Abstract
Purpose
The study evaluated the role of preoperative 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT in the prediction of recurrent gastric cancer after curative surgical resection.
Methods
A total of 271 patients with gastric cancer who underwent 18F-FDG PET/CT and subsequent curative surgical resection were enrolled. All patients underwent follow-up for cancer recurrence with a mean duration of 24 ± 12 months. 18F-FDG PET/CT images were visually assessed and, in patients with positive 18F-FDG cancer uptake, the maximum standardized uptake value (SUVmax) of cancer lesions was measured. 18F-FDG PET/CT findings were tested as prognostic factors for cancer recurrence and compared with conventional prognostic factors. Furthermore, 18F-FDG PET/CT findings were assessed as prognostic factors according to histopathological subtypes.
Results
Of 271 patients, 47 (17 %) had a recurrent event. Positive 18F-FDG cancer uptake was shown in 149 patients (55 %). Tumour size, depth of invasion, presence of lymph node metastasis, positive 18F-FDG uptake and SUVmax were significantly associated with tumour recurrence in univariate analysis, while only depth of invasion, positive 18F-FDG uptake and SUVmax had significance in multivariate analysis. The 24-month recurrence-free survival rate was significantly higher in patients with negative 18F-FDG uptake (95 %) than in those with positive 18F-FDG uptake (74 %; p < 0.0001). In subgroup analysis, 18F-FDG uptake was a significant prognostic factor in patients with tubular adenocarcinoma (p = 0.003) or poorly differentiated adenocarcinoma (p = 0.0001). However, only marginal significance was shown in patients with signet-ring cell carcinoma and mucinous carcinoma (p = 0.05).
Conclusion
18F-FDG uptake of gastric cancer is an independent and significant prognostic factor for tumour recurrence. 18F-FDG PET/CT could provide effective information on the prognosis after surgical resection of gastric cancer, especially in tubular adenocarcinoma and poorly differentiated adenocarcinoma.
Similar content being viewed by others
References
Shin A, Kim J, Park S. Gastric cancer epidemiology in Korea. J Gastric Cancer 2011;11:135–40.
Pisani P, Parkin DM, Bray F, Ferlay J. Estimates of the worldwide mortality from 25 cancers in 1990. Int J Cancer 1999;83:18–29.
Bertuccio P, Chatenoud L, Levi F, Praud D, Ferlay J, Negri E, et al. Recent patterns in gastric cancer: a global overview. Int J Cancer 2009;125:666–73.
Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 2011;14:113–23.
Yoo CH, Noh SH, Shin DW, Choi SH, Min JS. Recurrence following curative resection for gastric carcinoma. Br J Surg 2000;87:236–42.
Wu B, Wu D, Wang M, Wang G. Recurrence in patients following curative resection of early gastric carcinoma. J Surg Oncol 2008;98:411–4.
Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol 2010;11:439–49.
Shiraishi N, Inomata M, Osawa N, Yasuda K, Adachi Y, Kitano S. Early and late recurrence after gastrectomy for gastric carcinoma. Univariate and multivariate analyses. Cancer 2000;89:255–61.
Liu Y, Chen XH, Meng XH, Liu CF, Zhao LL, Han JW, et al. Multivariate prognostic study on node-positive gastric cancer: is tumor size a prognostic indicator? Hepatogastroenterology 2012;59:623–6. doi:10.5754/hge11455.
Wang X, Wan F, Pan J, Yu GZ, Chen Y, Wang JJ. Tumor size: a non-neglectable independent prognostic factor for gastric cancer. J Surg Oncol 2008;97:236–40.
Kostakoglu L, Agress Jr H, Goldsmith SJ. Clinical role of FDG PET in evaluation of cancer patients. Radiographics 2003;23:315–40.
Bilici A, Ustaalioglu BB, Seker M, Kefeli U, Canpolat N, Tekinsoy B, et al. The role of (18)F-FDG PET/CT in the assessment of suspected recurrent gastric cancer after initial surgical resection: can the results of FDG PET/CT influence patients’ treatment decision making? Eur J Nucl Med Mol Imaging 2011;38:64–73.
De Potter T, Flamen P, Van Cutsem E, Penninckx F, Filez L, Bormans G, et al. Whole-body PET with FDG for the diagnosis of recurrent gastric cancer. Eur J Nucl Med Mol Imaging 2002;29:525–9.
Dassen AE, Lips DJ, Hoekstra CJ, Pruijt JF, Bosscha K. FDG-PET has no definite role in preoperative imaging in gastric cancer. Eur J Surg Oncol 2009;35:449–55.
Kim SK, Kang KW, Lee JS, Kim HK, Chang HJ, Choi JY, et al. Assessment of lymph node metastases using 18F-FDG PET in patients with advanced gastric cancer. Eur J Nucl Med Mol Imaging 2006;33:148–55.
Stahl A, Ott K, Weber WA, Becker K, Link T, Siewert JR, et al. FDG PET imaging of locally advanced gastric carcinomas: correlation with endoscopic and histopathological findings. Eur J Nucl Med Mol Imaging 2003;30:288–95.
Pak KH, Yun M, Cheong JH, Hyung WJ, Choi SH, Noh SH. Clinical implication of FDG-PET in advanced gastric cancer with signet ring cell histology. J Surg Oncol 2011;104:566–70.
Mochiki E, Kuwano H, Katoh H, Asao T, Oriuchi N, Endo K. Evaluation of 18F-2-deoxy-2-fluoro-D-glucose positron emission tomography for gastric cancer. World J Surg 2004;28:247–53.
