Correlation between the Uptake of 18F-Fluorodeoxyglucose (18F-FDG) and the Expression of Proliferation-Associated Antigen Ki-67 in Cancer Patients: A Meta-Analysis

Abstract

ObjectiveTo study the correlation between 18F-FDG uptake and cell proliferation in cancer patients by meta-analysis of published articles.MethodsWe searched PubMed (MEDLINE included), EMBASE, and Cochrane Database of Systematic Review, and selected research articles on the relationship between 18F-FDG uptake and Ki-67 expression (published between August 1, 1994-August 1, 2014), according to the literature inclusion and exclusion criteria. The publishing language was limited to English. The quality of included articles was evaluated according to the Quality Assessment of Diagnosis Accuracy Studies-2 (QUADAS-2). The correlation coefficient (r) was extracted from the included articles and processed by Fisher's r-to-z transformation. The combined correlation coefficient (r) and the 95% confidence interval (CI) were calculated with STATA 11.0 software under a random-effects model. Begg's test was used to analyze the existence of publication bias and draw funnel plot, and the sources of heterogeneity were explored by sensitivity and subgroup analyses.ResultsAccording to the inclusion and exclusion criteria, 79 articles were finally included, including 81 studies involving a total of 3242 patients. All the studies had a combined r of 0.44 (95% CI, 0.41-0.46), but with a significant heterogeneity (I2 = 80.9%, P<0.01). Subgroup analysis for different tumor types indicated that most subgroups showed a reduced heterogeneity. Malignant melanoma (n = 1) had the minimum correlation coefficient (-0.22) between 18F-FDG uptake and Ki-67 expression, while the thymic epithelial tumors (TETs; n = 2) showed the maximum correlation coefficient of 0.81. The analytical results confirmed that correlation between 18F-FDG uptake and Ki-67 expression was extremely significant in TETs, significant in gastrointestinal stromal tumors (GISTs), moderate in patients with lung, breast, bone and soft tissue, pancreatic, oral, thoracic, and uterine and ovarian cancers, average in brain, esophageal and colorectal cancers, and poor in head and neck, thyroid, gastric and malignant melanoma tumors. Subgroup analysis indicated that positron emission tomography (PET) or PET/CT imaging technology or Ki-67 and standardized uptake value (SUV) measurement technology did not significantly affect the results of r values, and Begg's test showed no significant publication bias.ConclusionIn cancer patients, 18F-FDG uptake showed a moderate positive correlation with tumor cell proliferation. Different tumor types exhibited varied degree of correlation, and the correlation was significant in TETs and GSTs. However, our results need further validation by clinical trials with a large sample of different tumor types.

Anti-3-18F-FACBC (18F-Fluciclovine) PET/CT of Breast Cancer: An Exploratory Study

“…Our findings are similar to our prior report of weakly positive though nonsignificant correlation between Ki-67 and 18 F-fluciclovine uptake in lung cancer (32). Similar findings have also been reported in a meta-analysis of Ki-67 and 18 F-FDG in breast cancer (33).…”

Stromal markers of activated tumor associated fibroblasts predict poor survival and are associated with necrosis in non-small cell lung cancer

“…However, we did not observe a significant correlation between fibrillar collagens and the proliferation marker Ki-67. This negative result was somewhat unexpected, considering that we did find a marginal association between PSR-BF% and the regional glucose uptake marker SUVT, which is frequently used as a surrogate of cancer cell proliferation [44]. Yet it is worth considering that enhanced SUVT has been reported in fibrotic areas of idiopathic pulmonary fibrosis patients, which are rich in activated fibroblasts and fibrillar collagens but void of cancer cells [45].…”

PET imaging in ectopic Cushing syndrome: a systematic review

“…There have been numerous other reports of 18 F-FDG PET/CT being useful in the localization of ectopic ACTH-secreting tumors [38][39][40]. 18 F-FDG uptake shows a positive correlation with tumor cell proliferation [41]. The evaluation of glycolytic metabolism by 18 F-FDG is potentially useful in identifying high-risk patients with aggressive neuroendocrine tumors associated with a poor outcome.…”