Mustafa Erol, Hasan Önner, İlknur Küçükosmanoğlu

İnoperabl Pankreas Duktal Adenokarsinomunda Genel Sağ Kalım Öngörücülerinin Değerlendirilmesi

Amaç: Çalışmamızda, inoperabl pankreas duktal adenokarsinomlu (PDAK) hastaların genel sağ kalımının (GSK) bağımsız öngörücü parametreleri araştırılacaktır. Bulunan parametreler, PDAK hastaları için hassas tıp uygulamalarını şekillendirmede potansiyel biyobelirteç olarak kullanılabilecektir. Materyal ve metot: Ocak 2016 - Aralık 2019 tarihleri arasında inoperabl pankreas duktal adenokarsinom tanısı alan ve bölümümüzde 18-florodeoksiglukoz pozitron emisyon tomografisi/bilgisayarlı tomografi (18F-FDG PET/BT) tetkiki yapılan hastaların klinik ve patolojik verileri retrospektif olarak incelendi. 18F-FDG PET/BT görüntülerinden tümörün çapı, maksimumu standardize tutulum değeri (STDmaks), metabolik tümör volümü (MTV) ve toplam lezyon glikolizisi (TLG) hesaplandı. GSK üzerine etki eden değişkenlerin araştırılması için tek değişkenli ve çok değişkenli Cox regresyon analizleri yapıldı. GSK verileri Kaplan–Meier yöntemiyle, log-rank testi kullanılarak incelendi. Bulgular: Çalışmaya ortalama yaşı 65.85 ± 1.64 olan 31’i erkek 17’si kadın toplam 48 hasta dahil edildi. GSK üzerine etki eden faktörleri incelemek için yapılan tek değişkenli Cox regresyon analizlerinde p değeri:< 0.2 olan klinikopatolojik faktörler (tümör lokalizasyonu, tümör çapı, evre) ve 18F-FDG PET/BT parametrelerinin (STDmaks, MTV ve TLG) çok değişkenli Cox regresyon analizine dahil edilmesi sonucu TLG’nin, GSK’ın tek bağımsız öngürücüsü olduğu bulundu. Yapılan Kaplan-Meier analizinde, TLG’nin median değerinin 298.34’ün üzerinde olan hastaların ortanca GSK süresi 13.87 ay iken, TLG değeri bu değerin altında olan hastalarda ortanca GSK süresi 4.97 ay olarak bulundu. Sonuç: Çalışmamızda, tümörün hem metabolik aktivitesini hem de hacmini birlikte yansıtan, 18F-FDG PET/BT parametresi olan TLG değeri, PDAK hastalarının GSK’ının tek bağımsız öngörücüsü olarak bulundu. TLG, inoperabl PDAK'lı hastalarda sağkalım için potansiyel bir biyobelirteç olarak kullanılabilir ve hassas tıp uygulamalarına yardımcı olabilir.

Anahtar Kelimeler:

F-18 florodeoksiglukoz pozitron emisyon tomografisi/bilgisayarlı tomografi, Toplam lezyon glikolizisi, Pankreas duktal adenokarsinomu

Evaluation of Overall Survival Predictions In Inoperable Pancreas Ductal Adenocarcinoma

Objective: In this study, we aimed to determine the independent predictive parameters of overall survival (OS) ofpatients with inoperable pancreatic ductal adenocarcinoma (PDAC) and to investigate whether these parameterscan be used as potential biomarkers to shape precision medicine practices for PDAC patients.Material and Methods: The clinical and pathological data of patients who were diagnosed with inoperablepancreatic ductal adenocarcinoma between January 2016 and December 2019 and who underwent18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) in our departmentwere retrospectively analyzed. Tumor diameter, maximum standardized uptake value (SUVmax), metabolictumor volume (MTV), and total lesion glycolysis (TLG) were calculated from FDG PET/CT images. Univariate andmultivariate Cox regression analyzes were performed to investigate the variable affecting overall survival. Overallsurvival data were analyzed using the Kaplan–Meier method, using the log-rank test.Results: A total of 48 patients, 31 male and 17 female, with a mean age of 65.85 ± 1.64 were included in the study.In univariate Cox regression analyzes were performed to examine the factor affecting OS. Clinicopathologicalfactors (tumor localization, tumor diameter, stage) and FDG PET/CT parameters (SUVmax, MTV and TLG) with ap-value of < 0.2 were compared to multivariate Cox regression analysis. TLG was found to be the only independentpredictor of OS. In the Kaplan-Meier analysis, the median OS duration of the patients with a median value of TLGbelow 298.34 was 13.87 months, while the median OS duration was found to be 4.97 months in patients with a TLGvalue above this value.Conclusion: In our study, TLG value, which is an FDG PET/CT parameter that reflects both the metabolic activity andthe volume of the tumor, was found to be the only independent predictor of the OS of inoperable PDAC patients.TLG can be used as a potential biomarker for survival in patients with inoperable PDAC and may assist precisionmedicine applications.

