title: Prospective Evaluation of the Clinical Implications of the Tumor Metabolism and Chemotherapy-Related Changes in Advanced Biliary Tract Cancer.
abstract: Tumor metabolism measured by18F-FDG PET has a diagnostic and prognostic role in several cancers. The clinical implication of tumor metabolism in biliary tract cancer (BTC) has not been studied well. Therefore, we evaluated the prognostic value of tumor metabolism and chemotherapy-related changes in advanced BTC patients.Methods:We prospectively enrolled advanced BTC patients before the initiation of palliative chemotherapy. Using18F-FDG PET, we assessed the baseline SUVmaxand monitored the changes in SUVmaxduring chemotherapy. We analyzed the associations between SUVmax, and clinicopathologic factors and clinical outcomes.Results:Seventy-five patients were enrolled. All patients received gemcitabine/cisplatin as first-line chemotherapy. Primary tumor site, histologic differentiation, molecular characteristics, laboratory findings, and disease extent were associated with the metabolic characteristics. The high-metabolism group showed worse survival outcome (hazard ratio [HR] = 4.09,P= 0.001 for progression-free survival; HR = 2.61,P= 0.019 for overall survival [OS]) than the low-metabolism group. The lesser reduction of SUVmaxwas also associated with worse outcome (HR = 3.35,P= 0.002 for progression-free survival; HR = 1.96,P= 0.082 for OS). When both baseline tumor metabolism and its chemotherapy-related changes were considered, patients with a low metabolism and more reduction in metabolism obtained the best OS (20.7 vs. 6.2 mo,P= 0.013).Conclusion:Tumor metabolic activity and the chemotherapy-related changes in the metabolism are associated with prognosis in advanced BTC patients.
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Jaemin
authors.initials: J
authors.lastname: Jo
authors.affiliation: Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea; and.
authors.forename: Hyun Woo
authors.initials: HW
authors.lastname: Kwon
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Seongyeol
authors.initials: S
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea ohdoyoun@snu.ac.kr larrycheon@snu.ac.kr.|Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Do-Youn
authors.initials: DY
authors.lastname: Oh
authors.affiliation: Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea; and ohdoyoun@snu.ac.kr larrycheon@snu.ac.kr.|Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Gi Jeong
authors.initials: GJ
authors.lastname: Cheon
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.|Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Yung-Jue
authors.initials: YJ
authors.lastname: Bang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001661:Biliary Tract Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000378:metabolism* / Q000473:pathology; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D000072078:Positron Emission Tomography Computed Tomography; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: biliary tract neoplasm; carcinoma; metabolism; positron-emission tomography; prognosis