title: Metabolic information on staging FDG-PET-CT as a prognostic tool in the evaluation of 97 patients with gastric cancer.
abstract: OBJECTIVE
  Gastric cancer remains a leading cause of malignancy-related mortality. Many patients with locally advanced disease succumb despite peri-operative chemotherapy and the survival benefit of chemotherapy for advanced disease is modest, suggesting that current staging is imperfect. The role of fluorine-18-2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) in the staging of gastric cancer remains to be determined. This study aimed to determine, and compare with computerized tomography (CT), the association between FDG-PET uptake in the primary tumour and regional lymph nodes, and overall survival in patients with all stage gastric cancer.
  
  
  METHODS
  Patients with histologically confirmed gastric cancer (any stage) who, at diagnosis, had received a staging FDG-PET-CT at our institution between 2006 and 2011 were included. Records were retrospectively analysed. Patients with >50 % of tumour above the gastro-oesophageal junction or an active second malignancy were excluded.
  
  
  RESULTS
  97 patients were included in the analysis. Surgery with curative intent was performed in 68 patients. In univariate analysis, an association with overall survival was seen in patients who had FDG-PET-positive primary tumours (hazard ratio (HR) for death 3.33, 95 % confidence interval (95 % CI) 1.63-6.80, p = 0.001). FDG-PET lymph node positive (vs node negativity) was associated with inferior overall survival (HR 8.66, 95 % CI 4.59-16.37, p < 0.0001), and remained an independent predictor in the multivariate analysis. In contrast, positive lymphadenopathy identified on CT was not associated with overall survival (HR 1.34, 95 % CI 0.79-2.29, p = 0.82).
  
  
  CONCLUSIONS
  FDG-PET-positive tumours are associated with an inferior overall survival. In contrast to CT, FDG-PET-positive lymphadenopathy is associated with a decreased overall survival.
authors.affiliation: Department of Medical Oncology, Liverpool Hospital, Sydney, NSW, Australia, nickcoupe@me.com.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Coupe
authors.forename: Deme
authors.initials: D
authors.lastname: Karikios
authors.forename: Shanley
authors.initials: S
authors.lastname: Chong
authors.forename: June
authors.initials: J
authors.lastname: Yap
authors.forename: Weng
authors.initials: W
authors.lastname: Ng
authors.forename: Neil
authors.initials: N
authors.lastname: Merrett
authors.forename: Michael
authors.initials: M
authors.lastname: Lin
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D019788:Fluorodeoxyglucose F18; D006801:Humans; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000000981:diagnostic imaging; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis / Q000175:diagnosis / Q000000981:diagnostic imaging; D009367:Neoplasm Staging / Q000379:methods; D049268:Positron-Emission Tomography / Q000379:methods*; D011379:Prognosis; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18