18F-fluorodeoxyglucose--positron emission tomography/computed tomography aids staging and predicts mortality in patients with muscle-invasive bladder cancer.
OBJECTIVE
To investigate the association between extravesical (18)F-fluorodeoxyglucose (FDG) avid lesions on FDG-positron emission tomography/computed tomography (PET/CT) and mortality in patients with muscle-invasive bladder cancer.


METHODS
An international, bi-institutional cohort study of 211 patients with muscle-invasive bladder cancer who underwent staging CT and FDG-PET/CT imaging. On the basis of the presence of extravesical FDG-avid lesions suspicious for malignancy on PET/CT images, patients were divided into a PET/CT-positive and PET/CT-negative group. Data on staging and mortality were retrospectively analyzed from prospective databases. Kaplan-Meier analyses were performed to compare overall (OS) and disease-specific survival (DSS) between the groups. Multivariable Cox regression models were used to investigate the association between extravesical PET/CT lesions and mortality. Extravesical lesions suspicious for malignancy on conventional CT were included in the models.


RESULTS
Of the 211 patients, 98 (46.4%) had 1 or more extravesical lesions on PET/CT, 113 (53.5%) had a negative PET/CT. Conventional CT revealed extravesical lesions in 51 patients (24.4%). Median follow-up was 18 months. Patients with a positive PET/CT had a significantly shorter OS and DSS (median OS: 14 vs 50 months, P = .001; DSS: 16 vs 50 months, P <.001). In multivariable analysis, the presence of extravesical lesions on PET/CT was an independent prognostic indicator of mortality (OS: hazard ratio = 3.0, confidence interval 95% 1.7-5.1). This association was not statistically significant for conventional CT (hazard ratio = 1.6 (95% confidence interval 0.9-2.7).


CONCLUSIONS
On the basis of our results, the presence of extravesical FDG-avid lesions on PET/CT might be considered an independent indicator of mortality.
Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands. Electronic address: b.v.rhijn@nki.nl.
Laura S
LS
Mertens
Department of Surgery, Ludwig Institute for Cancer Research, University of Melbourne and Center for PET, Austin Hospital, Melbourne, Australia.
M Carmen
MC
Mir
Department of Medicine, Ludwig Institute for Cancer Research, University of Melbourne and Center for PET, Austin Hospital, Melbourne, Australia.
Andrew M
AM
Scott
Department of Medicine, Ludwig Institute for Cancer Research, University of Melbourne and Center for PET, Austin Hospital, Melbourne, Australia.
Sze Ting
ST
Lee
Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Annemarie
A
Fioole-Bruining
Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Erik
E
Vegt
Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Wouter V
WV
Vogel
Department of Medicine, Ludwig Institute for Cancer Research, University of Melbourne and Center for PET, Austin Hospital, Melbourne, Australia.
Rustom
R
Manecksha
Department of Surgery, Ludwig Institute for Cancer Research, University of Melbourne and Center for PET, Austin Hospital, Melbourne, Australia.
Damien
D
Bolton
Ian D
ID
Davis
Joint Medical Oncology Unit, Austin Hospital, Melbourne, Australia.
Ian
I
Davies
Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Simon
S
Horenblas
Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Bas W G
BW
van Rhijn
Department of Surgery, Ludwig Institute for Cancer Research, University of Melbourne and Center for PET, Austin Hospital, Melbourne, Australia.
Nathan
N
Lawrentschuk
D000368:Aged; D015331:Cohort Studies; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D064847:Multimodal Imaging; D009130:Muscle, Smooth; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D011379:Prognosis; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology*
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18