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Metabolic information on staging FDG-PET–CT as a prognostic tool in the evaluation of 97 patients with gastric cancer

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Abstract

Background and objective

Gastric cancer remains a leading cause of malignancy-related mortality. Many patients with locally advanced disease succumb despite peri-operative chemotherapy and the survival benefit of chemotherapy for advanced disease is modest, suggesting that current staging is imperfect. The role of fluorine-18-2-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) in the staging of gastric cancer remains to be determined. This study aimed to determine, and compare with computerized tomography (CT), the association between FDG-PET uptake in the primary tumour and regional lymph nodes, and overall survival in patients with all stage gastric cancer.

Methods

Patients with histologically confirmed gastric cancer (any stage) who, at diagnosis, had received a staging FDG-PET–CT at our institution between 2006 and 2011 were included. Records were retrospectively analysed. Patients with >50 % of tumour above the gastro-oesophageal junction or an active second malignancy were excluded.

Results

97 patients were included in the analysis. Surgery with curative intent was performed in 68 patients. In univariate analysis, an association with overall survival was seen in patients who had FDG-PET-positive primary tumours (hazard ratio (HR) for death 3.33, 95 % confidence interval (95 % CI) 1.63–6.80, p = 0.001). FDG-PET lymph node positive (vs node negativity) was associated with inferior overall survival (HR 8.66, 95 % CI 4.59–16.37, p < 0.0001), and remained an independent predictor in the multivariate analysis. In contrast, positive lymphadenopathy identified on CT was not associated with overall survival (HR 1.34, 95 % CI 0.79–2.29, p = 0.82).

Conclusion

FDG-PET-positive tumours are associated with an inferior overall survival. In contrast to CT, FDG-PET-positive lymphadenopathy is associated with a decreased overall survival.

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Authors and Affiliations

  1. Department of Medical Oncology, Liverpool Hospital, Sydney, NSW, Australia

    Nicholas A. Coupe & Deme Karikios

  2. Centre for Research Evidence Management and Surveillance, South Western Sydney Local Health District, Sydney, Australia

    Shanley Chong

  3. South Western Sydney Clinical School, University of New South Wales, Sydney, Australia

    Shanley Chong

  4. Department of Nuclear Medicine and PET, Liverpool Hospital, Sydney, NSW, Australia

    June Yap & Michael Lin

  5. Department of Medical Oncology, Liverpool Hospital, Sydney, NSW, Australia

    Weng Ng

  6. Discipline of Surgery, University of Western Sydney, Sydney, NSW, Australia

    Neil Merrett

  7. University of New South Wales, Sydney, Australia

    Michael Lin

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  1. Nicholas A. Coupe
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  2. Deme Karikios
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Correspondence to Nicholas A. Coupe.

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Coupe, N.A., Karikios, D., Chong, S. et al. Metabolic information on staging FDG-PET–CT as a prognostic tool in the evaluation of 97 patients with gastric cancer. Ann Nucl Med 28, 128–135 (2014). https://doi.org/10.1007/s12149-013-0791-8

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  • DOI: https://doi.org/10.1007/s12149-013-0791-8

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