Significance of CT attenuation and F-18 fluorodeoxyglucose uptake of visceral adipose tissue for predicting survival in gastric cancer patients after curative surgical resection

Gastric Cancer. 2020 Mar;23(2):273-284. doi: 10.1007/s10120-019-01001-2. Epub 2019 Sep 4.


Background: The purpose of this study was to investigate the prognostic significance of computed tomography (CT) attenuation and F-18 fluorodeoxyglucose (FDG) uptake of visceral adipose tissue (VAT) to predict peritoneal recurrence-free survival (RFS) as well as RFS and overall survival (OS) in patients with advanced gastric cancer (AGC).

Methods: We retrospectively enrolled 117 patients with AGC who underwent staging FDG positron emission tomography (PET)/CT and subsequent curative surgical resection. CT attenuation and FDG uptake (SUV) of VAT and maximum FDG uptake of primary tumor (SUVmaxT) were measured from PET/CT images. The relationship of VAT attenuation and SUV with clinico-histopathologic factors and survival was assessed.

Results: There was a significant positive correlation between VAT attenuation and SUV (p < 0.001, r = 0.799). In correlation analyses, both VAT attenuation and SUV showed significant positive correlations with T stage, TNM stage, tumor size, and platelet-to-lymphocyte ratio (p < 0.05), and patients who experienced recurrence during the first 3-year after surgery had significantly higher VAT attenuation and SUV than those who had no recurrence (p < 0.05). Patients with high VAT attenuation and SUV showed significantly worse RFS, peritoneal RFS, and OS than those with low values (p < 0.05). On multivariate survival analysis, VAT attenuation was significantly associated with peritoneal RFS and OS and VAT SUV was significantly associated with OS (p < 0.05).

Conclusions: CT attenuation and FDG uptake of VAT on staging FDG PET/CT were correlated with tumor characteristics and were significant predictive factors for peritoneal RFS and OS in patients with AGC.

Keywords: Fluorodeoxyglucose F18; Gastric cancer; Positron emission tomography; Prognosis; Visceral adipose tissue.

MeSH terms

  • Adenocarcinoma / diagnostic imaging
  • Adenocarcinoma / mortality*
  • Adenocarcinoma / secondary
  • Adenocarcinoma / surgery
  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Signet Ring Cell / diagnostic imaging
  • Carcinoma, Signet Ring Cell / mortality*
  • Carcinoma, Signet Ring Cell / secondary
  • Carcinoma, Signet Ring Cell / surgery
  • Female
  • Fluorodeoxyglucose F18 / metabolism*
  • Follow-Up Studies
  • Gastrectomy
  • Humans
  • Intra-Abdominal Fat / diagnostic imaging
  • Intra-Abdominal Fat / pathology*
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / diagnostic imaging
  • Neoplasm Recurrence, Local / mortality*
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Recurrence, Local / surgery
  • Positron Emission Tomography Computed Tomography / methods*
  • Prognosis
  • Radiopharmaceuticals / metabolism
  • Retrospective Studies
  • Stomach Neoplasms / diagnostic imaging
  • Stomach Neoplasms / mortality*
  • Stomach Neoplasms / pathology
  • Stomach Neoplasms / surgery
  • Survival Rate


  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18