Preoperative CA19‑9 level and dual time point FDG‑PET/CT as strong biological indicators of borderline resectability in pancreatic cancer: A retrospective study

Kobayashi,Kazuki; Einama,Takahiro; Tsunenari,Takazumi; Yonamine,Naoto; Takao,Mikiya; Takihata,Yasuhiro; Tsujimoto,Hironori; Ueno,Hideki; Tamura,Katsumi; Ishida,Jiro; Kishi,Yoji

doi:10.3892/ol.2024.14412

Preoperative CA19‑9 level and dual time point FDG‑PET/CT as strong biological indicators of borderline resectability in pancreatic cancer: A retrospective study

Authors:
- Kazuki Kobayashi
- Takahiro Einama
- Takazumi Tsunenari
- Naoto Yonamine
- Mikiya Takao
- Yasuhiro Takihata
- Hironori Tsujimoto
- Hideki Ueno
- Katsumi Tamura
- Jiro Ishida
- Yoji Kishi
View Affiliations

Affiliations: Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359‑8513, Japan, Department of Radiology, Tokorozawa PET Diagnostic Imaging Clinic, Tokorozawa, Saitama 359‑1124, Japan
Published online on: April 23, 2024 https://doi.org/10.3892/ol.2024.14412
Article Number: 279
Copyright: © Kobayashi et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Tumor resectability, which is increasingly determined based on preoperative chemotherapy, is critical in determining the best treatment for pancreatic cancers. The present study evaluated the usefulness of serum carbohydrate antigen 19‑9 (CA19‑9) and the preoperative 8F‑fluorodeoxyglucose positron emission tomography/computed tomography standardized uptake value (SUV) percentage change (SUVmax%=[(SUVmax2‑SUVmax1)/SUVmax1] x100, where SUVmax1 and SUVmax2 represent the initial and delayed phases, respectively) as biological factors indicative of tumor resectability. The present study included patients with resectable pancreatic cancer who underwent complete surgical resection, for whom both CA19‑9 and SUVmax% were documented using cut‑off values of 500 U/ml and 24.25%, respectively. Patients were classified as follows: i) High CA19‑9 and SUVmax%: both CA19‑9 and SUVmax% were elevated; ii) high CA19‑9 or SUVmax%: either CA19‑9 or SUVmax% were elevated; or iii) low CA19‑9 and SUVmax%: neither value met the cut‑off. Relapse‑free survival (RFS) and overall survival (OS) were calculated, for which univariate and multivariate analyses were performed. Of the 86 patients included, 39 were classified as high CA19‑9 or SUVmax% and 12 as high CA19‑9 and SUVmax%, with the former group having a significantly worse RFS (vs. low CA19‑9 and SUVmax%; P<0.001; vs. high CA19‑9 or SUVmax%; P=0.011) and OS (vs. low CA19‑9 and SUVmax%, P=0.002; vs. high CA19‑9 or SUVmax%, P<0.001). Therefore, high CA19‑9 and SUVmax% was an independent predictor of worse RFS (P<0.001) and OS (P=0.003). In conclusion, CA19‑9 and SUVmax% can be utilized as biological indicators of resectability.

