Preoperative Nodal ¹⁸F-FDG Avidity Rather than Primary Tumor Avidity Determines the Prognosis of Patients with Advanced Gastric Cancer.

ABSTRACT:

Purpose

This study investigated whether the metabolic avidity of primary tumors and/or metastatic lymph nodes (LNs) measured by ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) was related to survival after surgery in patients with advanced gastric cancer (AGC).

Materials and methods

One hundred sixty-eight patients with AGC who underwent preoperative ¹⁸F-FDG PET/CT and curative resection were included. The ¹⁸F-FDG avidity of the primary gastric tumor and LNs was determined quantitatively and qualitatively. The diagnostic performance of ¹⁸F-FDG PET/CT was calculated, and the prognostic significance of ¹⁸F-FDG avidity for recurrence-free survival (RFS) and overall survival (OS) was assessed.

Results

In all, 51 (30.4%) patients experienced recurrence, and 32 (19.0%) died during follow-up (median follow-up duration, 35 months; range, 3-81 months); 119 (70.8%) and 33 (19.6%) patients showed ¹⁸F-FDG-avid primary tumors and LNs, respectively. ¹⁸F-FDG PET/CT showed high sensitivity (73.8%) for the detection of advanced pathologic T (pT ?3) stage and high specificity (92.2%) for the detection of advanced pN (?2) stage. ¹⁸F-FDG avidity of LNs was significantly associated with RFS (P=0.012), whereas that of primary tumors did not show significance (P=0.532). Univariate and multivariate analyses revealed that ¹⁸F-FDG avidity of LNs was an independent prognostic factor for RFS (hazard ratio=2.068; P=0.029).

Conclusions

¹⁸F-FDG avidity of LNs is an independent prognostic factor for predicting RFS. Preoperative ¹⁸F-FDG PET/CT can be used to determine the risk and prognosis of patients with AGC after curative resection.

SUBMITTER: Kwon HW 

PROVIDER: S-EPMC6160526 | biostudies-literature | 2018 Sep

REPOSITORIES: biostudies-literature