Role of ¹⁸F-FDG PET/CT in the prediction of gastric cancer recurrence after curative surgical resection.
OBJECTIVE
The study evaluated the role of preoperative (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT in the prediction of recurrent gastric cancer after curative surgical resection.


METHODS
A total of 271 patients with gastric cancer who underwent (18)F-FDG PET/CT and subsequent curative surgical resection were enrolled. All patients underwent follow-up for cancer recurrence with a mean duration of 24 ± 12 months. (18)F-FDG PET/CT images were visually assessed and, in patients with positive (18)F-FDG cancer uptake, the maximum standardized uptake value (SUV(max)) of cancer lesions was measured. (18)F-FDG PET/CT findings were tested as prognostic factors for cancer recurrence and compared with conventional prognostic factors. Furthermore, (18)F-FDG PET/CT findings were assessed as prognostic factors according to histopathological subtypes.


RESULTS
Of 271 patients, 47 (17 %) had a recurrent event. Positive (18)F-FDG cancer uptake was shown in 149 patients (55 %). Tumour size, depth of invasion, presence of lymph node metastasis, positive (18)F-FDG uptake and SUV(max) were significantly associated with tumour recurrence in univariate analysis, while only depth of invasion, positive (18)F-FDG uptake and SUV(max) had significance in multivariate analysis. The 24-month recurrence-free survival rate was significantly higher in patients with negative (18)F-FDG uptake (95 %) than in those with positive (18)F-FDG uptake (74 %; p < 0.0001). In subgroup analysis, (18)F-FDG uptake was a significant prognostic factor in patients with tubular adenocarcinoma (p = 0.003) or poorly differentiated adenocarcinoma (p = 0.0001). However, only marginal significance was shown in patients with signet-ring cell carcinoma and mucinous carcinoma (p = 0.05).


CONCLUSIONS
(18)F-FDG uptake of gastric cancer is an independent and significant prognostic factor for tumour recurrence. (18)F-FDG PET/CT could provide effective information on the prognosis after surgical resection of gastric cancer, especially in tubular adenocarcinoma and poorly differentiated adenocarcinoma.
Department of Nuclear Medicine, Jeju National University Hospital, Jeju, Korea.
Jeong Won
JW
Lee
Sang Mi
SM
Lee
Moon-Soo
MS
Lee
Hyeong Cheol
HC
Shin
D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed
D019788:Fluorodeoxyglucose F18