Real-world utility of full staging with 18-fluorodeoxyglucose positron emission tomography (18FDG-PET) in addition to standard imaging in patients with non-metastatic non-resectable pancreatic ductal adenocarcinoma (PDAC)
Wheatley, Roseanna McNamara, Mairead G Gleeson, J. Hubner, Richard A Manoharan, Prakash Lamarca, Angela
Wheatley, Roseanna
McNamara, Mairead G
Gleeson, J.
Hubner, Richard A
Manoharan, Prakash
Lamarca, Angela
Citations
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Abstract
Background: Previous studies support 18FDG-PET utility for staging of patients (pts)
with non-metastatic PDAC (M0-PDAC); while its use has been adopted in some
countries (i.e. NICE guidelines in the United Kingdom), its use in this setting is vari-
able, especially in relation to non-resectable disease. This study explored the utility of
performing 18FDG-PET in real-world clinical practice for pts with a working diagnosis
of non-resectable M0-PDAC based on cross-sectional imaging.
Methods: Notes from consecutive pts with PDAC seen at The Christie NHS Foundation
Trust (01/07/2018-02/02/2022; Audit Committee approval: 2020/2654) were
reviewed. Eligible pts were those with a diagnosis of non-resectable M0-PDAC (with
primary tumour in situ) who underwent full staging with an 18FDG-PET (standard
practice for all pts during time period explored). The primary end-point was the
percentage of pts identified to have distant metastases on 18FDG-PET. Secondary
objectives: factors associated with presence of distant metastases, and impact of
18FDG-PET findings on patient outcomes (overall survival (OS); defined as the time
from when pts were first seen for consideration of systemic therapies to time of death
or last follow-up). Statistical analysis: STATA v.17, including logistic and Cox
Regression.
Results: A total of 1637 pts were screened; of these, 56 were eligible. Thirty pts
(53.37%) were male; median age: 72 years (range 34-83); the majority had primary
tumour located in the head (n¼40, 71.43%), ECOG performance Status (ECOG PS) 0/1
(n¼48, 85.71%) with none/mild comorbidities (37 pts, 66.07%; 22 pts (39.29%) had
diabetes) and treatment naive (52 pts, 92.86%; 4 pts had received prior chemo-
therapy (all FOLFIRINOX)); stage prior to 18FDG-PET: T4 (39 patients; 69.64%),
regional lymph node disease (25 patients; 44.64%), M0 (56 patients; 100%). In 19
patients (33.93%) the 18FDG-PET identified presence of metastatic disease; with
incidental findings in 12 patients (21.50%) (incidental findings were identified in 7
patients without evidence of distant metastatic disease in 18FDG-PET). Logistic
regression identified T4 stage (vs T1/2/3 stage) as the only factor associate with
higher risk of metastatic disease in 18FDG-PET (46.15% vs 5.88%; Odds Ration (OR)
13.71 (95% 1.65-113.81); p-value 0.015). At time of analysis 31 patients (55.36%) had
died; median follow up was 8.54 months (95% CI 6.10-10.64). Estimated median OS
for the whole population was 12.53 months (95% CI 9.16-14.74). Patients identified to
have presence of distant metastases in 18FDG-PET had a shorter OS (8.07 months
(95% CI 4.23-16.53) vs 14.38 (95% CI 11.01-19.17)); prognostic impact was confirmed
in multivariable Cox Regression (HR 3.48 (95% CI 1.76-12.04); p-value 0.002) adjusted
to other prognostic factors (PS (HR 3.48 (95% CI 1.57-7.71); p-value 0.002)).
Conclusions: 18FDG-PET allows identification of otherwise occult metastatic disease
in a third of the pts (this rate is higher for patients with stage T4 disease). Staging with
18FDG-PET in pts with non-resectable M0-PDAC should be considered standard of
care to allow access to appropriate standard-of-care treatment options and recruit-
ment into clinical trials. In addition, its prognostic implications could enable optimi-
sation of patient information given, management of expectations and future care planning.
Description
Date
2022
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Wheatley R, McNamara M, Gleeson J, Hubner R, Manoharan P, Valle J, et al. Real-world utility of full staging with 18-fluorodeoxyglucose positron emission tomography (18FDG-PET) in addition to standard imaging in patients with non-metastatic non-resectable pancreatic ductal adenocarcinoma (PDAC). Annals of Oncology. 2022 Jun;33:S280-S. PubMed PMID: WOS:000823826500102.