Sae Jung Na

Prognostic Value of Metabolic Tumor Volume Measured by 18F-FDG PET/CT in Locally Advanced Head and Neck Squamous Cell Carcinomas Treated by Surgery

PurposeWe assessed the prognostic value of metabolic tumor volume (MTV) measured using18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) inpatients with locally advanced head and neck squamous cell carcinoma (HNSCC).MethodsWe retrospectively reviewed 56 patients (51 men, five women; mean age 56.0 ± 8.8years) who had locally advanced HNSCC and underwent FDG PET/CT for initial evaluation. All patients had surgical resection and radiotherapy with or without concurrent chemotherapy. The peak standardized uptake value (SUVpeak) and MTV of the target lesion, including primary HNSCC andmetastatic cervical lymph nodes, were measured from FDG PET/CT images. We compared SUVpeak, MTV, and clinicopathologic variables such as age, Eastern Cooperative Oncology Group (ECOG) performance status, pN stage, pT stage, TNM stage, histologic grade and treatment modality to disease-free survival (DFS) and overall survival (OS).ResultsOn the initial FDG PET/CT scans, the median SUVpeak was 7.8 (range, 1.8-19.0) and MTV was17.0 cm3 (range, 0.1-131.0 cm3). The estimated 2-year DFS and OS rates were 67.2% and 81.8%. The cutoff points of SUVpeak 6.2 and MTV 20.7 cm3 were the best discriminative values for predicting clinical outcome. MTV and ECOG performance status were significantly related to DFS and OS on univariate and multivariate analyses (p < 0.05).ConclusionThe MTV obtained from initial FDG PET/CT scan is a significant prognostic factor for disease recurrence and mortality in locally advanced HNSCC treated with surgery and radiotherapy with or without chemotherapy.

Prognostic Significance of 18F-FDG Uptake in Hepatocellular Carcinoma Treated with Transarterial Chemoembolization or Concurrent Chemoradiotherapy: A Multicenter Retrospective Cohort Study

This study aimed to assess the prognostic value of 18F-FDG uptake in hepatocellular carcinoma (HCC) patients who had transarterial chemoembolization (TACE) or concurrent intraarterial chemotherapy with external-beam radiotherapy (CCRT) and to compare the prognosis between patients treated with TACE and those with CCRT according to 18F-FDG uptake. Methods: Two hundred fourteen intermediate–to–advanced-stage HCC patients without extrahepatic metastasis who underwent staging 18F-FDG PET/CT before TACE (153 patients) or CCRT (61 patients) were recruited from 7 hospitals. Progression-free survival (PFS) and overall survival (OS) were compared using an optimal cutoff value for tumor-to-normal liver uptake ratio (TLR). Further, PFS and OS were compared according to treatment modalities (TACE vs. CCRT) using the same TLR cutoff value. Results: On multivariate analysis, age and TLR were independent prognostic factors for PFS (P < 0.050). For OS, Child–Pugh classification and TLR were independent prognostic factors (P < 0.050). When the TLR was greater than 2.0, patients treated with CCRT showed significantly better PFS and OS than those treated with TACE after adjusting for tumor size and number (P = 0.014, for all). In contrast, there was no significant difference in PFS and OS between patients treated with TACE or CCRT when the TLR was 2.0 or less. Conclusion: 18F-FDG uptake was an independent prognostic factor for PFS and OS in HCC patients treated with TACE or CCRT. Especially, in HCCs with high 18F-FDG uptake, patients treated with CCRT showed better survival than those treated with TACE. 18F-FDG PET/CT may help determine the treatment modality for intermediate–to–advanced-stage HCCs.

The clinical value of dual-time point 18F-FDG PET/CT for differentiating extrahepatic cholangiocarcinoma from benign disease.