Keywords:

Pancreatic ductal adenocarcinoma fluorodeoxyglucose, Positron emission tomography / computed tomography, total lesion glycolysis,

PDF

___

Simoes PK, Olson SH, Saldia A, Kurtz RC. Epidemiology of pancreatic adenocarcinoma. Chin Clin Oncol 2017;6:24-24.
Siegel RL., Miller KD, Jemal A. Cancer statistics. CA: a cancer journal for clinicians 2016;66:7-30.
Addeo P, Velten M, Averous G, Faitot F, et al. Prognostic value of venous invasion in resected T3 pancreatic adenocarcinoma: depth of invasion matters. Surgery 2017;162:264-274.
Shaib Y, Davila J, Naumann C, El-Serag H. The impact of curative intent surgery on the survival of pancreatic cancer patients: a US Population-based study. ACG 2007;102:1377-1382.
Risum S, Høgdall C., Loft A, et al. Prediction of suboptimal primary cytoreduction in primary ovarian cancer with combined positron emission tomography/computed tomography—a prospective study. Gynecol Oncol 2008;108:265-270.
Nakata B, Nishimura S, Ishikawa T. Prognostic predictive value of 18F-fluorodeoxyglucose positron emission tomography for patients with pancreatic cancer. Int J Oncol 2001;19:53-58.
Maisey NR, Webb A, Flux GD, et al. FDG–PET in the prediction of survival of patients with cancer of the pancreas: a pilot study. Br J Cancer, 2000;83:287-293.
Zimny M, Fass J, Bares R, Cremerius U, et al. Fluorodeoxyglucose positron emission tomography and the prognosis of pancreatic carcinoma. Scand. J Gastroenterol 2000;35:883-888.
Brierley JD, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours. 7th ed. Geneva: John Wiley & Sons 2017;1025-1027.
Lim JE, Chien MW Earle CC, et al. Prognostic factors following curative resection for pancreatic adenocarcinoma: a population-based, linked database analysis of 396 patients. Ann Surg 2003;237:74-80.
Jamieson NB, Mohamed M, Oien KA, et al. The relationship between tumor inflammatory cell infiltrate and outcome in patients with pancreatic ductal adenocarcinoma. Ann Surg Oncol 2012;19:3581-3590.
Oshima M, Okano K, Muraki S, et al. Immunohistochemically detected expression of 3 major genes (CDKN2A/p16, TP53, and SMAD4/DPC4) strongly predicts survival in patients with resectable pancreatic cancer. Ann Surg 2013;258:336-346.
Önner H, Canaz F, Dinçer M, et al. Which of the fluorine-18 fluorodeoxyglucose positron emission tomography/computerized tomography parameters are better associated with prognostic factors in breast cancer?. Medicine 2019;98:22-28.
Kaida H, Toh U, Hayakawa M, et al. The relationship between 18F-FDG metabolic volumetric parameters and clinicopathological factors of breast cancer. Nucl Med Commun 2013;34:562-570.
Hatt M, Visvikis D, Albarghach NM, et al. Prognostic value of 18 F-FDG PET image-based parameters in oesophageal cancer and impact of tumour delineation methodology. Eur J Nucl Med Mol Imaging 2011;38:1191-1202.
Zhang H, Wroblewski K, Liao S, et al. Prognostic value of metabolic tumor burden from 18F-FDG PET in surgical patients with non–small-cell lung cancer. Acad Radiol 2013;20:32-40.
Erol M, Önner H, Taştekin G. Akciğer Kanserli Hastalarda F-18 FDG PET/BT Parametrelerinin Klinik Evre ile İlişkisi. Selcuk Med J 2021;37(1): 24-31.
Hatt M, Cheze-Le Rest C, Aboagye E, et al. Reproducibility of 18F-FDG and 3’-deoxy-3’-18F-fluorothymidine PET tumor volume measurements. J Nucl Med 2010;51:1368–76.