title: Clinically significant association between the maximum standardized uptake value on 18F-FDG PET and expression of phosphorylated Akt and S6 kinase for prediction of the biological characteristics of renal cell cancer.
abstract: BACKGROUND
  The relationship between the clinicopathological features and molecular changes associated with standardized uptake value (SUV) determined by Positron emission tomography (PET) with [18F] fluorodeoxyglucose (18F-FDG PET) in human renal cell carcinoma (RCC) has not been elucidated. On the other hand, overactivation of the phosphatidylinositol 3'kinase (PI3K), serine/threonine kinase Akt, and mammalian target of rapamycin (mTOR) pathway has been detected in a variety of human cancers, including RCC. So far, little is known about the relationship between the SUV and these proteins in human RCC. Thus, it is important to study the relevance of SUV with clinicopathological features in human RCCs from a molecular point of view.
  
  
  METHODS
  Seventy-seven consecutive patients with RCC who underwent nephrectomy and pretreatment determination of the maximum SUV (SUVmax) by 18F-FDG PET were analyzed. We investigated the relationship between the SUVmax, phosphorylated-Akt (Ser-473) (pAkt(Ser-473)), phosphorylated-Akt (Thr-308) (pAkt(Thr-308), and phosphorylated-S6 ribosomal protein (Ser-235/236) (pS6) protein levels in the primary tumor and various clinicopathological features.
  
  
  RESULTS
  The average SUVmax of the primary tumor was 6.9 (1.5 to 40.3). A higher SUVmax was correlated with higher expression of pAkt(Ser-473), pAkt (Thr-308), and pS6 protein in the primary tumor. A higher SUVmax and increased expression of pAkt (Ser-473), pAkt (Thr-308), and pS6 of the primary tumor was associated with less tumor differentiation, a higher pT stage, regional lymph node involvement, microscopic vascular invasion, and distant metastasis, as well as with early relapse following radical nephrectomy in patients who had localized or locally advanced RCC without distant metastasis (cTanyNanyM0) and with shorter overall survival in all patients.
  
  
  CONCLUSIONS
  A higher SUVmax on 18F-FDG PET is associated with elevated tumor levels of pAkt and pS6 protein and with aggressive behavior and metastatic potential of RCC, as well as with early relapse following radical nephrectomy and shorter overall survival. These findings suggest that SUVmax may be useful for predicting the biological characteristics of RCC.
authors.affiliation: Department of Urology, Dokkyo Medical University, 880 Kitakobayashi Mibu, Tochigi, 321-0293, Japan, mizuno-t@dokkyomed.ac.jp.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Mizuno
authors.forename: Takao
authors.initials: T
authors.lastname: Kamai
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Abe
authors.forename: Setsu
authors.initials: S
authors.lastname: Sakamoto
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kitajima
authors.forename: Daisaku
authors.initials: D
authors.lastname: Nishihara
authors.forename: Hideo
authors.initials: H
authors.lastname: Yuki
authors.forename: Tsunehito
authors.initials: T
authors.lastname: Kambara
authors.forename: Hironori
authors.initials: H
authors.lastname: Betsunoh
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yashi
authors.forename: Yoshitatsu
authors.initials: Y
authors.lastname: Fukabori
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Kaji
authors.forename: Ken-Ichiro
authors.initials: K
authors.lastname: Yoshida
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015153:Blotting, Western / Q000379:methods; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging* / Q000201:enzymology / Q000473:pathology; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007150:Immunohistochemistry; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging* / Q000201:enzymology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010766:Phosphorylation; D049268:Positron-Emission Tomography / Q000379:methods*; D051057:Proto-Oncogene Proteins c-akt / Q000378:metabolism*; D019275:Radiopharmaceuticals; D019893:Ribosomal Protein S6 Kinases / Q000378:metabolism*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D051057:Proto-Oncogene Proteins c-akt; D019893:Ribosomal Protein S6 Kinases