Relationship Between ¹⁸F-FDG Uptake on PET and Recurrence Patterns After Curative Surgical Resection in Patients with Advanced Gastric Cancer

Abstract

This study evaluated the predictive value of 18 F-FDG PET for distant metastasis-free survival and peritoneal recurrence-free survival as well as recurrence-free survival and overall survival after curative surgical resection in patients with advanced gastric cancer (AGC). Methods: Two hundred seventy-nine patients with AGC who underwent preoperative 18 F-FDG PET and subsequent curative surgical resection were included. The tumor-to-normal liver uptake ratio (TLR) of cancer lesions was measured, and the prognostic significance of TLR and tumor factors for distant metastasis-free survival, peritoneal recurrencefree survival, recurrence-free survival, and overall survival was assessed. Results: The 5-y recurrence-free survival, peritoneal recurrence-free survival, distant metastasis-free survival, and overall survival rates were 46.9%, 68.5%, 76.0%, and 58.1%, respectively. Depth of tumor invasion, lymph node metastasis, lymphovascular invasion, and TLR were independent prognostic factors for both recurrence-free survival and overall survival (P , 0.05). For distant metastasis-free survival, lymphovascular invasion and TLR were independent risk factors (P , 0.05). In patients with a TLR of 2.0 or less, the 5-y distant metastasis-free survival rate was 95.5%; in patients with a TLR greater than 2.0, the 5-y distant metastasis-free survival rate was 68.8%. For peritoneal recurrence-free survival, TLR showed no statistical significance (P 5 0.7) whereas pT stage, lymph node metastasis, Lauren classification, and Bormann type were independent prognostic factors (P , 0.05). Conclusion: 18 F-FDG uptake of AGC is an independent prognostic factor for distant metastasis-free survival, recurrence-free survival, and overall survival. The possibility of distant metastasis during follow-up should be considered in patients with high 18 F-FDG uptake.

The clinical implications of FDG-PET/CT differ according to histology in advanced gastric cancer

“…While the National Comprehensive Cancer Network guidelines recommend the use of preoperative 18 F-FDG PET/CT in GC patients to rule out distant metastasis, the prognostic impact of preoperative 18 F-FDG PET/CT remains a matter of debate. Several reports suggest a potential prognostic role for preoperative 18 F-FDG PET/CT, while others argue against this [8][9][10]. These discrepancies may be Hong Jae Chon, Chan Kim, and Arthur Cho equally contribute to this study.…”

Significance of CT attenuation and F-18 fluorodeoxyglucose uptake of visceral adipose tissue for predicting survival in gastric cancer patients after curative surgical resection

“…The only curative treatment for advanced gastric cancer (AGC) is compete resection of the primary tumor with lymph node dissection [1]. However, recurrence occurred in up to 53.1% of AGC patients even after curative surgery, which usually leads to death [2][3][4]. Among the various recurrence patterns of gastric cancer, peritoneal recurrence is the most frequent pattern, comprising 45.9-58.8% of patients with recurrence [2][3][4].…”

“…However, recurrence occurred in up to 53.1% of AGC patients even after curative surgery, which usually leads to death [2][3][4]. Among the various recurrence patterns of gastric cancer, peritoneal recurrence is the most frequent pattern, comprising 45.9-58.8% of patients with recurrence [2][3][4]. Peritoneal recurrence is known to be associated with poor prognosis, showing median survival of less than 10 months [4][5][6].…”

“…Further, a previous study even revealed that patients with peritoneal recurrence had worse prognosis than those with distant recurrence, but, no peritoneal recurrence [4]. In previous studies, depth of tumor invasion, lymph node metastasis, Lauren classification, and Bormann classification have been shown to be independent predictors of peritoneal recurrence [2][3][4][5]. Recently, an attempt has been made to control peritoneal metastasis by intraperitoneal chemotherapy in patients at high risk of peritoneal recurrence [7].…”

Locally advanced gastric cancer: total iodine uptake to predict the response of primary lesion to neoadjuvant chemotherapy

“…Accordingly, the Choi criteria (combining the change in the sum of the largest tumor diameter with the change in the tumor density) have been used as a potential indicator of the GIST (gastrointestinal stromal tumor) response in patients undergoing targeted therapy to add functional information to size-based monitoring (Choi 2008). Although 18 F-FDG-PET/CT has been shown to be able to assess the response of gastric cancer to neoadjuvant chemotherapy based on the change in the 18 F-FDG standardized uptake value (Giganti et al 2015), signet-ring cell carcinomas, mucinous adenocarcinomas and poorly differentiated adenocarcinomas exhibit relatively low 18 F-FDG uptake (Chen et al 2016;Lee et al 2015), which may prevent the use of 18 F-FDG-PET/ CT to monitor tumor response. Furthermore, this imaging modality is associated with prohibitively high costs.…”