Purpose The aim of this study was to assess the value of dual–time point PET/CT in the differentiation of extrahepatic cholangiocarcinoma from benign stricture and the added benefits of delayed PET/CT image. Patients and Methods Thirty-nine patients with suspected extrahepatic biliary malignancy based on conventional imaging studies such as ultrasonography, CT, and MRI between July 2008 and December 2010 were included. All patients underwent dual–time point PET/CT scans at 1 and 2 hours after radiotracer injection. From the site of suspected malignancy, the SUVmax for both time points (SUVmax1 and SUVmax2), the percent change in SUVmax between the 2 (&Dgr;%SUVmax) and the ratio of SUVmax1, SUVmax2, &Dgr;%SUVmax in comparison with average SUV of right hepatic lobe (T/L ratio1, T/L ratio2, and &Dgr;%T/L ratio) were generated. Diagnostic performances using visual assessment and various SUVmax cutoff values were analyzed in the differential diagnosis of extrahepatic cholangiocarcinoma from benign disease. PET/CT results were correlated with histological results and radiological follow-up for at least 6 months. Results Of 39 patients, the final diagnosis was cholangiocarcinoma in 34 and benign disease in 5. Between malignant and benign lesions, there were significant differences in SUVmax1 (5.43 ± 4.66 vs 2.26 ± 0.83, P = 0.003) and SUVmax2 (6.02 ± 5.26 vs 2.26 ± 0.76, P = 0.002). There was no significant difference in &Dgr;%SUVmax, T/L ratio1, T/L ratio2, and &Dgr;%T/L ratio. On receiver operator curve analysis, SUVmax1 with cutoff value of 2.5 demonstrated sensitivity of 97.6%, specificity of 60.0%, and accuracy of 92.3% and SUVmax2 with cutoff value of 3.1 demonstrated sensitivity of 88.2%, specificity of 100%, and accuracy of 89.7%. Conclusion SUVmax from both early and delayed PET/CT scans are useful parameters in the differentiation of extrahepatic biliary malignancy from benign disease. However, there was no added benefit of delayed PET/CT in patients suspicious for extrahepatic cholangiocarcinoma.

18F-FDG PET/CT Can Predict Survival of Advanced Hepatocellular Carcinoma Patients: A Multicenter Retrospective Cohort Study

Barcelona Clinic Liver Cancer (BCLC) stage C hepatocellular carcinoma (HCC) consists of a heterogeneous group of patients with a wide range of survival times, requiring further prognostic stratification to facilitate treatment allocation. We evaluated the prognostic value of 18F-FDG uptake on PET/CT at the time of presentation in patients with BCLC stage C HCC. Methods: A total of 291 patients with BCLC stage C HCC who underwent 18F-FDG PET/CT between 2009 and 2010 for staging were retrospectively enrolled from 7 university hospitals. The patients were further divided into 2 groups according to the extent of disease, as intrahepatic or extrahepatic. Tumor-to-liver SUV ratio (TLR) of the primary tumor was measured on 18F-FDG PET/CT. Prognostic values of TLR and other clinical variables were analyzed to predict overall survival (OS) in univariate and multivariate analyses. Differences in the OS stratified by TLR were examined by the Kaplan–Meier method. Results: Higher TLR was associated with extrahepatic disease (P = 0.018). On multivariate analysis, Child–Pugh classification and TLR were independent prognostic factors in the intrahepatic disease group (all P < 0.05), whereas TLR was the only independent prognostic factor in the extrahepatic disease group (P < 0.05). Patients with high TLR showed a significantly worse OS than those with low TLR (P < 0.05) in both groups. Conclusion: In patients with BCLC stage C HCC, 18F-FDG uptake in the primary tumor was significantly higher in patients with extrahepatic disease than in those with intrahepatic disease. In addition, 18F-FDG uptake on pretreatment PET/CT had an incremental prognostic value for OS in both intrahepatic and extrahepatic disease groups.

Evaluation of Slug expression is useful for predicting lymph node metastasis and survival in patients with gastric cancer

