Prognostic Value of Metabolic Information in Advanced Gastric Cancer Using Preoperative ¹⁸F-FDG PET/CT
10.1007/s13139-019-00622-w
- Author:
Hye Ryeong KWON
1
;
Kisoo PAHK
;
Sungsoo PARK
;
Hyun Woo KWON
;
Sungeun KIM
Author Information
1. Department of Nuclear Medicine, Korea University Anam Hospital, 73, Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea. hnwoo00@gmail.com
- Publication Type:Original Article
- Keywords:
Advanced gastric cancer;
FDG PET/CT;
Recurrence;
Maximum standardized uptake value;
Metabolictumor volume
- MeSH:
Electrons;
Glycolysis;
Humans;
Multivariate Analysis;
Positron-Emission Tomography and Computed Tomography;
Prognosis;
Recurrence;
Stomach Neoplasms;
Tumor Burden
- From:Nuclear Medicine and Molecular Imaging
2019;53(6):386-395
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: This study evaluated the usefulness of semiquantitative and volumetric PET parameters for predicting prognosis in patients with advanced gastric cancer (AGC).METHODS: We enrolled 213 patients who underwent ¹⁸F-fluoro-2-deoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) prior to curative surgery for AGC. Maximum standardized uptake value (SUVmax) and tumor-to-liver uptake ratio (TLR) were measured in all patients. Metabolic tumor volume (MTV) and total lesion glycolysis were measured in volume-measurable patients. For further quantification of FDG uptake, we developed PET prognostic scores by combining SUVmax and MTV (1: low SUVmax/low MTV; 2: high SUVmax/low MTV; 3: high SUVmax/high MTV). Comparison of PET parameters between recurrence and non-recurrence groups was performed. Univariate and multivariate analyses for recurrence-free survival (RFS) and overall survival (OS) were subsequently performed.RESULTS: The recurrence rate was 32.4% (69/213 patients). Mean SUVmax and mean MTV of the recurrence group were significantly higher than those of the non-recurrence group (p = 0.026 and p = 0.025). TLR showed marginal significance (p = 0.051). In multivariate analysis for RFS including all patients, SUVmax (p = 0.022), TLR (p = 0.010), and PET score (p = 0.003) were independent prognostic factors. In post hoc analysis of PET score, significant differences in RFS were observed between PET scores 2 and 3 as well as scores 1 and 3. No significant difference in RFS was observed between scores 1 and 2. Only PET score was statistically significant for OS in univariate analysis. None of the PET parameters were statistically significant for OS in multivariate analysis.CONCLUSION: High SUVmax and high MTV of the primary tumor suggest a high risk of recurrence for AGC patients. Even if SUVmax is similar, the prognosis may vary depending on MTV. Combining PET parameters results in a better prediction for prognosis.
