Intra-tumor metabolic heterogeneity of gastric cancer on 18 F-FDG PETCT indicates patient survival outcomes
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ORIGINAL ARTICLE
Intra‑tumor metabolic heterogeneity of gastric cancer on 18F‑FDG PETCT indicates patient survival outcomes Guobing Liu1 · Hongyan Yin1 · Xi Cheng2 · Yan Wang2 · Yan Hu1 · Tianshu Liu2 · Hongcheng Shi1 Received: 20 May 2020 / Accepted: 25 August 2020 © Springer Nature Switzerland AG 2020
Abstract The present study aimed to investigate the prognostic value of intra-tumor metabolic heterogeneity on 2-[18F] Fluoro2-deoxy-d-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) for patients with gastric cancer. Fifty-five patients with advanced gastric cancer that had received neoadjuvant chemotherapy and radical surgery were included. Clinicopathological information, 18F-FDG PET/CT before chemotherapy, pathological response, recurrence or metastasis, progression-free survival (PFS), and overall survival (OS) of the patients were collected. The maximum, peak, and mean standardized uptake values (SUVmax, SUVpeak, and SUVmean), tumor-to-liver ratio (TLR), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) on PET/CT were measured. Heterogeneity index-1 (HI-1) was calculated as SUVmean divided by the standard deviation, and heterogeneity index-2 (HI-2) was evaluated through linear regressions of MTVs according to different SUV thresholds. Associations between these parameters and patient survival outcomes were analyzed. None of the parameters on PET were associated with tumor recurrence. Pathological responders had significantly smaller TLR, MTV and HI-2 values than non-responders (P = 0.017, 0.017 and 0.013, respectively). In multivariate analysis of PFS, only HI-2 was an independent factor (hazard ratio [HR] = 2.693, P = 0.005) after adjusting for clinical tumornode-metastasis (TNM) stage. In multivariate analysis of OS, HI-2 was also an independent predictive factor (HR = 2.281, P = 0.009) after adjusting for tumor recurrence. Thus, HI-2 generated from baseline 18F-FDG PET/CT is significantly associated with survival of patients with gastric cancer. Preoperative assessment of HI-2 by 18F-FDG PET/CT might be promising to identify patients with poor prognosis. Keywords Gastric cancer · Prognosis · 2-[18F] Fluoro-2-deoxy-d-glucose (18F-FDG) · Positron emission tomography/ computed tomography (PET/CT) Abbreviations F-FDG 2-[18F] Fluoro-2-deoxy-d-glucose PET/CT Positron emission tomography/computed tomography SUVmax Maximum standard uptake value 18
Guobing Liu and Hongyan Yin have contributed equally to this article. * Tianshu Liu [email protected] * Hongcheng Shi [email protected] 1
Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, No. 180 in Fenglin Road, Shanghai 200032, People’s Republic of China
Department of Medical Oncology, Center of Evidence‑based Medicine, Zhongshan Hospital, Fudan University, No. 180 in Fenglin Road, Shanghai 200032, People’s Republic of China
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SUVpeak Peak standard uptake value MTV Metabolic tumor volume TLG Total lesion glycolysis TLR Tumor-to-liver ratio HI Heterogeneity index VOI Volum
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