Taliha Güçlü KANTAR, Tolga DOĞAN, Semra TAŞ, Ahmet Ali KANTAR, Burcu Yapar TAŞKÖYLÜ, Atike Gökçen DEMİRAY, Arzu YAREN, Tarık ŞENGÖZ, Gamze Gököz DOĞU
Acta Haematologica Oncologica Turcica - 2026;59(2):187-194
Aim: Reliable prognostic biomarkers are needed to improve risk stratification in patients with advanced pancreatic adenocarcinoma. We developed and validated a simple composite risk score that integrates clinical, laboratory, and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) derived parameters to predict survival. Methods: This retrospective single-center study included 50 patients with advanced pancreatic adenocarcinoma who underwent a baseline 18F-FDG PET/CT before systemic treatment. Receiver operating characteristic (ROC) analysis was used to determine cut-off values for total lesion glycolysis (TLG), metabolic tumor volume (MTV), and serum carbohydrate antigen 19-9 (CA19-9). A composite risk score (0-4) was created by assigning one point each for liver metastasis, MTV above the cut-off, TLG above the cut-off, and CA19-9 >1000 U/mL. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method and compared using the log-rank test. Results: The median OS and PFS were 13.73 and 7.23 months, respectively. ROC analysis identified cut-off values of 15.55 cm3 for MTV, 93.88 for TLG, and 1000 U/mL for CA19-9. Twenty-three patients (46.0%) were classified as low risk (score 0-1) and 27 (54.0%) as high-risk (score >=2). High-risk patients had significantly shorter OS (10.35 vs. 14.62 months, p=0.018) and PFS (6.01 vs. 7.29 months, p=0.048) than low-risk patients. One-year OS rates were 41.7% and 81.0%, respectively. Conclusions: The proposed composite risk score was associated with distinct survival outcomes in patients with advanced pancreatic adenocarcinoma. By integrating routinely available clinical, laboratory, and PET/CT-derived variables, this pragmatic model may assist baseline prognostic stratification. These findings require validation in larger prospective multicenter cohorts before clinical implementation.
