Does high [F]FDG uptake always mean poor prognosis? Colon cancer with high-level microsatellite instability is associated with high [F]FDG uptake on PET/CT.

OBJECTIVES

High-level microsatellite instability (MSI-high) is generally associated with higher F-18 fluorodeoxyglucose ([F]FDG) uptake than stable microsatellite (MSI-stable) tumors. However, MSI-high tumors have better prognosis, which is in contrast with general understanding that high [F]FDG uptake correlates with poor prognosis. This study evaluated metastasis incidence with MSI status and [F]FDG uptake.

METHODS

We retrospectively reviewed 108 right-side colon cancer patients who underwent preoperative [F]FDG PET/CT and postoperative MSI evaluations using a standard polymerase chain reaction at five Bethesda guidelines panel loci. The maximum standard uptake value (SUVmax), SUVmax tumor-to-liver ratio (TLR), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary tumor were measured using SUV 2.5 cut-off threshold. Student's t-test or Mann-Whitney U test was performed for continuous variables, and χ test or Fisher's exact test was performed for categorical variables (p value of  < 0.05 for statistical significance). Medical records were reviewed for metastasis incidence.

RESULTS

Our study population had 66 MSI-stable and 42 MSI-high tumors. [F]FDG uptake was higher in MSI-high tumors than MSI-stable tumors (TLR, median (Q1, Q3): 7.95 (6.06, 10.54) vs. 6.08 (4.09, 8.82), p = 0.021). Multivariable subgroup analysis demonstrated that higher [F]FDG uptake was associated with higher risks of distant metastasis in MSI-stable tumors (SUVmax: p = 0.025, MTV: p = 0.008, TLG: p = 0.019) but not in MSI-high tumors.

CONCLUSION

MSI-high colon cancer is associated with high [F]FDG uptake, but unlike MSI-stable tumors, the degree of [F]FDG uptake does not correlate with the rate of distant metastasis.

CLINICAL RELEVANCE STATEMENT

MSI status should be considered during PET/CT assessment of colon cancer patients, as the degree of [F]FDG uptake might not reflect metastatic potential in MSI-high tumors.

KEY POINTS

• High-level microsatellite instability (MSI-high) tumor is a prognostic factor for distant metastasis. • MSI-high colon cancers had a tendency of demonstrating higher [F]FDG uptake compared to MSI-stable tumors. • Although higher [F]FDG uptake is known to represent higher risks of distant metastasis, the degree of [F]FDG uptake in MSI-high tumors did not correlate with the rate at which distant metastasis occurred.