View Figures

View References

1	Masiak-Segit W, Rawicz-Pruszyński K, Skórzewska M and Polkowski W: Surgical treatment of pancreatic cancer. Pol Przegl Chir. 90:45–53. 2018. View Article : Google Scholar : PubMed/NCBI
2	Einama T, Takihata Y, Aosasa S, Konno F, Kobayashi K, Yonamine N, Fujinuma I, Tsunenari T, Nakazawa A, Shinto E, et al: Prognosis of pancreatic cancer based on resectability: A single center experience. Cancers (Basel). 15:11012023. View Article : Google Scholar : PubMed/NCBI
3	National Comprehensive Cancer Network (NCCN), . Clinical Practice Guidelines in Oncology (NCCN guidelines^®): Pancreatic adenocarcinoma. NCCN; Plymouth Meeting, PA: 2023, https://www.nccn.org/patients/guidelines/content/PDF/pancreatic-patient.pdf
4	Isaji S, Mizuno S, Windsor JA, Bassi C, Fernández-Del Castillo C, Hackert T, Hayasaki A, Katz MHG, Kim SW, Kishiwada M, et al: International consensus on definition and criteria of borderline resectable pancreatic ductal adenocarcinoma 2017. Pancreatology. 18:2–11. 2018. View Article : Google Scholar : PubMed/NCBI
5	Hartwig W, Strobel O, Hinz U, Fritz S, Hackert T, Roth C, Büchler MW and Werner J: CA19-9 in potentially resectable pancreatic cancer: Perspective to adjust surgical and perioperative therapy. Ann Surg Oncol. 20:2188–2196. 2013. View Article : Google Scholar : PubMed/NCBI
6	Azizian A, Rühlmann F, Krause T, Bernhardt M, Jo P, König A, Kleiß M, Leha A, Ghadimi M and Gaedcke J: CA19-9 for detecting recurrence of pancreatic cancer. Sci Rep. 10:13322020. View Article : Google Scholar : PubMed/NCBI
7	Liu H, Zenati MS, Rieser CJ, Abbas AA, Lee KK, Singji AD, Bahary N, Hogg ME, Zeh HJ III and Zureikat AH: CA19-9 change during neoadjuvant therapy may guide the need for additional adjuvant therapy following resected pancreatic cancer. Ann Surg Oncol. 27:3950–3960. 2020. View Article : Google Scholar : PubMed/NCBI
8	Mie T, Ozaka M, Okamoto T, Takeda T, Ushida Y, Mori C, Furukawa T, Yamada Y, Kasuga A, Matsuyama M, et al: CA19-9 reduction after 4 months of treatment is a prognostic factor for locally advanced pancreatic cancer. In Vivo. 36:2844–2851. 2022. View Article : Google Scholar : PubMed/NCBI
9	Yazawa S, Asao T, Izawa H, Miyamoto Y and Matta KL: The presence of CA19-9 in serum and saliva from Lewis blood-group negative cancer patients. Jpn J Cancer Res. 79:538–543. 1988. View Article : Google Scholar : PubMed/NCBI
10	Einama T, Yamagishi Y, Takihata Y, Konno F, Kobayashi K, Yonamine N, Fujinuma I, Tsunenari T, Kouzu K, Nakazawa A, et al: Clinical impact of dual time point ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography fusion imaging in pancreatic cancer. Cancers (Basel). 14:36882022. View Article : Google Scholar : PubMed/NCBI
11	Diederichs CG, Staib L, Glatting G, Beger HG and Reske SN: FDG PET: Elevated plasma glucose reduces both uptake and detection rate of pancreatic malignancies. J Nucl Med. 39:1030–1033. 1998.PubMed/NCBI
12	Motoi F, Kosuge T, Ueno H, Yamaue H, Satoi S, Sho M, Honda G, Matsumoto I, Wada K, Furuse J, et al: Randomized phase II/III trial of neoadjuvant chemotherapy with gemcitabine and S-1 versus upfront surgery for resectable pancreatic cancer (Prep-02/JSAP05). Jpn J Clin Oncol. 49:190–194. 2019. View Article : Google Scholar : PubMed/NCBI
13	Wang XY, Yang F, Jin C and Fu DL: Utility of PET/CT in diagnosis, staging, assessment of resectability and metabolic response of pancreatic cancer. World J Gastroenterol. 20:15580–15589. 2014. View Article : Google Scholar : PubMed/NCBI
