Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou, Chuo-ku, Kobe, 650-0017, Japan.
Sci Rep. 2022 Jul 5;12(1):11370. doi: 10.1038/s41598-022-14965-6.
In recent years, the usefulness of neoadjuvant chemotherapy for resectable advanced gastric cancer, particularly stage III, has been reported. Preoperative staging is mainly determined by computed tomography (CT), and the usefulness of F-fluoro-2-deoxyglucose positron emission tomography/CT (FDG-PET/CT) for gastric cancer has been limited in usefulness. The study aimed to evaluate the usefulness of FDG-PET/CT in preoperative diagnosis of advanced gastric cancer. We retrospectively enrolled 113 patients with gastric cancer who underwent preoperative FDG-PET/CT. All patients underwent gastrectomy with lymph-node dissection. The maximum standardized uptake value (SUVmax) of the primary tumor (T-SUVmax) and lymph nodes (N-SUVmax) were measured for all patients. The cutoff values of T-SUVmax for pathological T3/4 from receiver operating characteristic analysis were 8.28 for differentiated and 4.32 for undifferentiated types. The T-SUVmax and N-SUVmax cutoff values for pathological lymph-node metastasis were 4.32 and 1.82, respectively. Multivariate analysis showed that T-SUVmax for differentiated types was a significant predictor of pathological T3/4, and N-SUVmax was a significant predictor of lymph-node metastasis. In conclusion, the SUVmax of FDG-PET/CT was a useful predictor of pathological T3/4 and lymph-node metastasis in gastric cancer. The diagnosis by preoperative FDG-PET/CT is promising to contribute a more accurate staging of gastric cancer than by CT scan alone.
近年来，新辅助化疗在可切除的进展期胃癌（尤其是 III 期）中的有效性已得到报道。术前分期主要由计算机断层扫描（CT）确定，氟-18-脱氧葡萄糖正电子发射断层扫描/CT（FDG-PET/CT）在胃癌中的应用价值有限。本研究旨在评估 FDG-PET/CT 在术前诊断进展期胃癌中的作用。我们回顾性纳入了 113 例接受术前 FDG-PET/CT 的胃癌患者。所有患者均接受了胃切除术和淋巴结清扫术。对所有患者测量原发肿瘤（T-SUVmax）和淋巴结（N-SUVmax）的最大标准化摄取值（SUVmax）。通过受试者工作特征分析，确定 T-SUVmax 对分化型和未分化型病理 T3/4 的截断值分别为 8.28 和 4.32。T-SUVmax 和 N-SUVmax 对病理淋巴结转移的截断值分别为 4.32 和 1.82。多因素分析显示，分化型 T-SUVmax 是病理 T3/4 的显著预测因子，N-SUVmax 是淋巴结转移的显著预测因子。总之，FDG-PET/CT 的 SUVmax 是预测胃癌病理 T3/4 和淋巴结转移的有用指标。与单独 CT 扫描相比，术前 FDG-PET/CT 诊断有望更准确地分期胃癌。
