한빛사논문
- 조회204
Lee, Woohyung MD, PhDa; Oh, Minyoung MD, PhDb; Kim, Jae Seung MD. PhDb; Sung, Minkyu MD. PhDa; Hong, Kwangpyo MDa; Kwak, Bong Jun MD. PhDa; Park, Yejong MD. PhDa; Jun, Eunsung MD, PhDa; Song, Ki Byung MD, PhDa; Hwang, Dae Wook MD, PhDa; Lee, Jae Hoon MD, PhDa; Yoo, Changhoon MD. PhDc; Kim, Kyu-pyo MD. PhDc; Park, Inkeun MD. PhDc; Jeong, Jae Ho MD. PhDc; Chang, Heung-Moon MD. PhDc; Ryoo, Baek-Yeol MD. PhDc; Lee, Jung Bok PhDd; Kim, Song Cheol MD, PhDe
aDivision of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
bDepartment of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
cDepartment of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
dDepartment of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
eDivision of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Brain Korea 21 Project, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
Drs. Woohyung Lee and Minyoung Oh contributed equally to this work as first authors.
Drs. Song Cheol Kim and Jaeseung Kim contributed equally to this work as corresponding authors.
*Corresponding authors: Song Cheol Kim, Jaeseung Kim
Abstract
Background: There is no standardized assessment for evaluating response although neoadjuvant chemotherapy (NAT) is widely accepted for borderline resectable or locally advanced pancreatic cancer (BRPC or LAPC). This study was aimed to evaluate NAT response using positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose (18F-FDG-PET/CT) parameters alongside carbohydrate antigen (CA) 19-9 levels.
Methods: Patients who underwent surgery after NAT for BRPC and LAPC between 2017 and 2021 were identified. The study assessed the prognostic value of PET-derived parameters after NAT, determining cutoff values using the K-adaptive partitioning method. It created four groups based on the elevation or normalization of PET parameters and CA19-9 levels, comparing survival between these groups.
Results: Of 200 eligible patients, FOLFIRINOX and gemcitabine-based NAT were administered in 167 and 34 patients, respectively (mean NAT cycles, 8.3). In a multivariate analysis, metabolic tumor volume (MTV) demonstrated the most robust performance in assessing response (HR 3.11, 95% CI 1.73-5.58, P<0.001) based on cut-off value of 2.4. Patients with decreased MTV had significantly better survival than those with elevated MTV among individuals with CA19-9 levels <37 IU/L (median survival; 35.5 vs. 20.9 mo, P<0.001) and CA19-9 levels ≥37 IU/L (median survival; 34.3 vs. 17.8 mo, P=0.03). In patients suspected to be Lewis antigen negative, predictive performance of MTV was found to be limited (P=0.84).
Conclusion: Elevated MTV is an influential prognostic factor for worse survival, regardless of post-NAT CA19-9 levels. These results could be helpful in identifying patients with a poor prognosis despite normalization of CA19-9 levels after NAT.
논문정보
- Research article
- 2024년 04월 (BRIC 등록일 2024-03-28)
- 국내 연구진
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