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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 
 GASTRIC CANCER, Vol.22(1) : 113-122, 2019 
Journal Title
Issue Date
Advanced gastric cancer ; Diffuse type ; PET/CT ; Prognostic impact ; Signet ring cell carcinoma
BACKGROUND: The prognostic impact of preoperative 18F-FDG PET/CT in advanced gastric cancer (AGC) remains a matter of debate. This study aims to evaluate the prognostic impact of SUVmax in preoperative 18F-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 SUVmax in preoperative 18F-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 SUVmax 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 SUVmax.

CONCLUSIONS: Preoperative high SUVmax 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 SUVmax 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 SUVmax in AGC.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Nuclear Medicine (핵의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Noh, Sung Hoon(노성훈) ORCID logo https://orcid.org/0000-0003-4386-6886
Rha, Sun Young(라선영) ORCID logo https://orcid.org/0000-0002-2512-4531
Ahn, Joong Bae(안중배) ORCID logo https://orcid.org/0000-0001-6787-1503
Yun, Mi Jin(윤미진) ORCID logo https://orcid.org/0000-0002-1712-163X
Cho, Arthur Eung Hyuck(조응혁) ORCID logo https://orcid.org/0000-0001-8670-2473
Hyung, Woo Jin(형우진) ORCID logo https://orcid.org/0000-0002-8593-9214
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