Cancer Prevention Center, Yonsei Cancer Center, Seoul, Republic of Korea.
Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Gastric Cancer. 2018 Mar;21(2):213-224. doi: 10.1007/s10120-017-0739-0. Epub 2017 Jun 22.
We aimed to find the clinical value of metastatic tumor burden evaluated with F18-FDG PET/CT in gastric cancer patients, considering the human epidermal growth factor receptor 2 (HER2) status.
We retrospectively reviewed 124 patients with locally advanced or metastatic gastric cancer at Yonsei Cancer Center between January 2006 and December 2014 who had undergone baseline FDG PET/CT before first-line chemotherapy. We measured the maximum standardized uptake value from the primary tumor (SUV) and whole-body (WB) PET/CT parameters, including WB SUV, WB SUV, WB metabolic tumor volume (WB MTV), and WB total lesion glycolysis (WB TLG), in all metabolically active metastatic lesions (SUV threshold ≥2.5 or 40% isocontour for ≤2.5), and we determined their association with patient survival outcomes.
SUV was higher in HER2-positive gastric cancers (median 12.1, range 3.4-34.6) compared to HER-2 negative (7.4, 1.6-39.1, P < 0.001). Among all patients, WB TLG > 600, which is indicative of a high metastatic tumor burden, showed worse progression-free survival (PFS) [hazard ratio (HR), 2.003; 95% CI, 1.300-3.086; P = 0.002] and overall survival (OS) (HR, 3.001; 95% CI, 1.950-4.618; P < 0.001) than did WB TLG ≤ 600. Among HER2-positive gastric cancer patients treated with trastuzumab, higher metabolic tumor burden predicted worse OS, but not PFS.
HER2-positive gastric cancers had higher SUV compared to HER2-negative gastric cancers. In both HER2-negative patients and -positive patients receiving trastuzumab, FDG PET/CT volume-based parameters may have a role in further stratifying the prognosis of stage IV gastric cancer.
本研究旨在探讨 18F-FDG PET/CT 评估转移性肿瘤负荷在胃癌患者中的临床价值，考虑到人类表皮生长因子受体 2（HER2）状态。
我们回顾性分析了 2006 年 1 月至 2014 年 12 月期间在延世癌症中心接受一线化疗前接受基线 FDG PET/CT 检查的 124 例局部晚期或转移性胃癌患者。我们测量了原发肿瘤（SUV）和全身（WB）PET/CT 参数的最大标准化摄取值，包括所有代谢活跃的转移病灶（SUV 阈值≥2.5 或 2.5 以下的 40%等轮廓）中的 WB SUV、WB SUV、WB 代谢肿瘤体积（WB MTV）和 WB 总病变糖酵解（WB TLG），并确定它们与患者生存结局的关系。
与 HER2 阴性胃癌相比，HER2 阳性胃癌的 SUV 更高（中位数 12.1，范围 3.4-34.6）（P<0.001）。在所有患者中，WB TLG>600 表明转移性肿瘤负荷较高，无进展生存期（PFS）更差[风险比（HR），2.003；95%置信区间，1.300-3.086；P=0.002]和总生存期（OS）（HR，3.001；95%置信区间，1.950-4.618；P<0.001）比 WB TLG≤600。在接受曲妥珠单抗治疗的 HER2 阳性胃癌患者中，较高的代谢肿瘤负荷预示着 OS 更差，但 PFS 无差异。
与 HER2 阴性胃癌相比，HER2 阳性胃癌的 SUV 更高。在接受曲妥珠单抗治疗的 HER2 阴性和阳性患者中，FDG PET/CT 体积参数可能在进一步分层 IV 期胃癌的预后方面发挥作用。