BackgroundSlug is a transcription factor that activates the epithelial–mesenchymal transition (EMT) process in cancer progression. The aim of our study was to evaluate the clinical significance of Slug expression in gastric cancer.MethodsThe expression of Slug in gastric cancer tissues of 456 patients who underwent gastrectomy was evaluated by immunohistochemistry using tissue microarrays. Slug expression level was defined by the composite score determined by multiplying the tumor staining scores for intensity and extent. The associations of Slug expression with clinicopathological characteristics and overall and recurrence-free survival were analyzed.ResultsPatients were divided into three groups according to Slug composite score (≤4, 6, and 9). Low, mid, and high expression of Slug was observed in 104 (22.7%), 130 (28.3%), and 225 (49.0%) of cases, respectively. Overall survival and recurrence-free survival progressively increased from high to low Slug expression. In terms of lymph node metastasis, the rate of positive lymph node metastasis was 38/104 (36.5%), 79/130 (60.8%), and 178/225 (79.1%) in low, mid, and high Slug expression groups, respectively, displaying a tendency to increase with higher Slug expression. In a multivariate analysis adjusting for patient age, tumor size, tumor depth, and histology, high Slug expression was associated with a high rate of positive lymph node metastasis compared with low Slug expression (odds ratio 3.42; 95% confidence interval, 1.74–6.69). In a subgroup analysis of T1 cancer, patients with negative Slug expression (defined as <5% positive tumor cells or no/weak staining) showed no lymph node metastasis (0/13), whereas those with positive Slug expression showed 15.9% (17/107) lymph node metastasis, with a negative predictive value of 100%.ConclusionsHigh expression of Slug in gastric cancer tissue was associated with lymph node metastasis and poor survival. Evaluation of Slug would be useful for discriminating patients at high risk of lymph node metastasis in early gastric cancer.

Prognostic value of metabolic parameters on preoperative 18F-Fluorodeoxyglucose positron emission tomography/ computed tomography in patients with stage III gastric cancer.

This study investigated the prognostic value of metabolic parameters determined by 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in patients with stage III gastric cancer. Patients with pre-operative PET/CT and confirmed stage III after curative surgical resection were retrospectively enrolled. Parameters evaluated from pre-operative PET/CTwere maximum standardized uptake value (SUVmax) and peak SUV (SUVpeak) of primary tumor, SUVmax or SUVpeak of tumor to liver ratio (TLRmax and TLRpeak). Volumetric parameters, metabolic tumor volume (MTV) and total lesion glycolysis (TLG), were also evaluated. These PET/CT parameters were compared with the overall survival (OS) and recurrence-free survival (RFS). From total of 133 consecutive patients, tumor recurrence was found in 54 patients (40.6%) and 53 died during the follow-up period (median, 43 mo; range 5-62). In univariate analysis, SUVmax, SUVpeak, TLRmax and TLRpeak were significantly associated with the OS and RFS. In multivariate analysis, high TLRmax and TLRpeak were significantly unfavorable prognostic factors for RFS (both P<0.05) even after adjusting for age, depth of tumor invasion, lymph node metastasis, and chemotherapy. MTV and TLG showed no statistically significant correlation with outcome. In conclusion, glucose metabolism of primary tumor measured by pre-operative PET/CT provides prognostic information, especially for recurrence, in stage III gastric cancer.

Clinical Correlation Between Tumor Maximal Standardized Uptake Value in Metabolic Imaging and Metastatic Tumor Characteristics in Advanced Non-small Cell Lung Cancer.

AbstractThis study aimed to elucidate whether the maximal standardized uptake value (SUVmax) of primary tumors in metabolic imaging correlated with pathological or metastatic characteristics and whether it was prognostic in stage IV nonsmall cell lung cancer (NSCLC).We retrospectively reviewed the medical records of 412 eligible patients between June 2007 and January 2013. All enrolled patients fulfilled the following criteria: they were newly diagnosed with stage IV NSCLC without any previous treatment and had undergone a systemic evaluation, including 18(F)-Fluoro-2-deoxyglucose positron emission tomography/computed tomography, to assess synchronous metastatic sites. Patient and tumor characteristics were analyzed, and clinical correlations between SUVmax and metastatic features were investigated.The median age of the study population was 65 years (range, 30–94), and 259 (62.9%) patients were male. The median SUVmax was statistically higher in males, in tumors with squamous cell histology, and in poorly differentiated tumors. Multivariate logistic regression analysis revealed that SUVmax ≥ 11.4 (top 30 percentiles) were significantly correlated with positive lymph node status (odds ratio [OR] 3.473), abdomen/pelvis metastasis (OR 1.949), and the absence of bone metastasis (OR 0.399) in the subgroup of nonsquamous NSCLC (n = 343). In Kaplan–Meier survival analysis, overall survival was significantly lower among cohorts with high SUVmax (≥11.4) than with low SUVmax (<11.4) (P < 0.001, median 7.4 months vs 12.1 months).The tumors with different SUVmax have distinctive metastatic and biological features in stage IV NSCLC. The underlying mechanisms of this unique metabolic biology need to be resolved in future studies.