Prognostic Value of Metabolic Information in Advanced Gastric Cancer Using Preoperative 18F-FDG PET/CT

Hye Ryeong Kwon; Kisoo Pahk; Sungsoo Park; Hyun Woo Kwon; Sungeun Kim

doi:10.1007/s13139-019-00622-w

Prognostic Value of Metabolic Information in Advanced Gastric Cancer Using Preoperative ¹⁸F-FDG PET/CT

Hye Ryeong Kwon, Kisoo Pahk, Sungsoo Park, Hyun Woo Kwon, Sungeun Kim

Research output: Contribution to journal › Article › peer-review

2 Citations (Scopus)

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.

Original language	English
Pages (from-to)	386-395
Number of pages	10
Journal	Nuclear Medicine and Molecular Imaging
Volume	53
Issue number	6
DOIs	https://doi.org/10.1007/s13139-019-00622-w
Publication status	Published - 2019 Dec 1

Keywords

Advanced gastric cancer
FDG PET/CT
Maximum standardized uptake value
Metabolic tumor volume
Recurrence

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging

UN SDGs

This output contributes to the following Sustainable Development Goal(s)

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@article{a29ced66f3da44dca0c9e57b8ead57cc,

title = "Prognostic Value of Metabolic Information in Advanced Gastric Cancer Using Preoperative 18F-FDG PET/CT",

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.",

keywords = "Advanced gastric cancer, FDG PET/CT, Maximum standardized uptake value, Metabolic tumor volume, Recurrence",

author = "Kwon, {Hye Ryeong} and Kisoo Pahk and Sungsoo Park and Kwon, {Hyun Woo} and Sungeun Kim",

year = "2019",

month = dec,

day = "1",

doi = "10.1007/s13139-019-00622-w",

language = "English",

volume = "53",

pages = "386--395",

journal = "Nuclear Medicine and Molecular Imaging",

issn = "1869-3474",

publisher = "Springer Verlag",

number = "6",

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TY - JOUR

T1 - Prognostic Value of Metabolic Information in Advanced Gastric Cancer Using Preoperative 18F-FDG PET/CT

AU - Kwon, Hye Ryeong

AU - Pahk, Kisoo

AU - Park, Sungsoo

AU - Kwon, Hyun Woo

AU - Kim, Sungeun

PY - 2019/12/1

Y1 - 2019/12/1

N2 - 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.

AB - 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.

KW - Advanced gastric cancer

KW - FDG PET/CT

KW - Maximum standardized uptake value

KW - Metabolic tumor volume

KW - Recurrence

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JO - Nuclear Medicine and Molecular Imaging

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