A research team led by Professor Yu Xianjuan from Cancer Hospital of Fudan University focuses on exploring the biological characteristics of pancreatic cancer, conducting individualized and standardized research on surgery, and translating it into clinical treatment to make surgery more targeted. Members of the research team used PET-CT imaging combined with computerized 3D synthesis to propose that tumor metabolic load can predict the prognosis of pancreatic cancer patients and guide the treatment strategy of pancreatic cancer. The paper was published in the European Journal of Nuclear Medicine and Molecular Imaging. Pancreatic cancer is a highly malignant tumor, and the 5-year survival rate of pancreatic cancer patients is less than 5%. However, the incidence of pancreatic cancer is increasing year by year at a rate of 2% per year, posing a serious health risk to society. Surgery is the only treatment that can cure pancreatic cancer, however, it is common to see that some patients are prone to recurrence and metastasis after surgery. Therefore, it is important to determine the prognosis of patients before surgery to guide the choice of surgery-based treatment for patients. Tumor load is one of the most important prognostic indicators of pancreatic cancer, yet there is a lack of clinical indicators that can reflect tumor load sensitively and accurately. Tumor diameter is the most direct and commonly used indicator to reflect tumor load in clinical practice. However, tumor diameter is only a one-dimensional indicator and cannot fully reflect the whole tumor volume and the load of tumor cells with active capacity. Serum CA19-9 is another indicator that can indirectly reflect both tumor load and tumor activity. Although CA19-9 is the most important serological index for pancreatic cancer, it has its own drawbacks that limit its clinical application. Firstly, CA19-9 expression is elevated in only 70% of patients and lacks sensitivity; secondly, CA19-9 is also elevated in benign diseases of the pancreas or biliary tract, with a certain rate of false positives; in addition, CA19-9 expression is falsely negative in about 5% of patients, mainly due to Lewis antigen negativity in this group of patients. Therefore, there is an urgent need to find some indicators that can directly and more accurately reflect the tumor activity load. In this paper, researchers analyzed the effective tumor load with glycolytic activity in pancreatic cancer from the perspective of tumor glucose metabolism, combining medical PET-CT imaging and computerized 3D reconstruction techniques. It was found that the metabolic tumor load [tumor metabolic volume (MTV) or total tumor glucose metabolism (TLG)] of pancreatic cancer can directly and accurately reflect the effective tumor load, which is closely related to the tumor diameter, serum CA19-9 level and biological characteristics of metastatic recurrence of pancreatic cancer, and is an independent predictor of postoperative prognosis of pancreatic cancer. The investigators further confirmed that metabolic tumor load was significantly better than conventional tumor load indicators (tumor diameter and serum CA19-9) in predicting postoperative survival and recurrence of patients. These findings reveal the important role of metabolic tumor load in predicting postoperative prognosis of pancreatic cancer and also suggest that preoperative detection of metabolic tumor load has some application in assessing surgical efficacy, which may provide a basis for clinical translational studies in the selection of surgery-centered treatment strategies for pancreatic cancer. In conclusion, this study confirmed the effectiveness of neoadjuvant chemotherapy in pancreatic cancer based on the safety of undergoing pancreaticoduodenectomy after neoadjuvant chemotherapy, and then the authors suggested the important role of SUVmax in predicting the efficacy of neoadjuvant chemotherapy. However, due to the relatively small number of cases in this study, the results still need to be confirmed in a large clinical trial.