A new strategy based on fluorodeoxyglucose‐positron emission tomography for managing liver metastasis from colorectal cancer

Abstract

Background Prognostic models are needed to manage liver metastasis from colorectal cancer (CRLM). Thus, we developed an algorithm to guide treatment based on the standardized uptake value (SUV) from fluorodeoxyglucose‐positron emission tomography (FDG‐PET). Methods We retrospectively evaluated 148 patients who underwent surgery for CRLM, including 107 cases of primary surgery and 41 cases with preoperative chemotherapy before conversion surgery. We evaluated the prognostic value of perioperative SUV among primary surgery cases, as well as the prognostic value of the SUV change ratio after conversion surgery (postchemotherapy/prechemotherapy SUV). Results In the primary surgery group, recurrence‐free survival (RFS) was independently predicted by an SUV of ≥6.04 (P = 0.042) and ≥4 liver metastases ( P = 0.003). The combination of an SUV of ≥6.04 and ≥4 liver metastases was strongly associated with poor RFS ( P < 0.001). In the conversion surgery group, the SUV change ratio was associated with tumor size change and pathological response. An SUV change ratio of ≥0.293 was associated with shorter RFS ( P = 0.006) and independently predicted RFS ( P = 0.026). We established a therapeutic algorithm for managing CRLM based on these results. Conclusion FDG‐PET may be useful for predicting recurrence and prognosis in cases of CRLM, and our algorithm may be useful for managing multiple CRLMs.

The metabolic clinical risk score as a new prognostic model for surgical decision‐making in patients with colorectal liver metastases

“…21,23 In colorectal cancer and in CRLM, the prognostic value of 18 FDG-PET/CT has also been demonstrated, but its value in association with a clinical score has not yet been explored. 20,[24][25][26][27][28] We first observed that individual preoperative clinicopathological factors, CRS scores, and high-and low-risk CRS were not significantly different between patients who had the opposite postoperative oncological outcomes, confirming the poor prognostic accuracy of traditional clinical surrogates. 16,30 In contrast, all metabolic parameters, including SUV max and SUV peak , with the exception of MTV, were significantly increased in the patients who rapidly relapsed as compared with the patients with prolonged RFS, suggesting that metabolic characteristics could potentially predict the benefit of surgery in individual cases.…”

“…[21][22][23] In CRLM, several studies have also demonstrated the prognostic value of the metabolic parameters measured during preoperative 18 FDG-PET/CT. 20,[24][25][26][27][28] In the present study, we analyzed whether baseline 18 FDG-PET/ CT metabolic characteristics of CRLM may serve to discriminate between patients who will obtain a significant oncological benefit from surgery and those who will not. In addition, we evaluated the potential predictive value of a new score, combining metabolic data with standard CRS.…”

Usefulness of 18-FDG PET/CT in Detecting Malignancy in Intraductal Papillary Mucinous Neoplasms of the Pancreas

“…The use of 18F-FDG PET/CT enables the differentiation between normal and tumor tissue on the basis that neoplastic cells have higher glucose metabolic activity (18,19). The use of 18F-FDG PET/CT for oncological imaging is well established and widely accepted for many types of malignancies, and we have reported the clinical usefulness of 18-FDG PET/CT in assessing the malignant potential of some hepatobiliary pancreatic tumors (20)(21)(22).…”

FDG‐PET for preoperative evaluation of tumor invasion in ampullary cancer: A retrospective analysis

“…5 We previously reported that the maximal standardized uptake value (SUVmax) and SUV change ratio are treatment factors for colorectal cancer liver metastasis. 6 Meanwhile, few studies have reported on the clinical value of FDG-PET in ampullary tumors. The differential diagnosis of benign or malignant 7,8 and the correlation between histological type and FDG uptake have been reported.…”

“…We previously reported that the maximal standardized uptake value (SUVmax) and SUV change ratio are treatment factors for colorectal cancer liver metastasis 6 . Meanwhile, few studies have reported on the clinical value of FDG‐PET in ampullary tumors.…”