Preoperative Nodal ¹⁸F-FDG Avidity Rather than Primary Tumor Avidity Determines the Prognosis of Patients with Advanced Gastric Cancer.
- Author:
Hyun Woo KWON
1
;
Liang AN
;
Hye Ryeong KWON
;
Sungsoo PARK
;
Sungeun KIM
Author Information
- Publication Type:Original Article
- Keywords: Gastric cancer; ¹⁸F-fluorodeoxyglucose; Positron Emission Tomography Computed Tomography; Recurrence
- MeSH: Electrons; Fluorodeoxyglucose F18; Follow-Up Studies; Humans; Lymph Nodes; Multivariate Analysis; Positron-Emission Tomography and Computed Tomography; Prognosis*; Recurrence; Sensitivity and Specificity; Stomach Neoplasms*
- From:Journal of Gastric Cancer 2018;18(3):218-229
- CountryRepublic of Korea
- Language:English
- Abstract: PURPOSE: This study investigated whether the metabolic avidity of primary tumors and/or metastatic lymph nodes (LNs) measured by 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) was related to survival after surgery in patients with advanced gastric cancer (AGC). MATERIALS AND METHODS: One hundred sixty-eight patients with AGC who underwent preoperative 18F-FDG PET/CT and curative resection were included. The 18F-FDG avidity of the primary gastric tumor and LNs was determined quantitatively and qualitatively. The diagnostic performance of 18F-FDG PET/CT was calculated, and the prognostic significance of 18F-FDG avidity for recurrence-free survival (RFS) and overall survival (OS) was assessed. RESULTS: In all, 51 (30.4%) patients experienced recurrence, and 32 (19.0%) died during follow-up (median follow-up duration, 35 months; range, 3–81 months); 119 (70.8%) and 33 (19.6%) patients showed 18F-FDG-avid primary tumors and LNs, respectively. 18F-FDG PET/CT showed high sensitivity (73.8%) for the detection of advanced pathologic T (pT ≥3) stage and high specificity (92.2%) for the detection of advanced pN (≥2) stage. 18F-FDG avidity of LNs was significantly associated with RFS (P=0.012), whereas that of primary tumors did not show significance (P=0.532). Univariate and multivariate analyses revealed that 18F-FDG avidity of LNs was an independent prognostic factor for RFS (hazard ratio=2.068; P=0.029). CONCLUSIONS: 18F-FDG avidity of LNs is an independent prognostic factor for predicting RFS. Preoperative 18F-FDG PET/CT can be used to determine the risk and prognosis of patients with AGC after curative resection.
