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

Hong Jae Chon, Chan Kim, Arthur Cho, Yoo Min Kim, Su Jin Jang, Bo Ok Kim, Chan Hyuk Park, Woo Jin Hyung, Joong Bae Ahn, Sung Hoon Noh, Mijin Yun, Sun Young Rha

Research output: Contribution to journalArticle

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Abstract

Background: The prognostic impact of preoperative 18 F-FDG PET/CT in advanced gastric cancer (AGC) remains a matter of debate. This study aims to evaluate the prognostic impact of SUV max in preoperative 18 F-FDG PET/CT of AGC according to histologic subtype, with a focus on the differences between tubular adenocarcinoma and signet ring cell (SRC) carcinoma. Methods: As a discovery set, a total of 727 AGC patients from prospective database were analyzed according to histologic subtype with Cox proportional hazard model and p-spline curves. In addition, another 173 patients from an independent institution was assessed as an external validation set. Results: In multivariate analysis, high SUV max in preoperative 18 F-FDG PET/CT of AGC was negatively correlated with disease-free survival (DFS) and overall survival (OS) in patients with diffuse type (DFS: HR 2.17, P < 0.001; OS: HR 2.47, P < 0.001) or SRC histology (DFS: HR 2.26, P = 0.005; OS: HR 2.61, P = 0.003). This negative prognostic impact was not observed in patients with intestinal type or well or moderately differentiated histology. These findings have been consistently confirmed in a validation set. The p-spline curves also showed a gradual increase in log HR as SUV max rises only for SRC histology and for diffuse-type AGC. Finally, a novel predictive model for recurrence of AGC with diffuse type or SRC histology was generated and validated based on the preoperative SUV max . Conclusions: Preoperative high SUV max of AGC is a poor prognostic factor in those with diffuse type or SRC histology. This study is the first to demonstrate the differential prognostic impact of preoperative PET/CT SUV max in AGC according to histologic subtype and provide a clue to explain previous discrepancies in the prognostic impact of preoperative PET/CT in AGC. Prospective studies are required to validate the role of preoperative SUV max in AGC.

Original languageEnglish
Pages (from-to)113-122
Number of pages10
JournalGastric Cancer
Volume22
Issue number1
DOIs
Publication statusPublished - 2019 Jan 22

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Stomach Neoplasms
Histology
Disease-Free Survival
Survival
Signet Ring Cell Carcinoma
Proportional Hazards Models
Adenocarcinoma
Multivariate Analysis
Databases
Prospective Studies
Recurrence

All Science Journal Classification (ASJC) codes

  • Oncology
  • Gastroenterology
  • Cancer Research

Cite this

Chon, Hong Jae ; Kim, Chan ; Cho, Arthur ; Kim, Yoo Min ; Jang, Su Jin ; Kim, Bo Ok ; Park, Chan Hyuk ; Hyung, Woo Jin ; Ahn, Joong Bae ; Noh, Sung Hoon ; Yun, Mijin ; Rha, Sun Young. / The clinical implications of FDG-PET/CT differ according to histology in advanced gastric cancer. In: Gastric Cancer. 2019 ; Vol. 22, No. 1. pp. 113-122.
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title = "The clinical implications of FDG-PET/CT differ according to histology in advanced gastric cancer",
abstract = "Background: The prognostic impact of preoperative 18 F-FDG PET/CT in advanced gastric cancer (AGC) remains a matter of debate. This study aims to evaluate the prognostic impact of SUV max in preoperative 18 F-FDG PET/CT of AGC according to histologic subtype, with a focus on the differences between tubular adenocarcinoma and signet ring cell (SRC) carcinoma. Methods: As a discovery set, a total of 727 AGC patients from prospective database were analyzed according to histologic subtype with Cox proportional hazard model and p-spline curves. In addition, another 173 patients from an independent institution was assessed as an external validation set. Results: In multivariate analysis, high SUV max in preoperative 18 F-FDG PET/CT of AGC was negatively correlated with disease-free survival (DFS) and overall survival (OS) in patients with diffuse type (DFS: HR 2.17, P < 0.001; OS: HR 2.47, P < 0.001) or SRC histology (DFS: HR 2.26, P = 0.005; OS: HR 2.61, P = 0.003). This negative prognostic impact was not observed in patients with intestinal type or well or moderately differentiated histology. These findings have been consistently confirmed in a validation set. The p-spline curves also showed a gradual increase in log HR as SUV max rises only for SRC histology and for diffuse-type AGC. Finally, a novel predictive model for recurrence of AGC with diffuse type or SRC histology was generated and validated based on the preoperative SUV max . Conclusions: Preoperative high SUV max of AGC is a poor prognostic factor in those with diffuse type or SRC histology. This study is the first to demonstrate the differential prognostic impact of preoperative PET/CT SUV max in AGC according to histologic subtype and provide a clue to explain previous discrepancies in the prognostic impact of preoperative PET/CT in AGC. Prospective studies are required to validate the role of preoperative SUV max in AGC.",
author = "Chon, {Hong Jae} and Chan Kim and Arthur Cho and Kim, {Yoo Min} and Jang, {Su Jin} and Kim, {Bo Ok} and Park, {Chan Hyuk} and Hyung, {Woo Jin} and Ahn, {Joong Bae} and Noh, {Sung Hoon} and Mijin Yun and Rha, {Sun Young}",
year = "2019",
month = "1",
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Chon, HJ, Kim, C, Cho, A, Kim, YM, Jang, SJ, Kim, BO, Park, CH, Hyung, WJ, Ahn, JB, Noh, SH, Yun, M & Rha, SY 2019, 'The clinical implications of FDG-PET/CT differ according to histology in advanced gastric cancer', Gastric Cancer, vol. 22, no. 1, pp. 113-122. https://doi.org/10.1007/s10120-018-0847-5

