed to evaluate our experience with preoperative FDG-PET in patients with BR/LA PDAC in predictingNAT response and survival.Methods:We reviewed all patients with resected BR/LA PDAC who underwent NAT with FDGPET within 60 days of resection. Pre- and post-NAT metabolic (FDGPET) and biochemical (CA 19-9) responses were dichotomized in addition to pathologic responses. We compared post-NAT metabolic and biochemical responses as preoperative predictors of pathologic responses and recurrence-free survival (RFS) and overall survival (OS). Results:We identified 202 eligible patients. Post-NAT, 58% of patients had optimization of CA 19-9 levels. Major metabolic and pathologic responses were present in 51% and 38% of patients, respectively. Median RFS andOS timeswere 21 and 48.7months, respectively.Metabolic response was superior to biochemical response in predicting pathologic response (area under the curve, 0.86 vs 0.75; P,.001).Metabolic response was the only univariate preoperative predictor of OS (odds ratio, 0.25; 95% CI, 0.13-0.40), and was highly correlated (P5.001) with pathologic response as opposed to biochemical response alone. After multivariate adjustment,metabolic response was the single largest independent preoperative predictor (P,.001) for pathologic response (odds ratio, 43.2; 95% CI, 16.9-153.2), RFS (hazard ratio, 0.37; 95% CI, 0.2-0.6), and OS (hazard ratio, 0.21; 95% CI, 0.1-0.4). Conclusions: Among patients with post-NAT resected BR/LA PDAC, FDG-PET highly predicts pathologic response and survival, superior to biochemical responses alone. Given the poor ability of anatomic imaging or biochemical markers to assess NAT responses in these patients, FDG-PET is a preoperative metric of NAT efficacy, thereby allowing potential therapeutic alterations and surgical treatment decisions. We suggest that FDG-PET should be an adjunct and recommended modality during the NAT phase of care for these patients.
AB - Background: Neoadjuvant therapy (NAT) is used in borderline resectable/ locally advanced (BR/LA) pancreatic ductal adenocarcinoma (PDAC). Anatomic imaging (CT/MRI) poorly predicts response, and biochemical (CA 19-9) markers are not useful (nonsecretors/nonelevated) in many patients. Pathologic response highly predicts survival post- NAT, but is only known postoperatively. Because metabolic imaging (FDG-PET) reveals primary tumor viability, this study aimed to evaluate our experience with preoperative FDG-PET in patients with BR/LA PDAC in predictingNAT response and survival.Methods:We reviewed all patients with resected BR/LA PDAC who underwent NAT with FDGPET within 60 days of resection. Pre- and post-NAT metabolic (FDGPET) and biochemical (CA 19-9) responses were dichotomized in addition to pathologic responses. We compared post-NAT metabolic and biochemical responses as preoperative predictors of pathologic responses and recurrence-free survival (RFS) and overall survival (OS). Results:We identified 202 eligible patients. Post-NAT, 58% of patients had optimization of CA 19-9 levels. Major metabolic and pathologic responses were present in 51% and 38% of patients, respectively. Median RFS andOS timeswere 21 and 48.7months, respectively.Metabolic response was superior to biochemical response in predicting pathologic response (area under the curve, 0.86 vs 0.75; P,.001).Metabolic response was the only univariate preoperative predictor of OS (odds ratio, 0.25; 95% CI, 0.13-0.40), and was highly correlated (P5.001) with pathologic response as opposed to biochemical response alone. After multivariate adjustment,metabolic response was the single largest independent preoperative predictor (P,.001) for pathologic response (odds ratio, 43.2; 95% CI, 16.9-153.2), RFS (hazard ratio, 0.37; 95% CI, 0.2-0.6), and OS (hazard ratio, 0.21; 95% CI, 0.1-0.4). Conclusions: Among patients with post-NAT resected BR/LA PDAC, FDG-PET highly predicts pathologic response and survival, superior to biochemical responses alone. Given the poor ability of anatomic imaging or biochemical markers to assess NAT responses in these patients, FDG-PET is a preoperative metric of NAT efficacy, thereby allowing potential therapeutic alterations and surgical treatment decisions. We suggest that FDG-PET should be an adjunct and recommended modality during the NAT phase of care for these patients.
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U2 - 10.6004/jnccn.2022.7041
DO - 10.6004/jnccn.2022.7041
M3 - Review article
C2 - 36075389
AN - SCOPUS:85137583558
SN - 1540-1405
VL - 20
SP - 1023
EP - 1032
JO - JNCCN Journal of the National Comprehensive Cancer Network
JF - JNCCN Journal of the National Comprehensive Cancer Network
IS - 9
ER -