Abstract
BackgroundThe purpose of this study was to investigate the prognostic significance of computed tomography (CT) attenuation and F-18 fluorodeoxyglucose (FDG) uptake of visceral adipose tissue (VAT) to predict peritoneal recurrence-free survival (RFS) as well as RFS and overall survival (OS) in patients with advanced gastric cancer (AGC).MethodsWe retrospectively enrolled 117 patients with AGC who underwent staging FDG positron emission tomography (PET)/CT and subsequent curative surgical resection. CT attenuation and FDG uptake (SUV) of VAT and maximum FDG uptake of primary tumor (SUVmaxT) were measured from PET/CT images. The relationship of VAT attenuation and SUV with clinico-histopathologic factors and survival was assessed.ResultsThere was a significant positive correlation between VAT attenuation and SUV (p < 0.001, r = 0.799). In correlation analyses, both VAT attenuation and SUV showed significant positive correlations with T stage, TNM stage, tumor size, and platelet-to-lymphocyte ratio (p < 0.05), and patients who experienced recurrence during the first 3-year after surgery had significantly higher VAT attenuation and SUV than those who had no recurrence (p < 0.05). Patients with high VAT attenuation and SUV showed significantly worse RFS, peritoneal RFS, and OS than those with low values (p < 0.05). On multivariate survival analysis, VAT attenuation was significantly associated with peritoneal RFS and OS and VAT SUV was significantly associated with OS (p < 0.05).ConclusionsCT attenuation and FDG uptake of VAT on staging FDG PET/CT were correlated with tumor characteristics and were significant predictive factors for peritoneal RFS and OS in patients with AGC.
Highlights
The only curative treatment for advanced gastric cancer (AGC) is compete resection of the primary tumor with lymph node dissection [1]
We retrospectively reviewed the medical records of patients who were diagnosed with gastric cancer and underwent surgical resection of the gastric cancer at our medical center between March 2012 and December 2016
We excluded patients (1) who were diagnosed with early gastric cancer (n = 195), (2) who had distant metastatic lesions on staging work-up (n = 37), (3) in whom microscopic or macroscopic peritoneal seeding metastases were found during surgical exploration or malignant cells were found on peritoneal washing cytology (n = 9), (4) who had a previous history of malignancy or major abdominal surgery (n = 5), (5) who had computed tomography (CT) images that were in appropriate for analyzing visceral adipose tissue (VAT) (n = 3), and (6) who were not followed up for 2 years after surgery without event (n = 8)
Summary
The only curative treatment for advanced gastric cancer (AGC) is compete resection of the primary tumor with lymph node dissection [1]. The purpose of this study was to investigate the prognostic significance of computed tomography (CT) attenuation and F-18 fluorodeoxyglucose (FDG) uptake of visceral adipose tissue (VAT) to predict peritoneal recurrence-free survival (RFS) as well as RFS and overall survival (OS) in patients with advanced gastric cancer (AGC). Patients with high VAT attenuation and SUV showed significantly worse RFS, peritoneal RFS, and OS than those with low values (p < 0.05). Conclusions CT attenuation and FDG uptake of VAT on staging FDG PET/CT were correlated with tumor characteristics and were significant predictive factors for peritoneal RFS and OS in patients with AGC
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