Differences on metabolic behavior between intra and extrahepatic cholangiocarcinomas at 18F-FDG–PET/CT: prognostic implication of metabolic parameters and tumor markers
Background and purpose
Cholangiocarcinoma is an infrequent neoplasm barely studied with 18F-FDG–PET/CT. We evaluated the metabolic behavior of cholangiocarcinoma in PET/CT according to its location (intra or extrahepatic) and analyzed the relationship between metabolic parameters of the primary tumor and tumor markers (CA19-9 and CEA), determining their prognostic significance.
Retrospective study of PET/CT of 60 patients with untreated cholangiocarcinoma, divided into two groups according to tumor location. FDG uptake was evaluated visually and semiquantitatively [SUVmax and tumor-to-liver ratio (TLR)], and differences between intra and extrahepatic cholangiocarcinomas were tested, both for FDG uptake in the primary tumor and for the presence of regional or distant disease (per-patient), as well as regarding tumor marker levels. A correlation between metabolic parameters and tumor markers was performed, and prognostic value of these factors was determined (univariate and multivariate analyses).
Intrahepatic cholangiocarcinomas were significantly more FDG-avid than extrahepatic ones (p = 0.006 for SUVmax; p = 0.002 for TLR). There were differences neither between both groups considering the capacity of PET/CT to detect regional (p = 0.261) and distant involvement (p = 0.876), nor regarding the levels of tumor markers (p = 0.160 for CA19-9; p = 0.708 for CEA). Metabolic parameters and tumor markers showed a weak positive correlation (R2 0.22–0.27). At the multivariate analysis, advanced stage (p = 0.024), increased CEA (p = 0.022), and higher TLR (p = 0.003) were significantly related with shorter overall survival.
Intra and extrahepatic cholangiocarcinomas behave differently on PET/CT, though no differences between both groups exist in its capacity to detect regional or distant disease. Metabolic parameters and levels of tumor markers seem to relate with tumor burden, impacting in prognosis.
KeywordsFDG–PET/CT Cholangiocarcinoma SUVmax Tumor markers Prognosis
Compliance with ethical standards
Conflicts of interest
The authors declare that they have no conflicts of interest.
This is a retrospective work involving human participants. The final manuscript was revised and approved by the Ethics Committee of our institution.
Informed consent was waived due to its retrospective nature, though prior to data analysis, all patients were de-identified, and confidential information was protected according to national standards.
- 10.Khan SA, Davidson BR, Goldin R, Heaton N, Karani J, Pereira SP, Rosenberg WM, Tait P, Taylor-Robinson SD, Thillainayagam AV, Thomas HC, Wasan H. British society of gastroenterology. Guidelines for the diagnosis and treatment of cholangiocarcinoma: an update. Gut. 2012;61:1657–69.CrossRefGoogle Scholar
- 13.Annunziata S, Caldarella C, Pizzuto DA, Galiandro F, Sadeghi R, Giovanella L, Treglia G. Diagnostic accuracy of fluorine-18-fluorodeoxyglucose positron emission tomography in the evaluation of the primary tumor in patients with cholangiocarcinoma: a meta-analysis. Biomed Res Int. 2014;2014:247693.CrossRefGoogle Scholar
- 24.Sakamoto Y, Kokudo N, Matsuyama Y, Sakamoto M, Izumi N, Kadoya M, Kaneko S, Ku Y, Kudo M, Takayama T, Nakashima O. Liver Cancer study group of Japan. Proposal of a new staging system for intrahepatic cholangiocarcinoma: analysis of surgical patients from a nationwide survey of the liver cancer study group of Japan. Cancer. 2016;122:61–70.CrossRefGoogle Scholar
- 27.Suzuki H, Komuta M, Bolog A, Yokobori T, Wada S, Araki K, Kubo N, Watanabe A, Tsukagoshi M, Kuwano H. Relationship between 18-F-fluoro-deoxy-d-glucose uptake and expression of glucose transporter 1 and pyruvate kinase M2 in intrahepatic cholangiocarcinoma. Dig Liver Dis. 2015;47:590–6.CrossRefGoogle Scholar
- 28.Hyder O, Hatzaras I, Sotiropoulos GC, Paul A, Alexandrescu S, Marques H, Pulitano C, Barroso E, Clary BM, Aldrighetti L, Ferrone CR, Zhu AX, Bauer TW, Walters DM, Groeschl R, Gamblin TC, Marsh JW, Nguyen KT, Turley R, Popescu I, Hubert C, Meyer S, Choti MA, Gigot JF, Mentha G, Pawlik TM. Recurrence after operative management of intrahepatic cholangiocarcinoma. Surgery. 2013;153:811–8.CrossRefGoogle Scholar
- 30.Lee JY, Kim HJ, Yim SH, Shin DS, Yu JH, Ju DY, Park JH, Park DI, Cho YK, Sohn CI, Jeon WK, Kim BI. Primary tumor maximum standardized uptake value measured on 18F-fluorodeoxyglucose positron emission tomography-computed tomography is a prognostic value for survival in bile duct and gallbladder cancer. Korean J Gastroenterol. 2013;62:227–33.CrossRefGoogle Scholar
- 31.Song JY, Lee YN, Kim YS, Kim SG, Jin SJ, Park JM, Choi GS, Chung JC, Lee MH, Cho YH, Choi MH, Kim DC, Choi HJ, Moon JH, Lee SH, Jeong SW, Jang JY, Kim HS, Kim BS. Predictability of preoperative 18F-FDG PET for histopathological differentiation and early recurrence of primary malignant intrahepatic tumors. Nucl Med Commun. 2015;36:319–27.CrossRefGoogle Scholar