Abstract
BackgroundIn this era of molecular targeting therapy when various systematic treatments can be selected, prognostic biomarkers are required for the purpose of risk-directed therapy selection. Numerous reports of various malignancies have revealed that 18-Fluoro-2-deoxy-D-glucose (18F-FDG) accumulation, as evaluated by positron emission tomography, can be used to predict the prognosis of patients. The purpose of this study was to evaluate the impact of the maximum standardized uptake value (SUVmax) from 18-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) on survival for patients with advanced renal cell carcinoma (RCC).MethodsA total of 26 patients with advanced or metastatic RCC were enrolled in this study. The FDG uptake of all RCC lesions diagnosed by conventional CT was evaluated by 18F-FDG PET/CT. The impact of SUVmax on patient survival was analyzed prospectively.ResultsFDG uptake was detected in 230 of 243 lesions (94.7%) excluding lung or liver metastases with diameters of less than 1 cm. The SUVmax of 26 patients ranged between 1.4 and 16.6 (mean 8.8 ± 4.0). The patients with RCC tumors showing high SUVmax demonstrated poor prognosis (P = 0.005 hazard ratio 1.326, 95% CI 1.089-1.614). The survival between patients with SUVmax equal to the mean of SUVmax, 8.8 or more and patients with SUVmax less than 8.8 were statistically different (P = 0.0012). This is the first report to evaluate the impact of SUVmax on advanced RCC patient survival. However, the number of patients and the follow-up period were still not extensive enough to settle this important question conclusively.ConclusionsThe survival of patients with advanced RCC can be predicted by evaluating their SUVmax using 18F-FDG-PET/CT. 18F-FDG-PET/CT has potency as an "imaging biomarker" to provide helpful information for the clinical decision-making.
Highlights
In this era of molecular targeting therapy when various systematic treatments can be selected, prognostic biomarkers are required for the purpose of risk-directed therapy selection
Multiple tyrosine kinase inhibitors targeting vascular endothelial growth factor receptor (VEGFR) such as sunitinib and sorafenib have revolutionized the treatment of renal cell carcinoma (RCC) [10,11]
Mammalian target of rapamycin inhibitor was not available in Japan at the time of this study, the efficacies of mammalian target of rapamycin (mTOR) inhibitors have been reported [12,13]. These developments have made it necessary to predict the prognosis of individual patients with advanced RCC and to select optimal management
Summary
In this era of molecular targeting therapy when various systematic treatments can be selected, prognostic biomarkers are required for the purpose of risk-directed therapy selection. Mammalian target of rapamycin (mTOR) inhibitor was not available in Japan at the time of this study, the efficacies of mTOR inhibitors have been reported [12,13] These developments have made it necessary to predict the prognosis of individual patients with advanced RCC and to select optimal management. The most common classification was proposed by the Memorial Sloan-Kettering Cancer Center group for cytokinebased therapies (MSKCC classification)[14], and modified criteria adapted for the new era of molecular targeting was reported recently and recommended in the National Comprehensive Cancer Network guideline (NCCN classification)[12,15] These classifications are not enough to determine the best treatment selection for an individual patient. Novel biomarkers to predict the prognosis of individual patients are desired
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