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Preoperative Standardized Uptake Value of Metastatic Lymph Nodes Measured by 18F-FDG PET/CT Improves the Prediction of Prognosis in Gastric Cancer

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Author(s)
Bong-Il SongHae Won KimKyoung Sook WonSeung Wan RyuSoo Sang SohnYu Na Kang
Keimyung Author(s)
Song, Bong IlKim, Hae WonWon, Kyoung SookRyu, Seung WanSohn, Soo SangKang, Yu Na
Department
Dept. of Nuclear Medicine (핵의학)
Dept. of Surgery (외과학)
Dept. of Pathology (병리학)
Journal Title
Medicine
Issued Date
2015
Volume
94
Issue
26
Abstract
This study assessed whether preoperative maximum standardized uptake value (SUVmax) of metastatic lymph nodes (LNs) measured by 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) could improve the prediction of prognosis in gastric cancer.

One hundred fifty-one patients with gastric cancer and pathologically confirmed LN involvement who had undergone preoperative 18F-FDG PET/CT prior to curative surgical resection were retrospectively enrolled. To obtain nodal SUVmax, a transaxial image representing the highest 18F-FDG uptake was carefully selected, and a region of interest was manually drawn on the highest 18F-FDG accumulating LN. Conventional prognostic parameters and PET findings (primary tumor and nodal SUVmax) were analyzed for prediction of recurrence-free survival (RFS) and overall survival (OS). Furthermore, prognostic accuracy of survival models was assessed using c-statistics.

Of the 151 patients, 38 (25%) experienced recurrence and 34 (23%) died during follow-up (median follow-up, 48 months; range, 5–74 months). Twenty-seven patients (18%) showed positive 18F-FDG nodal uptake (range, 2.0–22.6). In these 27 patients, a receiver-operating characteristic curve demonstrated a nodal SUVmax of 2.8 to be the optimal cutoff for predicting RFS and OS. The univariate and multivariate analyses showed that nodal SUVmax (hazard ratio [HR] = 2.71, P < 0.0001), pathologic N (pN) stage (HR = 2.58, P = 0.0058), and pathologic T (pT) stage (HR = 1.77, P = 0.0191) were independent prognostic factors for RFS. Also, nodal SUVmax (HR = 2.80, P < 0.0001) and pN stage (HR = 2.28, P = 0.0222) were independent prognostic factors for OS. A predictive survival model incorporating conventional risk factors (pT/pN stage) gave a c-statistic of 0.833 for RFS and 0.827 for OS, whereas a model combination of nodal SUVmax with pT/pN stage gave a c-statistic of 0.871 for RFS (P = 0.0355) and 0.877 for OS (P = 0.0313).

Nodal SUVmax measured by preoperative 18F-FDG PET/CT is an independent prognostic factor for RFS and OS. Combining nodal SUVmax with pT/pN staging can improve survival prediction precision in patients with gastric cancer.
Keimyung Author(s)(Kor)
송봉일
김해원
원경숙
류승완
손수상
강유나
Publisher
School of Medicine
Citation
Bong-Il Song et al. (2015). Preoperative Standardized Uptake Value of Metastatic Lymph Nodes Measured by 18F-FDG PET/CT Improves the Prediction of Prognosis in Gastric Cancer. Medicine, 94(26), e1037–e1037. doi: 10.1097/MD.0000000000001037
Type
Article
ISSN
0025-7974
DOI
10.1097/MD.0000000000001037
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/33027
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Nuclear Medicine (핵의학)
1. School of Medicine (의과대학) > Dept. of Pathology (병리학)
1. School of Medicine (의과대학) > Dept. of Surgery (외과학)
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