Prognostic Ability of <sup>18</sup>F-FDG PET/CT in the Assessment of Colorectal Liver Metastases

Muralidharan, Vijayaragavan; Kwok, Marco; Lee, Sze Ting; Lau, Lawrence; Scott, Andrew M.; Christophi, Christopher

doi:10.2967/jnumed.112.102749

Cited by 34 publications

(33 citation statements)

References 29 publications

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“…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].…”

Section: Modelsupporting

confidence: 79%

“…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.…”

Section: Modelmentioning

confidence: 73%

“…Other researchers conducted similar studies, but discrepancy in the reported results existed. According to Riedl et al [22], the SUV max measured on the pre-operative 18 F-FDG PET was associated with a significant shorter OS, while Muralidharan et al [24] did not find any association between the SUV max or the SUV mean and OS or recurrence free survival. The differences in the prognostic ability of the metabolic parameters reported by various authors might be the result of variability of technical and biological factors as well as heterogeneity of the population in the studies [27].…”

Section: Modelmentioning

confidence: 99%

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

Samim

Prevoo

Veen

et al. 2017

Journal of Vascular and Interventional Radiology

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Purpose Recurrent disease following thermal ablation therapy is a frequently reported problem. Preoperative identification of patients with high risk of recurrent disease might enable individualized treatment based on patients' risk profile. The aim of the present work was to investigate the role of metabolic parameters derived from the pre-ablation 18 F-FDG PET/CT as imaging biomarkers for recurrent disease in patients with colorectal liver metastases (CLM). Methods Included in this retrospective study were all consecutive patients with CLM treated with percutaneous or open thermal ablation therapy who had a pre-treatment baseline 18 F-FDG PET/CT available. Multivariable cox regression for survival analysis was performed using different models for the metabolic parameters (SUL peak , SUL mean , SUL max , partial volume corrected SUL mean (cSUL mean ), and total lesion glycolysis (TLG)) corrected for tumour and procedure characteristics. The study endpoints were defined as local tumour progression free survival (LTP-FS), new intrahepatic recurrence free survival (NHR-FS) and extrahepatic recurrence free survival (EHR-FS). Clinical and imaging followup data was used as the reference standard. Results Fifty-four patients with 90 lesions were selected. Univariable cox regression analysis resulted in eight models. Multivariable analysis revealed that after adjusting for lesion size and the approach of the procedure, none of the metabolic parameters were associated with LTP-FS or EHR-FS. Percutaneous approach was significantly associated with a shorter LTP-FS. It was demonstrated that lower values of SUL peak , SUL max , SUL mean , and cSUL mean are associated with a significant better NHR-FS, independent of the lesion size and number and prior chemotherapy. Conclusion We found no association between the metabolic parameters on pre-ablation 18 F-FDG PET/CT and the LTP-FS. However, low values of the metabolic parameters were significantly associated with improved NHR-FS. The clinical implication of these findings might be the identification of high-risk patients who might benefit most from adjuvant or combined treatment strategies.

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Section: Modelsupporting

confidence: 79%

Section: Modelmentioning

confidence: 73%

Section: Modelmentioning

confidence: 99%

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

Samim

Prevoo

Veen

et al. 2017

Journal of Vascular and Interventional Radiology

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“…1B), as in the case of the MTV. This issue was not addressed in the work of Muralidharan et al (17). The above arguments we have put forward regarding MTV and TLG are not an assertion that these measures have no prognostic usefulness.…”

Section: Discussionmentioning

confidence: 54%

“…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.…”

mentioning

confidence: 99%

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

et al. 2014

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Synchronous colorectal cancer liver metastasis (SCLM) remains a clinical challenge, largely because of the limited availability of tools that use reliable prognostic indicators to guide treatment. This study assessed the prognostic ability of preoperative 18 F-FDG PET/ CT in patients with SCLM who had undergone curative-intent colorectal and liver surgery. Methods: All included patients had undergone simultaneous colorectal and hepatic surgery to treat SCLM. Cox regression for survival analysis was undertaken using clinicopathologic variables and metabolic parameters (metabolic tumor volume [MTV], total lesion glycolysis [TLG], and peak standardized uptake value [SUV peak ]) as covariates, with tumor recurrence and death used as endpoints. Results: One hundred twenty patients (82 men, 38 women; mean age ± SD, 59.9 ± 10.1 y) met the inclusion and exclusion criteria. Univariate analysis showed that MTV, TLG, and the size of hepatic metastases were significant indicators of both recurrence-free survival and overall survival, whereas those of primary colorectal tumors were not. Multivariate analysis revealed that the SUV peak of primary tumors and hepatic metastases remained significant after adjusting for other clinicopathologic variables, whereas the MTV and TLG of hepatic metastases became insignificant after adjusting for differences in tumor size. The combination of a high SUV peak of hepatic metastases and a low SUV peak of primary tumors was related to poor prognosis under the multivariate model. Conclusion: In patients with SCLM who underwent curative-intent colorectal and liver surgery, metabolic parameters of hepatic metastases possess prognostic significance whereas those of primary colorectal tumors do not. For hepatic metastases, the SUV peak is an independent prognostic factor, whereas MTV and TLG are surrogate measures of tumor size. Reduced recurrencefree survival rates are associated with higher SUV peak for hepatic metastases and lower SUV peak for primary tumors. Further studies are needed to elucidate the underlying mechanisms. Col orectal cancer (CRC) accounts for much of the global morbidity and mortality associated with cancer, especially in developed countries. The liver is the single most common site of distant metastasis; up to 50% of CRC patients develop liver metastasis during the course of the disease, and 20%225% of patients with newly diagnosed CRC present with synchronous liver metastasis at the time of initial diagnosis (1-3).Hepatic metastasectomy is the standard of care to treat liver metastasis when curative surgery is feasible. However, the prognosis after hepatectomy is poor, with the 5-and 10-y survival rates after hepatectomy being approximately 40% and 25%, respectively (4). The prognosis is even poorer for patients with synchronous hepatic metastasis (a hepatic metastasis presented at the same time of its primary colorectal tumor) than for those with metachronous hepatic metastasis (a hepatic metastasis that has developed after the resection of the primary colorectal tumor) ...

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

Watanabe

Harimoto

Araki

et al. 2018

Journal of Surgical Oncology

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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.

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Prognostic Ability of ¹⁸F-FDG PET/CT in the Assessment of Colorectal Liver Metastases

Cited by 34 publications

References 29 publications

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

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

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

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

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Prognostic Ability of 18F-FDG PET/CT in the Assessment of Colorectal Liver Metastases

Cited by 34 publications

References 29 publications

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

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

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

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

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Prognostic Ability of ¹⁸F-FDG PET/CT in the Assessment of Colorectal Liver Metastases