The clinical implications of FDG-PET/CT differ according to histology in advanced gastric cancer. / Chon, Hong Jae; Kim, Chan; Cho, Arthur; Kim, Yoo Min; Jang, Su Jin; Kim, Bo Ok; Park, Chan Hyuk; Hyung, Woo Jin; Ahn, Joong Bae; Noh, Sung Hoon; Yun, Mijin; Rha, Sun Young.

In: Gastric Cancer, Vol. 22, No. 1, 22.01.2019, p. 113-122.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The clinical implications of FDG-PET/CT differ according to histology in advanced gastric cancer

AU - Chon, Hong Jae

AU - Kim, Chan

AU - Cho, Arthur

AU - Kim, Yoo Min

AU - Jang, Su Jin

AU - Kim, Bo Ok

AU - Park, Chan Hyuk

AU - Hyung, Woo Jin

AU - Ahn, Joong Bae

AU - Noh, Sung Hoon

AU - Yun, Mijin

AU - Rha, Sun Young

PY - 2019/1/22

Y1 - 2019/1/22

N2 - Background: The prognostic impact of preoperative 18 F-FDG PET/CT in advanced gastric cancer (AGC) remains a matter of debate. This study aims to evaluate the prognostic impact of SUV max in preoperative 18 F-FDG PET/CT of AGC according to histologic subtype, with a focus on the differences between tubular adenocarcinoma and signet ring cell (SRC) carcinoma. Methods: As a discovery set, a total of 727 AGC patients from prospective database were analyzed according to histologic subtype with Cox proportional hazard model and p-spline curves. In addition, another 173 patients from an independent institution was assessed as an external validation set. Results: In multivariate analysis, high SUV max in preoperative 18 F-FDG PET/CT of AGC was negatively correlated with disease-free survival (DFS) and overall survival (OS) in patients with diffuse type (DFS: HR 2.17, P < 0.001; OS: HR 2.47, P < 0.001) or SRC histology (DFS: HR 2.26, P = 0.005; OS: HR 2.61, P = 0.003). This negative prognostic impact was not observed in patients with intestinal type or well or moderately differentiated histology. These findings have been consistently confirmed in a validation set. The p-spline curves also showed a gradual increase in log HR as SUV max rises only for SRC histology and for diffuse-type AGC. Finally, a novel predictive model for recurrence of AGC with diffuse type or SRC histology was generated and validated based on the preoperative SUV max . Conclusions: Preoperative high SUV max of AGC is a poor prognostic factor in those with diffuse type or SRC histology. This study is the first to demonstrate the differential prognostic impact of preoperative PET/CT SUV max in AGC according to histologic subtype and provide a clue to explain previous discrepancies in the prognostic impact of preoperative PET/CT in AGC. Prospective studies are required to validate the role of preoperative SUV max in AGC.

AB - Background: The prognostic impact of preoperative 18 F-FDG PET/CT in advanced gastric cancer (AGC) remains a matter of debate. This study aims to evaluate the prognostic impact of SUV max in preoperative 18 F-FDG PET/CT of AGC according to histologic subtype, with a focus on the differences between tubular adenocarcinoma and signet ring cell (SRC) carcinoma. Methods: As a discovery set, a total of 727 AGC patients from prospective database were analyzed according to histologic subtype with Cox proportional hazard model and p-spline curves. In addition, another 173 patients from an independent institution was assessed as an external validation set. Results: In multivariate analysis, high SUV max in preoperative 18 F-FDG PET/CT of AGC was negatively correlated with disease-free survival (DFS) and overall survival (OS) in patients with diffuse type (DFS: HR 2.17, P < 0.001; OS: HR 2.47, P < 0.001) or SRC histology (DFS: HR 2.26, P = 0.005; OS: HR 2.61, P = 0.003). This negative prognostic impact was not observed in patients with intestinal type or well or moderately differentiated histology. These findings have been consistently confirmed in a validation set. The p-spline curves also showed a gradual increase in log HR as SUV max rises only for SRC histology and for diffuse-type AGC. Finally, a novel predictive model for recurrence of AGC with diffuse type or SRC histology was generated and validated based on the preoperative SUV max . Conclusions: Preoperative high SUV max of AGC is a poor prognostic factor in those with diffuse type or SRC histology. This study is the first to demonstrate the differential prognostic impact of preoperative PET/CT SUV max in AGC according to histologic subtype and provide a clue to explain previous discrepancies in the prognostic impact of preoperative PET/CT in AGC. Prospective studies are required to validate the role of preoperative SUV max in AGC.

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