Abstract
BackgroundThe benefits of preoperative 18FDG-PET/CT for gastric cancer remain uncertain. The aim of this study was to investigate the effects of preoperative 18FDG-PET/CT on the surgical strategy for locally advanced gastric cancer retrospectively.MethodsFrom January 2007 to November 2008, 18FDG-PET/CT was performed in 142 patients who had been diagnosed with advanced gastric cancer by computed tomography or gastrofiberscope findings.ResultsDetection rates were 88.7% (126/142) for primary tumors and 24.6% (35/142) for local lymph nodes (LN). Nine patients with metastatic lesions underwent induction chemotherapy without operation. Of 133 patients subjected to operation, positive FDG uptake in primary tumors (p = 0.047) and local lymph nodes (p < 0.001) was related to non-curable operations. The mean standard uptake value (SUV) of primary tumors of patients who underwent non-curable operations was significantly higher than that of patients with curable operations (p = 0.001). When the SUV was greater than 5 and FDG uptake of LN was positive, non-curable operations were predicted with a sensitivity of 35.2%, a specificity of 91.0% and an accuracy of 76.7%.ConclusionsHigh SUV of the primary tumor and positive FDG uptake in local lymph nodes at PET/CT could predict non-curative resection in locally advanced gastric cancer. Therefore, information from preoperative PET/CT can help physician decisions regarding other modalities without laparotomy.
Highlights
The benefits of preoperative 18FDG-Positron emission tomography (PET)/computed tomography (CT) for gastric cancer remain uncertain
The PET/CT findings of these patients are listed in Table 1, showing that all patients had positive FDG uptake in the primary tumor
We believe that confining our enrollment of patients to those with advanced gastric cancer might mask the difference in FDG uptake by histological type, since the tumor size and depth of invasion can effect on the FDG uptake [9]. Despite these limitations, our results show that high FDG uptake rate of the primary tumor and local lymph nodes is related to non-curable surgery
Summary
The benefits of preoperative 18FDG-PET/CT for gastric cancer remain uncertain. The aim of this study was to investigate the effects of preoperative 18FDG-PET/CT on the surgical strategy for locally advanced gastric cancer retrospectively. Methods: From January 2007 to November 2008, 18FDG-PET/CT was performed in 142 patients who had been diagnosed with advanced gastric cancer by computed tomography or gastrofiberscope findings. The primary aim of surgery is curability, i.e., elimination of macroscopic and microscopic remnants of the malignant tumor by resection of the stomach and proper lymphadenectomy [1]. Since noncurative treatment is a definite poor prognostic factor for patients who undergo surgery for gastric cancer [2,3], Positron emission tomography (PET) imaging using the radiolabeled glucose analog 18fluorodeoxyglucose (FDG) can present biologic images according to glucose metabolism. The National Comprehensive Cancer Network (NCCN) recently announced that preoperative PET/CT for gastric cancer patients can be recommended as an option of preoperative staging [5], the benefits of PET/CT remain uncertain
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