Abstract
BackgroundThe prognostic value of postoperative 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) to patients with gastric cancer remains unclear. This study aims to investigate the prognostic value of whole body (WB) metabolic tumor burden (MTBWB) on postsurgical 18F-FDG PET/CT to patients with gastric cancer.MethodsA total of 376 patients with surgeries-confirmed gastric cancer were enrolled. Clinicopathologic information, overall survival (OS) and MTBWB parameters on postsurgical PET/CT, in terms of WB maximum standardized uptake value (SUVWBmax), WB metabolic tumor volume (MTVWB), and WB total lesion glycolysis (TLGWB) were collected. In-between differences of patient clinicopathologic characteristics, OS and MTBWB measurements were compared using chi-square test, Fisher’s exact test, Student’s t test or the Kaplan-Meier survival analysis. The optimal cutoffs of MTBWB measurements were calculated through the receiver operating characteristic (ROC) curve analysis. Univariable and multivariable Cox proportional hazard regression were performed to test the predictive value of the clinicopathologic factors and MTBWB measurements to patient survival.ResultsThe PET-positive patients had significantly decreased OS based on either Kaplan-Meier survival analysis (P < 0.001) or univariable Cox regression (hazard ratio [HR] = 2.850, P < 0.001). In patients with PET-positive tumors, the associations between OS and SUVWBmax, MTVWB and TLGWB were significant, both in univariable analysis (P < 0.001, P < 0.001 and P = 0.001, respectively) and in multivariable analysis (P = 0.002, P < 0.001 and P = 0.005, respectively). Patient OS among groups dichotomized by cutoffs of SUVWBmax > 8.6, MTVWB > 91.5 cm3, and TLGWB > 477.6 cm3 were significantly different (P = 0.001, P < 0.001 and P = 0.001, respectively).ConclusionsMTBWB, in terms of SUVWBmax, MTVWB and TLGWB, on postsurgical 18F-FDG PET/CT provides prognostic value to patients with gastric cancer after curative resection.
Highlights
The prognostic value of postoperative 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/ computed tomography (PET/CT) to patients with gastric cancer remains unclear
Surgical resection of cancer lesions with lymph node dissection is the only curative treatment, but survival rate is till unsatisfactory even when achieving R0 resection
The T stages of primary tumor were relatively higher in patients with positive FDG uptake compared to negative patients (P < 0.001)
Summary
The prognostic value of postoperative 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/ computed tomography (PET/CT) to patients with gastric cancer remains unclear. This study aims to investigate the prognostic value of whole body (WB) metabolic tumor burden (MTBWB) on postsurgical 18F-FDG PET/CT to patients with gastric cancer. There are about 7.4 new cases of gastric cancer per 100,000 men and women per year in United States [2]. The prognosis of gastric cancer is dismal, with the 5-year survival rate being about 20–25%, ranking the second leading cause of cancer-related death [3]. Surgical resection of cancer lesions with lymph node dissection is the only curative treatment, but survival rate is till unsatisfactory even when achieving R0 resection. A practical method that can precisely predict the survival outcomes of patients with gastric cancer is essential, because stratification of
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