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

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5 Citations (Scopus)

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

Bibliographical note

Funding Information:
Acknowledgements This work was supported by the National

Funding Information:
Research Foundation of Korea (NRF) Grant funded by the Ministry of Science, ICT and Future Planning (Grant NRF-2016M3A9E8941664 to H.C. NRF-2016R1C1B2014671 to C.K.) and by a Grant from the National R&D Program for Cancer Control, Ministry of Health and Welfare (Grant 1520190 to S.Y.R).

Funding Information:
Conflict of interest Research grants from funding agencies: the National Research Foundation of Korea (NRF) Grant funded by the Ministry of Science, ICT and Future Planning (Grant NRF-2016M3A9E8941664 to H.C. NRF-2016R1C1B2014671 to C.K.) and the Grant from the National R&D Program for Cancer Control, Ministry of Health and Welfare (Grant 1520190 to S.Y.R). Honoraria for speaking at symposia: no. Financial support for attending symposia: no. Financial support for educational programs: no. Employment or consultation: no. Support from a project sponsor: no. Position on advisory board or board of directors or other type of management relationships: no. Multiple affiliations: no. Financial relationships, for example equity ownership or investment interest: no. Intellectual property rights (e.g. patents, copyrights and royalties from such rights). Holdings of spouse and/or children that may have financial interest in the work: no.

All Science Journal Classification (ASJC) codes

  • Oncology
  • Gastroenterology
  • Cancer Research

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