Nakajima T. Gastric cancer treatment guidelines in Japan. Gastric Cancer 2002;5:1–5.
Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma - 2nd English edition. Gastric Cancer 1998;1:10–24.
Hamilton SR, Aaltonen LA. Tumors of the stomach. In: WHO classification of tumors. Pathology and genetics. Tumors of the digestive system. Lyon: IARC Press; 2000. p. 38–52.
Yun M, Lim JS, Noh SH, Hyung WJ, Cheong JH, Bong JK, et al. Lymph node staging of gastric cancer using (18)F-FDG PET: a comparison study with CT. J Nucl Med 2005;46:1582–8.
Oh HH, Lee SE, Choi IS, Choi WJ, Yoon DS, Min HS, et al. The peak-standardized uptake value (P-SUV) by preoperative positron emission tomography-computed tomography (PET-CT) is a useful indicator of lymph node metastasis in gastric cancer. J Surg Oncol 2011;104:530–3.
Hur H, Kim SH, Kim W, Song KY, Park CH, Jeon HM. The efficacy of preoperative PET/CT for prediction of curability in surgery for locally advanced gastric carcinoma. World J Surg Oncol 2010;8:86.
Yamada A, Oguchi K, Fukushima M, Imai Y, Kadoya M. Evaluation of 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography in gastric carcinoma: relation to histological subtypes, depth of tumor invasion, and glucose transporter-1 expression. Ann Nucl Med 2006;20:597–604.
Mukai K, Ishida Y, Okajima K, Isozaki H, Morimoto T, Nishiyama S. Usefulness of preoperative FDG-PET for detection of gastric cancer. Gastric Cancer 2006;9:192–6.
Koga H, Sasaki M, Kuwabara Y, Hiraka K, Nakagawa M, Abe K, et al. An analysis of the physiological FDG uptake pattern in the stomach. Ann Nucl Med 2003;17:733–8.
Takahashi H, Ukawa K, Ohkawa N, Kato K, Hayashi Y, Yoshimoto K, et al. Significance of (18)F-2-deoxy-2-fluoro-glucose accumulation in the stomach on positron emission tomography. Ann Nucl Med 2009;23:391–7.
Berger KL, Nicholson SA, Dehdashti F, Siegel BA. FDG PET evaluation of mucinous neoplasms: correlation of FDG uptake with histopathologic features. AJR Am J Roentgenol 2000;174:1005–8.
Sasaki R, Komaki R, Macapinlac H, Erasmus J, Allen P, Forster K, et al. [18F]fluorodeoxyglucose uptake by positron emission tomography predicts outcome of non-small-cell lung cancer. J Clin Oncol 2005;23:1136–43.
Lee JW, Paeng JC, Kang KW, Kwon HW, Suh KS, Chung JK, et al. Prediction of tumor recurrence by 18F-FDG PET in liver transplantation for hepatocellular carcinoma. J Nucl Med 2009;50:682–7.
Lee SM, Kim TS, Lee JW, Kim SK, Park SJ, Han SS. Improved prognostic value of standardized uptake value corrected for blood glucose level in pancreatic cancer using F-18 FDG PET. Clin Nucl Med 2011;36:331–6.
Kawamura T, Kusakabe T, Sugino T, Watanabe K, Fukuda T, Nashimoto A, et al. Expression of glucose transporter-1 in human gastric carcinoma: association with tumor aggressiveness, metastasis, and patient survival. Cancer 2001;92:634–41.
Shimada H, Okazumi S, Koyama M, Murakami K. Japanese Gastric Cancer Association Task Force for Research Promotion: clinical utility of (18)F-fluoro-2-deoxyglucose positron emission tomography in gastric cancer. A systematic review of the literature. Gastric Cancer 2011;14:13–21.
Kim JP, Kim SC, Yang HK. Prognostic significance of signet ring cell carcinoma of the stomach. Surg Oncol 1994;3:221–7.
Park JC, Lee YC, Kim JH, Kim YJ, Lee SK, Shin SK, et al. Clinicopathological features and prognostic factors of proximal gastric carcinoma in a population with high Helicobacter pylori prevalence: a single-center, large-volume study in Korea. Ann Surg Oncol 2010;17:829–37.
Chung HW, Lee EJ, Cho YH, Yoon SY, So Y, Kim SY, et al. High FDG uptake in PET/CT predicts worse prognosis in patients with metastatic gastric adenocarcinoma. J Cancer Res Clin Oncol 2010;136:1929–35.
Lai JF, Kim S, Kim K, Li C, Oh SJ, Hyung WJ, et al. Prediction of recurrence of early gastric cancer after curative resection. Ann Surg Oncol 2009;16:1896–902.
Kim JW, Hwang I, Kim MJ, Jang SJ. Clinicopathological characteristics and predictive markers of early gastric cancer with recurrence. J Korean Med Sci 2009;24:1158–64.
Youn HG, An JY, Choi MG, Noh JH, Sohn TS, Kim S. Recurrence after curative resection of early gastric cancer. Ann Surg Oncol 2010;17:448–54.
Acknowledgment
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lee, J.W., Lee, S.M., Lee, MS. et al. Role of 18F-FDG PET/CT in the prediction of gastric cancer recurrence after curative surgical resection. Eur J Nucl Med Mol Imaging 39, 1425–1434 (2012). https://doi.org/10.1007/s00259-012-2164-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00259-012-2164-2