High FDG uptake in PET/CT predicts worse prognosis in patients with metastatic gastric adenocarcinoma

• Published in: Journal of cancer research and clinical oncology 2010-12, Vol.136 (12), p.1929-1935
• Main Authors: Chung, Hyun Woo, Lee, Eun Jeong, Cho, Yo-Han, Yoon, So Young, So, Young, Kim, Sung-Yong, Lee, Mark Hong, Kim, Jeong Hwan, Lee, Sun-Young, Sung, In-Kyung, Park, Hyung-Seok, Yoo, Moon-Won, Lee, Kyung-Yung
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - diagnosis; Adenocarcinoma - drug therapy; Adult; Aged; Aged, 80 and over; Antineoplastic agents; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Cancer; Cancer Research; FDG; Female; Fluorodeoxyglucose F18 - pharmacokinetics; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal diseases; Hematology; Humans; Internal Medicine; Kaplan-Meier Estimate; Male; Medical prognosis; Medical sciences; Medicine; Medicine & Public Health; Metastasis; Metastatic gastric adenocarcinoma; Middle Aged; Neoplasm Metastasis; Oncology; Original Paper; Palliative Care - methods; Palliative Care - statistics & numerical data; PET/CT; Pharmacology. Drug treatments; Positron-Emission Tomography - methods; prognosis; Proportional Hazards Models; Reproducibility of Results; Sensitivity and Specificity; Stomach Neoplasms - diagnosis; Stomach Neoplasms - drug therapy; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Tomography; Tomography, X-Ray Computed - methods; Treatment Outcome; Tumors
• ISSN: 0171-5216; 1432-1335
• DOI: 10.1007/s00432-010-0852-5

Purpose We evaluated the role of FDG-PET/CT in patients with metastatic gastric adenocarcinoma before palliative chemotherapy to predict prognosis and chemotherapeutic response. Methods The study included 35 consecutive newly diagnosed patients with metastatic gastric adenocarcinoma who underwent FDG-PET/CT before palliative chemotherapy. Maximum standardized uptake value (SUVmax) of the primary tumor was assessed to evaluate survival and chemotherapeutic response. Survival analysis was performed for time to progression and overall survival using the Kaplan-Meier method. Cox proportional hazard models were used to determine independent prognostic factors. Results All primary tumors were visualized using FDG-PET/CT (mean SUVmax = 8.1 ± 4.5, range 2.5-22.1). Sensitivity, specificity, and accuracy of FDG-PET/CT in detection of solid organ metastasis were 95.2% (20/21), 100% (14/14), and 97.1% (34/35), respectively. No significant difference of primary tumor SUVmax was found among the chemotherapeutic response groups. Univariate survival analysis demonstrated ECOG performance status (≥2), presence of solid organ metastasis, number of organs involved in distant metastasis (≥2), and SUVmax of the primary tumor (>8) as significant predictors for poor overall survival. Multivariate survival analysis showed SUVmax of the primary tumor (P = 0.048), presence of solid organ metastasis (P = 0.015), and ECOG performance status (P = 0.002) as significant independent prognostic predictors for overall survival. Conclusions High FDG uptake of the primary tumor in patients with metastatic gastric adenocarcinoma is associated with poor overall survival. Assessment of tumor FDG uptake has limited value for prediction of chemotherapeutic response, but provides useful information regarding prognosis.