Prognostic value of (18)F-FDG-PET/CT parameters in patients with pancreatic carcinoma: A systematic review and meta-analysis

BACKGROUND: The identification of pancreatic carcinoma (PC) patients with poor prognosis is a priority in clinical oncology because of their high 5-year mortality. However, the prognostic value of pretreatment (18)F-fluorodeoxyglucose ((18)F-FDG)- positron emission tomography (PET)/computed tomography (CT) parameters in PC patients is controversial and no consensus exists as to its predictive capability. This meta-analysis was performed to comprehensively explore the prognostic significance of (18)F-FDG-PET/CT parameters in patients with pancreatic carcinoma. METHODS: Extensive literature searches of the PubMed, Embase, Web of Science, and Cochrane Library databases were conducted to identify literature published until March 5, 2017. Comparative analyses of the pooled hazard ratios (HRs) for event-free survival (EFS) and overall survival (OS) were performed to assess their correlations with pretreatment maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG). Either the fixed- or the random-effects model was adopted, depending on the heterogeneity observed across studies. Subgroup and sensitivity analyses were performed to assess the robustness of the results. RESULTS: Sixteen studies including 1146 patients were identified. The pooled HRs for the probability of EFS were 1.90 (95% confidential interval (CI): 1.48–2.45) for SUVmax, 1.76 (95% CI: 1.20–2.58) for MTV, and 1.81 (95% CI: 1.27–2.58) for TLG. The pooled HRs for the probability of OS were 1.21 (95% CI: 1.12–1.31) for SUVmax, 1.56 (95% CI: 1.13–2.16) for MTV, and 1.70 (95% CI: 1.25–2.30) for TLG. A slight publication bias was detected using Begg test. After adjustment using the trim and fill procedure, the corrected HRs were not significantly different. The results of the subgroup analyses by SUVmax, MTV, and TLG showed that these factors may have similar prognostic significance. CONCLUSION: (18)F-FDG-PET/CT parameters, such as SUVmax, MTV, and TLG, may be significant prognostic factors in patients with pancreatic carcinoma. (18)F-FDG-PET/CT imaging could be a promising tool to provide prognostic information for these patients.