title: Prognostic value of SUVmax measured by pretreatment 18F-FDG PET/CT in patients with primary gastric lymphoma.
abstract: OBJECTIVE
  The aim of this retrospective study was to determine whether glucose metabolism assessed by fluorine-18 fluorodeoxyglucose (F-FDG) PET/computed tomography (CT) provides prognostic information independent of established prognostic factors in patients with gastric lymphoma.
  
  
  METHODS
  We reviewed the medical records of 86 patients retrospectively (men, 42; women, 44; mean age 58±13 years) with pathologically proven gastric lymphoma (34 mucosa-associated lymphoid tissue and 52 aggressive non-Hodgkin's lymphoma). They underwent F-FDG PET/CT as part of a pretreatment work-up from February 2004 to July 2012. For the analysis, patients were classified by age, sex, Musshoff stage, serum lactate dehydrogenase, International Prognostic Index score, extragastric spread, and visual intensity [visual assessment and maximum standardized uptake value (SUVmax), respectively]. The relationship between F-FDG uptake and survival was analyzed using the Kaplan-Meier method with a log-rank test and Cox's proportional-hazard regression method.
  
  
  RESULTS
  The median survival of all 86 study participants was 1117 days and the median SUV measured by PET/CT was 6.1 (range, 1.9-32.7). Patients with an SUVmax less than or equal to 5.2 survived significantly longer than patients with an SUVmax more than 5.2 (median, 1163 vs. 1004 days; P=0.003). Survival was also found to be significantly related to age (P=0.0005), histological type (P=0.004), extragastric spread (P=0.0004), International Prognostic Index score (P<0.0001), serum lactate dehydrogenase (P=0.02), stage (P<0.0001), and visual intensity (P=0.041). A multivariate analysis showed that patients with a higher SUVmax [P=0.021; 95% confidence interval (CI), 1.52-8.14; hazard ratio (HR)=6.29], older age (P=0.001; 95% CI, 4.64-219.96; HR=18.8), more aggressive histologic type (P=0.006; 95% CI, 2.20-70.63; HR=12.76), and higher stage (P=0.0006; 95% CI, 5.81-206.43; HR=17.48) showed worse survival.
  
  
  CONCLUSIONS
  A higher SUVmax on pretreatment F-FDG PET/CT can predict poorer survival in patients with gastric lymphoma.
authors.affiliation: aDepartment of Nuclear Medicine bMolecular Imaging Research Center, Korea Institute of Radiological and Medical Sciences, Seoul, Korea.
authors.forename: Jae Pil
authors.initials: JP
authors.lastname: Hwang
authors.forename: Ilhan
authors.initials: I
authors.lastname: Lim
authors.forename: Byung Hyun
authors.initials: BH
authors.lastname: Byun
authors.forename: Byung Il
authors.initials: BI
authors.lastname: Kim
authors.forename: Chang Woon
authors.initials: CW
authors.lastname: Choi
authors.forename: Sang Moo
authors.initials: SM
authors.lastname: Lim
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005462:Fluorine Radioisotopes; D019788:Fluorodeoxyglucose F18; D005947:Glucose / Q000378:metabolism; D006801:Humans; D053208:Kaplan-Meier Estimate; D018442:Lymphoma, B-Cell, Marginal Zone / Q000000981:diagnostic imaging / Q000378:metabolism / Q000401:mortality; D008228:Lymphoma, Non-Hodgkin / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000401:mortality; D008297:Male; D008875:Middle Aged; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D011379:Prognosis; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000401:mortality
chemical_list: D005462:Fluorine Radioisotopes; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D005947:Glucose