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Prognostic value of metabolic tumor volume and total lesion glycolysis on preoperative 18 F-FDG PET/CT in patients with localized primary gastrointestinal stromal tumors

 Sang Hyun Hwang  ;  Minkyu Jung  ;  Yong Hyu Jeong  ;  KwanHyeong Jo  ;  Soyoung Kim  ;  Jiyoung Wang  ;  Arthur Cho 
 CANCER & METABOLISM, Vol.9(1) : 8, 2021-01 
Journal Title
Issue Date
18F-Fluorodeoxyglucose ; Gastrointestinal stromal tumor ; Metabolic tumor volume ; PET ; Prognosis
Background: This study aimed to evaluate the prognostic value of pretreatment 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in patients with localized primary gastrointestinal stromal tumors (GISTs) and to compare the predictive values of 18F-FDG PET/CT parameters with those of clinicopathological prognostic factors.

Methods: Sixty-two localized GIST patients who underwent staging with 18F-FDG PET/CT from January 2007 to December 2013 before surgery were retrospectively enrolled. A volume of interest with a standardized uptake value (SUV) threshold of 2.5 was used to determine the metabolic tumor volume (MTV) and total lesion glycolysis (TLG). These metabolic indices, along with the maximum SUV (SUVmax), were analyzed to evaluate recurrence-free survival (RFS). Other significant clinical and pathologic indices were also retrospectively reviewed for RFS analysis.

Results: Patients were followed up for a median of 42.0 months (range, 5.6-111.5). During the follow-up period, 13 patients (21.0%) experienced disease recurrence. In univariate analysis, tumor size (> 5 cm), mitotic count (> 5/high-power field), modified National Institutes of Health (NIH) consensus criteria, adjuvant imatinib treatment, SUVmax (≥ 7.04), MTV (≥ 50.76 cm3), and TLG (≥ 228.79 g) were significant prognostic factors affecting RFS (p < 0.05). In multivariate analysis, only MTV (hazard ratio, 17.69; 95% confidence interval [CI], 2.03-154.17, p = 0.009) and TLG (hazard ratio, 20.48; 95% CI, 2.19-191.16, p = 0.008) were independent prognostic factors for RFS. The 5-year RFS rates were 96.4% and 96.6% in patients with a low MTV and TLG and 27.3% and 23.6% in patients with a high MTV and TLG, respectively (p < 0.001).

Conclusion: MTV and TLG are independent prognostic factors for predicting recurrence in patients with localized primary GIST. Patients with a high MTV or TLG are at risk for poor prognosis and should be closely observed for disease recurrence.
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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
Yonsei Authors
Kim, Soyoung(김소영) ORCID logo https://orcid.org/0000-0002-6163-1434
Wang, Jiyoung(왕지영) ORCID logo https://orcid.org/0000-0002-1275-9167
Jung, Min Kyu(정민규) ORCID logo https://orcid.org/0000-0001-8281-3387
Jeong, Yong Hyu(정용휴) ORCID logo https://orcid.org/0000-0002-0198-0026
Cho, Arthur Eung Hyuck(조응혁) ORCID logo https://orcid.org/0000-0001-8670-2473
Hwang, Sang Hyun(황상현) ORCID logo https://orcid.org/0000-0002-8130-6671
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