ArticleJournal of the National Comprehensive Cancer Network : JNCCN2022
FDG-PET Predicts Neoadjuvant Therapy Response and Survival in Borderline Resectable/Locally Advanced Pancreatic Adenocarcinoma.
Article in Journal of the National Comprehensive Cancer Network : JNCCN, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 42 papers.
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Who cites it
42 citing papers in PubMed, 55 citations in OpenAlex.
- Restaging the primary tumor in localized pancreatic ductal adenocarcinoma after systemic therapy: a scoping review of the role of CT, FDG-PET, and CA19-9.European radiology · 2026Review
- Development and validation of a nomogram based on three-dimensional quantitative parameters from dual-layer detector spectral computed tomography for predicting treatment response to neoadjuvant chemotherapy in pancreatic ductal adenocarcinoma.Journal of gastrointestinal oncology · 2026Article
- Pancreatic ductal adenocarcinoma and pancreatic surgery in the 21st century: triumphs, turning points, and unresolved challenges.Updates in surgery · 2026Review
- Repeatability of semi-quantitative [European journal of nuclear medicine and molecular imaging · 2026Article
- ASO Author Reflections: Arterial Reconstruction in Pancreatic Cancer: Shifting from Anatomical Feasibility Towards Biological Selection.Annals of surgical oncology · 2026Article
- Surgical Perspectives on Neoadjuvant Therapy in Borderline Resectable and Locally Advanced Pancreatic Cancer.Cancers · 2026Review
- Predicting overall survival in pancreatic ductal adenocarcinoma usingEJNMMI research · 2026Article
- Surgical decision-making in borderline resectable pancreatic cancer in the era of neoadjuvant therapy: from response assessment to individualized operative strategy.Frontiers in surgery · 2026Review
- Early postoperative recurrence prediction in pancreatic ductal adenocarcinoma: a nomogram based on dual-energy computed tomography andQuantitative imaging in medicine and surgery · 2026Article
- [Advances in Surgical Treatment Following Conversion Therapy for Pancreatic Cancer].Sichuan da xue xue bao. Yi xue ban = Journal of Sichuan University. Medical science edition · 2025Review
- Evolving concepts in adjuvant/neoadjuvant therapy for resectable pancreas cancer.The Journal of clinical investigation · 2025Review
- AI-Driven insights in pancreatic cancer imaging: from pre-diagnostic detection to prognostication.Abdominal radiology (New York) · 2025Review
- Advances in neoadjuvant therapy for pancreatic cancer: Current trends and future directions.World journal of clinical oncology · 2025Review
- Molecular KRAS ctDNA Predicts Metastases and Survival in Pancreatic Cancer: A Prospective Cohort Study.Annals of surgical oncology · 2025Article
- Value of [European journal of nuclear medicine and molecular imaging · 2025Article
- Nationwide implementation of the international multidisciplinary best-practice for locally advanced pancreatic cancer (PREOPANC-4): study protocol.BMC cancer · 2025Article
- Article
- Evolving Paradigms in the Treatment of Oligometastatic Pancreatic Ductal Adenocarcinoma.Journal of gastrointestinal cancer · 2025Review
- An update on pancreatic cancer imaging, staging, and use of the PACT-UK radiology template pre- and post-neoadjuvant treatment.The British journal of radiology · 2025Review
- Liquid Biopsy in Pancreatic Ductal Adenocarcinoma: A Review of Methods and Applications.International journal of molecular sciences · 2024Review
Corrections and comments
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Authors and funding
21 authors at 2 institutions in 2 countries.
Funding
Abstract
backgroundNeoadjuvant 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 predicting NAT response and survival.
methodsWe reviewed all patients with resected BR/LA PDAC who underwent NAT with FDG-PET within 60 days of resection. Pre- and post-NAT metabolic (FDG-PET) 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).
resultsWe 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 and OS times were 21 and 48.7 months, 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 (P=.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).
conclusionsAmong 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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