FDG PET/CT as a survival prognostic factor in patients with advanced renal cell carcinoma

Violetta Pankowska,Bogdan Malkowski,Krzysztof Roszkowski,Ewelina Wedrowska,Mateusz Wedrowski

doi:10.1007/s10238-018-0539-9

Violetta Pankowska, Bogdan Malkowski + Show 3 more

Open Access

https://doi.org/10.1007/s10238-018-0539-9

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Abstract

Accurate prediction of the outcome of molecular target-based treatment in advanced renal cell carcinoma (RCC) is an important clinical problem. Positron emission tomography/computed tomography using [18F]-2-fluoro-2-deoxyglucose (FDG PET/CT) is a noninvasive tool for the assessment of glucose accumulation which can be a marker of the biological characteristics of the tumor. In this paper, we assess FDG PET/CT as a survival prognostic marker in patients with advanced RCC. The study included 121 patients treated in the years 2011–2016 with a diagnosis of advanced renal cell carcinoma (stage IV, multifocal metastases in all patients). Assessment using FDG PET/CT was conducted by measuring the maximum standard uptake value (SUVmax) for the marker used (the highest SUV measurement result for each patient in a single examination). SUVmax measurements were compared with various clinical risk factors used as prognostic markers. The median follow-up period was 19 months (ranging from 3 to 61 months). SUVmax measurements in all patients ranged from 1.3 to 30.0 (median 6.9). Higher SUVmax was correlated with poorer prognosis. Multi-way analysis with standard risk factors revealed that SUVmax was an independent factor for overall survival (OS; p < 0.003, hazard ratio 1.312, 95% CI 1.147–1.346). For SUVmax < 7.0, median OS was 32 months. For 7.0 ≤ SUVmax < 12.0, median OS was 12.5 months. For SUVmax ≥ 12.0, median OS was 10 months. The differences were statistically significant. A preliminary SUVmax assessment conducted using FDG PET/CT can provide information useful in the prediction of survival of patients with advanced RCC.

Highlights

Renal cell carcinoma (RCC) is not a common cancer, constituting 3% of all tumors in adults [1]
Positron emission tomography/computed tomography using [18F]-2-fluoro-2-deoxyglucose (FDG PET/CT) is a useful noninvasive tool for the assessment of glucose metabolism which can be a marker of the biological activity of the tumor
Kayani reported that high SUVmax was correlated with a shorter overall survival (OS) in patients treated with the tyrosine kinase inhibitor (TKI) sunitinib [13]

Summary

Introduction

Renal cell carcinoma (RCC) is not a common cancer, constituting 3% of all tumors in adults [1]. Positron emission tomography/computed tomography using [18F]-2-fluoro-2-deoxyglucose (FDG PET/CT) is a useful noninvasive tool for the assessment of glucose metabolism which can be a marker of the biological activity of the tumor. SUVmax was described by other authors as a simplified quantitative measure of FDG accumulation (i.e., the highest SUV of all RCC lesions in each patient) that predicted overall survival (OS) of patients with advanced RCC [12]. Kayani reported that high SUVmax was correlated with a shorter OS in patients treated with the tyrosine kinase inhibitor (TKI) sunitinib [13]. Chen reported that the baseline SUVmax was correlated with the OS of RCC patients treated with everolimus, an oral mTOR inhibitor (mTORi) [14]. Other authors supported the usefulness of FDG PET/CT as a prognostic tool for patients with RCC [15, 16]. We present our results from a longer followup period

Methods

Results

Treatment methods

Discussion

Compliance with ethical standards

10. European Association of Urology