14	Evangelista L, Zucchetta P, Moletta L, Serafini S, Cassarino G, Pegoraro N, Bergamo F, Sperti C and Cecchin D: The role of FDG PET/CT or PET/MRI in assessing response to neoadjuvant therapy for patients with borderline or resectable pancreatic cancer: A systematic literature review. Ann Nucl Med. 35:767–776. 2021. View Article : Google Scholar : PubMed/NCBI
15	Pu Y, Wang C, Zhao S, Xie R, Zhao L, Li K, Yang C, Zhang R, Tian Y, Tan L, et al: The clinical application of ¹⁸F-FDG PET/CT in pancreatic cancer: A narrative review. Transl Cancer Res. 10:3560–3575. 2021. View Article : Google Scholar : PubMed/NCBI
16	Ghidini M, Vuozzo M, Galassi B, Mapelli P, Ceccarossi V, Caccamo L, Picchio M and Dondossola D: The role of positron emission tomography/computed tomography (PET/CT) for staging and disease response assessment in localized and locally advanced pancreatic cancer. Cancers (Basel). 13:41552021. View Article : Google Scholar : PubMed/NCBI
17	Lee JW, Kang CM, Choi HJ, Lee WJ, Song SY, Lee JH and Lee JD: Prognostic value of metabolic tumor volume and total lesion glycolysis on preoperative ¹⁸F-FDG PET/CT in patients with pancreatic cancer. J Nucl Med. 55:898–904. 2014. View Article : Google Scholar : PubMed/NCBI
18	Mohamed E, Needham A, Psarelli E, Carroll M, Vinjamuri S, Sanghera B, Wong WL, Hlloran C and Ghaneh P: Prognostic value of ¹⁸FDG PET/CT volumetric parameters in the survival prediction of patients with pancreatic cancer. Eur J Surg Oncol. 46:1532–1538. 2020. View Article : Google Scholar : PubMed/NCBI
19	Fiore M, Taralli S, Trecca P, Scolozzi V, Marinelli L, Triumbari EKA, Caputo D, Angeletti S, Ciccozzi M, Coppola A, et al: A bio-imaging signature as a predictor of clinical outcomes in locally advanced pancreatic cancer. Cancers (Basel). 12:20162020. View Article : Google Scholar : PubMed/NCBI
20	Higashi K, Clavo AC and Wahl R: Does FDG uptake measure proliferative activity of human cancer cells? In vitro comparison with DNA flow cytometry and tritiated thymidine uptake. J Nucl Med. 34:414–419. 1993.PubMed/NCBI
21	Sun Y, Duan Q, Wang S, Zeng Y and Wu R: Diagnosis of pancreatic cancer using ¹⁸F-FDG PET/CT and CA19-9 with SUVmax association to clinical characteristics. J BUON. 20:452–459. 2015.PubMed/NCBI
22	Saleh Farghaly HR, Mohamed Sayed MH, Nasr HA and Abdelaziz Maklad AM: Dual time point fluorodeoxyglucose positron emission tomography/computed tomography in differentiation between malignant and benign lesions in cancer patients. Does it always work? Indian J Nucl Med. 30:314–319. 2015. View Article : Google Scholar : PubMed/NCBI
23	Xi Y, Guo R, Hu J, Zhang M, Zhang X and Li B: 18F-fluoro-2-deoxy-D-glucose retention index as a prognostic parameter in patients with pancreatic cancer. Nucl Med Commun. 35:1112–1118. 2014. View Article : Google Scholar : PubMed/NCBI
24	Hata T, Chiba K, Mizuma M, Masuda K, Ohtsuka H, Nakagawa K, Morikawa T, Hayashi H, Motoi F and Unno M: Levels of tumor markers CEA/CA 19-9 in serum and peritoneal lavage predict postoperative recurrence in patients with pancreatic cancer. Ann Gastroenterol Surg. 6:862–872. 2022. View Article : Google Scholar : PubMed/NCBI
25	Tajima H, Makino I, Ohbatake Y, Nakanuma S, Hayashi H, Nakagawara H, Miyashita T, Takamura H and Ohta T: Neoadjuvant chemotherapy for pancreatic cancer: Effects on cancer tissue and novel perspectives. Oncol Lett. 13:3975–3981. 2017. View Article : Google Scholar : PubMed/NCBI
26	Tang TY, Li X, Zhang Q, Guo CX, Zhang XZ, Lao MY, Shen YN, Xiao WB, Ying SH, Sun K, et al: Development of a novel multiparametric MRI radiomic nomogram for preoperative evaluation of early recurrence in resectable pancreatic cancer. J Magn Reson Imaging. 52:231–245. 2020. View Article : Google Scholar : PubMed/NCBI