Abstract
ObjectiveThe present study investigated the prognosis value of preoperative fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in patients with local advanced gastric cancer (LAGC).MethodsIn total, 144 patients [median age 63 (range: 48−80) years old] with LAGC underwent18F-FDG PET/CT prior to any treatment. The maximum standardized uptake values (SUVmax), mean standardized uptake values (SUVmean), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of the primary lesion were measured on PET/CT and correlated with clinicopathological features and survival. ResultsSignificant differences in SUVmean, SUVmax, MTV and TLG were found according to Lauren’s classification, histologic grade and T category (P<0.05). During the 26.5-month follow-up, 51 (35.4%) patients died and 70 (48.6%) exhibited disease progression. The optimal thresholds of MTV and TLG were 15.1 cm3 and 47.3 cm3, respectively. The 3-year progression-free survival (PFS) and overall survival (OS) for patients with high TLG values were 30% and 38% compared to 38% and 47% for low TLG values, respectively (P<0.05). Univariate and multifactor analyses demonstrated that lymph node metastasis and T stage were independent prognostic factors for PFS; T stage, histologic grade and TLG were independent prognostic factors for OS (P<0.05). Molecular markers had no relationship with patient’s outcomes. ConclusionsMetabolic activity of primary gastric tumors from 18F-FDG PET/CT is a prognostic factor in patients with LAGC.
Highlights
Gastric cancer remains a leading cause of cancer-related deaths worldwide and causes approximately 700,000 deaths annually, especially in China [1]
PFS, progression-free survival; HER2, human epidermal growth factor receptor 2; EGFR, epidermal growth factor receptor; SUVmax, the maximum standardized uptake values; SUVmean, mean standardized uptake values; MTV, metabolic tumor volume; TLG, total lesion glycolysis; HR, hazard ratio; 95% CI, 95% confidence interval
The results showed that lymph node metastasis (HR, 2.16; 95% CI, 1.01−4.65; P=0.048) and T stage (HR, 1.89; 95% CI, 1.11−3.16; P=0.020) were independent prognostic factors for PFS; whereas T stage (HR, 2.33; 95% CI, 1.21−4.51; P=0.012), histologic grade (HR, 0.39; 95% CI, 0.17−0.94; P=0.035) and TLG (HR, 2.10; 95% CI, 1.13−3.89; P=0.019) were independent prognostic factors for overall survival (OS)
Summary
Gastric cancer remains a leading cause of cancer-related deaths worldwide and causes approximately 700,000 deaths annually, especially in China [1]. Research has established the role of first-line palliative chemotherapy in advanced gastric cancer, combination regimens, by improving survival and relieving symptoms compared to the best supportive care [3,4]. Conventional radiologic technologies, including computed tomography (CT) and magnetic resonance imaging (MRI), have been more widely used to evaluate the response of patients to chemotherapy rather than to predict the prognosis of patients with gastric cancer. As a functional multimodality imaging system, several studies have reported fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) to be a potentially effective noninvasive tool to evaluate therapeutic response and predict survival early in the treatment course for malignant tumors. The role of PET/CT in predicting the prognosis of patients with gastric cancer remains controversial. Recent studies have revealed that volumebased parameters, such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG), may provide both volume and metabolic information for prognosis and treatment response, making them better factors than maximum standardized uptake values (SUVmax)
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