18F-FDG PET Scanning Correlates with Tissue Markers of Poor Prognosis and Predicts Mortality for Patients After Liver Resection for Colorectal Metastases

Abstract

18 F-FDG PET has proven invaluable in the staging of patients with metastatic colorectal cancer. The aim of the current study was to determine whether this biologic scan would correlate with other cellular characteristics and the clinical behavior of tumors. Methods: Ninety patients with resectable colorectal cancer metastatic to the liver underwent 18 F-FDG PET before hepatectomy. At surgery, tumors were harvested and prepared for assessment by histology and immunohistochemistry. Expression of Ki67 (a marker for cell proliferation), GLUT1 and GLUT3 (markers for glucose transportation), p53 and p27 (markers for cell cycle control), and BCL-2 (a marker for apoptosis) was assessed by a pathologist who was unaware of the PET results and the clinical outcome. Patients were followed to determine outcome. Survival analysis was performed comparing patient outcome in groups segregated according to standardized uptake values (SUVs) greater or less than 5, 7, or 10. Results: Maximum SUV correlated with GLUT1 (P 5 0.03), Ki67 (P 5 0.026), and p53 (P 5 0.024) but did not correlate with p27, BCL-2, or GLUT3. Survival was significantly longer for patients with a low SUV than for patients with a high SUV, with P values of 0.014, 0.025, and 0.0095 for SUV cutoffs of 5, 7, and 10, respectively. Conclusion: 18 F-FDG PET is a biologic scan that predicts prognosis in patients with metastatic colorectal cancer. It is uncertain if this ability is due to cellular glucose metabolism or to a correlation with other cellular characteristics of aggressive tumors. PETusi ng 18 F-FDG has become an indispensable staging modality for many types of cancer, including colorectal cancer (1,2), esophageal cancer (3), melanoma (4), sarcoma (5), and lung cancer (6). This imaging technique detects glucose-avid cancer deposits and can enhance the detection of metastatic deposits, resulting in more complete tumor resections and preventing nontherapeutic laparotomies for patients with unresectable disease (7). The result of the application of this technique is more appropriate and more efficient clinical care, resulting in improved long-term outcome (1). This scanning technique is now standard in the preoperative work-up for many types of cancer.18 F-FDG PET is a biologic scanning technique that measures the glucose metabolism in a tumor. Enhanced glucose metabolism has been related to the aggressiveness of cancer cells. Thus, it is not surprising that in some types of cancer, such as esophageal cancer (8), lung cancer (9), and gastrointestinal stromal tumors (10), the quantity of 18 F-FDG uptake as assessed by PET correlates with outcome. Whether such a correlation exists for patients with colorectal cancer metastatic to the liver has not been reported and was the subject of the current prospective trial. Because this evaluation was prospective, we were able to secure freshly harvested tumors at resection. Molecular analysis of these tissues allowed an analysis of the correlation between 18 F-FDG uptake and those molecular markers thought to be importan...

18F-FDG PET as novel imaging biomarker for disease progression after ablation therapy in colorectal liver metastases

“…Although we included only patients treated with thermal ablation therapy, our results are consistent with findings by other authors [8,[22][23][24]. A recent meta-analysis pooled the data on the prognostic significance of metabolic parameters and patients' survival and found a significant association between a high pretreatment SUV and a poor OS (pooled hazard ratio of 1.24, 95% CI 1.06-1.45) [26].…”

“…Previous studies reported the prognostic significance of metabolic parameters for the survival of patients with surgically treated CLM [8,[22][23][24]. However, to our knowledge, this is the first study that investigated this for patients with CLM treated by means of curativeintent thermal ablation with stratified results for site of recurrence.…”

Prognostic Value of Metabolic Parameters in Patients with Synchronous Colorectal Cancer Liver Metastasis Following Curative-Intent Colorectal and Hepatic Surgery

“…A study by De Geus-Oei et al reported that a high SUV of hepatic metastases is significantly associated with poor survival, although the study included both patients who underwent surgery and patients who received chemotherapy (15). Riedl et al demonstrated that the SUV max of hepatic metastases is associated with tissue markers of poor prognosis (glucose transporter 1, Ki-67, and p53) and prognosis itself, but there was no mention of whether the liver metastases were synchronous or metachronous and whether the SUV max was for the primary tumor or the hepatic metastasis (16). Recently, Muralidharan et al have reported that the MTV and TLG, but not SUV max , of a hepatic metastasis is significantly associated with prognosis.…”

“…18 F-FDG PET/CT uses the increased rates of glucose metabolism in tumors to characterize the biology of different cancers, with several studies having reported that high rates of 18 F-FDG uptake in tumors are associated with increased aggressiveness and poor survival (13,14). However, only a limited number of studies have addressed the prognostic ability of 18 F-FDG PET/CT in patients with CRC liver metastasis (15)(16)(17). In particular, no published article has dealt exclusively with SCLM, for which the prognosis is worse than the prognosis for metachronous metastasis.…”

Aerobic glycolysis in cancers: Implications for the usability of oxygen‐responsive genes and fluorodeoxyglucose‐PET as markers of tissue hypoxia

“…Several studies have shown that high glucose uptake or Glut-1 expression predicts poor prognosis and that Glut-1 levels often are elevated in 18F-FDG-avid tumors, [30][31][32][33][34][35][36][37][38][39][40][41] but their regional or microregional spatial association has seldom been studied and remains unclear. Our colocalization analysis of 18 F-FDG uptake and Glut-1 expression shows some, albeit weak, spatial linkage and again the strongest correlation was observed in the relatively nonglycolytic tumor model (Table I).…”