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Predictive value of pretreatment metabolic activity measured by fluorodeoxyglucose positron emission tomography in patients with metastatic advanced gastric cancer: the maximal SUV of the stomach is a prognostic factor

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Abstract

Purpose

Few studies have evaluated metabolic activity by 18F-FDG PET as a prognostic factor in advanced gastric cancer (AGC). We investigated its prognostic role in metastatic AGC.

Methods

We enrolled 82 patients with metastatic AGC, who were treatment-naive and underwent pretreatment 18F-FDG PET/CT scanning. In each patient, the maximal standardized uptake value (SUVmax) was measured in each target lesion. StomachSUVmax was defined as SUVmax in the stomach, while TotalSUVmax was defined as the highest SUVmax among all the target lesions.

Results

The stomach was the organ most frequently displaying the highest SUVmax among all the target lesions (in 67.1 % of patients). A TotalSUVmax value of 11.5 was the value with the maximum sum of sensitivity and specificity from receiver-operating characteristic curves for progression-free survival (PFS). PFS was significantly longer in patients with a TotalSUVmax value <11.5 than in those with a TotalSUVmax value ≥11.5 (P = 0.023); however, overall survival (OS) was not (P = 0.055). A StomachSUVmax value of 6.0 was derived by similar methods. PFS and OS were significantly longer in those with a StomachSUVmax value <6.0 than in those with a StomachSUVmax value ≥6.0 (P = 0.001 and P = 0.006, respectively). Furthermore, those with a low TotalSUVmax and those with a low StomachSUVmax showed better chemotherapeutic responses (P = 0.016 and P = 0.034, respectively). Among patients with histologically undifferentiated carcinomas, those with lower TotalSUVmax and those with lower StomachSUVmax showed longer median PFS (P = 0.027 and P = 0.005, respectively) and OS (P = 0.009 and P <0.001, respectively). Multivariate analysis demonstrated StomachSUVmax as an independent predictor of PFS (P = 0.002) and OS (P = 0.038).

Conclusion

Pretreatment metabolic activity may be a useful prognostic marker in patients with metastatic AGC undergoing palliative chemotherapy. Notably, StomachSUVmax was the single, most robust factor predicting prognosis.

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Authors and Affiliations

  1. Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Sodaemun-gu, Seoul, 120-752, Korea

    Jun Chul Park, Kungseok Cheoi, Hyunsoo Chung, Hyuk Lee, Sung Kwan Shin, Sang Kil Lee & Yong Chan Lee

  2. Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Korea

    Jae-Hoon Lee & Mi ** Yun

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  1. Jun Chul Park
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Correspondence to Yong Chan Lee.

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Park, J.C., Lee, JH., Cheoi, K. et al. Predictive value of pretreatment metabolic activity measured by fluorodeoxyglucose positron emission tomography in patients with metastatic advanced gastric cancer: the maximal SUV of the stomach is a prognostic factor. Eur J Nucl Med Mol Imaging 39, 1107–1116 (2012). https://doi.org/10.1007/s00259-012-2116-x

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