18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography Metabolic Parameters Before and After Neoadjuvant Chemotherapy Can Predict the Postoperative Prognosis of Locally Advanced Gastric Cancer

Lili Mi; Yan Zhao; Xinming Zhao; Fei Yin; Xiaolei Yin; Ning Li; Jianfei Shi; Xin Han; Xiaoling Duan; Man Zhao; Guangjie Han; Jinfeng Wang

doi:10.1089/cbr.2020.3942

¹⁸F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography Metabolic Parameters Before and After Neoadjuvant Chemotherapy Can Predict the Postoperative Prognosis of Locally Advanced Gastric Cancer

Cancer Biother Radiopharm. 2021 Oct;36(8):662-671. doi: 10.1089/cbr.2020.3942. Epub 2020 Aug 12.

Authors

Lili Mi¹, Yan Zhao², Xinming Zhao³, Fei Yin¹, Xiaolei Yin¹, Ning Li¹, Jianfei Shi¹, Xin Han¹, Xiaoling Duan¹, Man Zhao¹, Guangjie Han¹, Jinfeng Wang¹

Affiliations

¹ Department of Gastroenterology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
² Department of Oncology, and The Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
³ Department of Nuclear Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China.

PMID: 32783634
DOI: 10.1089/cbr.2020.3942

Abstract

Objective: To explore the value of ¹⁸F-fluorodeoxyglucose positron emission tomography-computed tomography (¹⁸F-FDG PET/CT) metabolic parameters before and after neoadjuvant chemotherapy in predicting histopathological response and prognosis of locally advanced gastric cancer. Materials and Methods: A total of 56 patients with locally advanced gastric cancer underwent ¹⁸F-FDG PET/CT before and after neoadjuvant chemotherapy. The maximum standardized uptake value (SUV_max), mean standardized uptake value (SUV_mean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the lesions were measured before and after neoadjuvant chemotherapy. The percentage changes in the maximum standardized uptake value (ΔSUV_max%), mean standardized uptake value (ΔSUV_mean%), metabolic tumor volume (ΔMTV%), and total lesion glycolysis (ΔTLG%), which were derived from ¹⁸F-FDG PET/CT, were calculated, and the cutoff values were determined by receiver operating characteristic curve analysis. Differences in progression-free survival (PFS) and overall survival (OS) between groups dichotomized by these cutoffs were analyzed using the Kaplan-Meier method and Cox proportional hazards regression model. Results: The patients were divided into histopathological responders and nonresponders according to the following cutoff values: 58.8% SUV_max reduction, 45.8% SUV_mean reduction, 36.9% MTV reduction, and 57.8% TLG reduction. The differences in PFS and OS between groups dichotomized by these cutoffs were significant (all p < 0.01). Multivariate analysis suggested that a ΔTLG% > 57.8% was an independent postoperative risk factor for PFS (hazard ratio [HR] 0.348, 95% confidence interval [CI] 0.131-0.926, p = 0.035) and OS (HR 0.107, 95% CI 0.023-0.498, p = 0.004). Conclusions: The metabolic parameters before and after neoadjuvant chemotherapy of ¹⁸F-FDG PET/CT accurately reflected the chemotherapy effect, and ΔTLG% was the only independent postoperative predictive factor of PFS and OS for locally advanced gastric cancer.

Keywords: 18F-FDG PET/CT; locally advanced gastric cancer; neoadjuvant chemotherapy; prognosis.

MeSH terms

Antineoplastic Agents / pharmacology*
Drug Monitoring / methods
Female
Fluorodeoxyglucose F18 / pharmacology*
Gastrectomy / adverse effects
Gastrectomy / methods
Humans
Male
Middle Aged
Neoadjuvant Therapy / methods
Positron Emission Tomography Computed Tomography / methods*
Postoperative Complications / diagnosis*
Predictive Value of Tests
Prognosis
Radiopharmaceuticals / pharmacology
Stomach Neoplasms* / diagnostic imaging
Stomach Neoplasms* / metabolism
Stomach Neoplasms* / pathology
Stomach Neoplasms* / therapy
Treatment Outcome
Tumor Burden

Substances

Antineoplastic Agents
Radiopharmaceuticals
Fluorodeoxyglucose F18