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2-[18F]FDG PET/CT parameters associated with WHO/ISUP grade in clear cell renal cell carcinoma

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Abstract

Purpose

To explore the potential parameters from preoperative 2-[18F]FDG PET/CT that might associate with the World Health Organization/the International Society of Urological Pathology (WHO/ISUP) grade in clear cell renal cell carcinoma (ccRCC).

Methods

One hundred twenty-five patients with newly diagnosed ccRCC who underwent 2-[18F]FDG PET/CT prior to surgery or biopsy were retrospectively reviewed. The metabolic parameters and imaging features obtained from 2-[18F]FDG PET/CT examinations were analyzed in combination with clinical characteristics. Univariate and multivariate logistic regression analyses were performed to identify the predictive factors of WHO/ISUP grade.

Results

Metabolic parameters of primary tumor maximum standardized uptake value (SUVmax), tumor-to-liver SUV ratio (TLR), and tumor-to-kidney SUV ratio (TKR) were significantly different between any two of the four different WHO/ISUP grades, except those between the WHO/ISUP grade 3 and grade 4. The optimal cutoff values to predict high WHO/ISUP grade for SUVmax, TLR, and TKR were 4.15, 1.63, and 1.59, respectively. TLR (AUC: 0.841) was superior to TKR (AUC: 0.810) in distinguishing high and low WHO/ISUP grades (P = 0.0042). In univariate analysis, SUVmax, TLR, TKR, primary tumor size, tumor thrombus, distant metastases, and clinical symptoms could discriminate between the high and low WHO/ISUP grades (P < 0.05). In multivariate analysis, TLR (P < 0.001; OR: 1.732; 95%CI: 1.289–2.328) and tumor thrombus (P < 0.001; OR: 6.199; 95%CI: 2.499–15.375) were significant factors for differentiating WHO/ISUP grades.

Conclusion

Elevated TLR (> 1.63) and presence of tumor thrombus from preoperative 2-[18F]FDG PET/CT can distinguish high WHO/ISUP grade ccRCC effectively. 2-[18F]FDG PET/CT may be a feasible method for noninvasive assessment of WHO/ISUP grade.

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Data availability

The data used in the current study is available from the corresponding authors on reasonable request.

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Funding

This study was supported by grants from the Clinical Medicine Plus X - Young Scholars Project of Peking University, the Fundamental Research Funds for the Central Universities (PKU2018LCXQ012, PKU2019LCXQ021), and the Youth Clinical Research Project of Peking University First Hospital (2018CR14).

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Author notes

  1. Yanyan Zhao, Caixia Wu and Wei Li contributed equally to this work.

Authors and Affiliations

  1. Department of Nuclear Medicine, Peking University First Hospital, Beijing, China

    Yanyan Zhao, Caixia Wu, Xueqi Chen, Xuhe Liao, Yonggang Cui, Guangyu Zhao, Meng Liu & Zhanli Fu

  2. Department of Nuclear Medicine, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Wei Li

  3. Department of Urology, Peking University First Hospital, Beijing, China

    Ziao Li

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  1. Yanyan Zhao
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Contributions

Conceptualization: Meng Liu, Zhanli Fu;

Methodology: Meng Liu, Zhanli Fu, Yanyan Zhao, Caixia Wu;

Formal analysis and investigation: Yanyan Zhao, Caixia Wu, Wei Li, Xueqi Chen, Xuhe Liao, Yonggang Cui, Guangyu Zhao;

Writing—original draft preparation: Yanyan Zhao, Caixia Wu;

Writing—review and editing: Meng Liu, Zhanli Fu, Ziao Li;

Funding acquisition: Meng Liu;

Supervision: Meng Liu, Zhanli Fu.

All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Meng Liu or Zhanli Fu.

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The Ethics Committee of Peking University First Hospital approved this retrospective study and waived the need for written informed consent.

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Zhao, Y., Wu, C., Li, W. et al. 2-[18F]FDG PET/CT parameters associated with WHO/ISUP grade in clear cell renal cell carcinoma. Eur J Nucl Med Mol Imaging 48, 570–579 (2021). https://doi.org/10.1007/s00259-020-04996-4

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  • DOI: https://doi.org/10.1007/s00259-020-04996-4

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