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Lee SM, Song GJ, Son MW, Yun JH, Lee MS, Lee JW. Association of Increased CT-Attenuation of Visceral Adipose Tissue After Surgery with Poor Survival Outcomes in Patients with Stage II-III Gastric Cancer: A Retrospective Cohort Study. Cancers (Basel) 2025; 17:235. [PMID: 39858017 PMCID: PMC11764301 DOI: 10.3390/cancers17020235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2024] [Revised: 01/07/2025] [Accepted: 01/09/2025] [Indexed: 01/27/2025] Open
Abstract
BACKGROUND/OBJECTIVES This study aimed to investigate whether post-operative changes in the computed tomography (CT)-attenuation of subcutaneous (SAT) and visceral (VAT) adipose tissues were significantly associated with recurrence-free survival (RFS), peritoneal RFS, and overall survival (OS) in patients with stage II-III gastric cancer. METHODS This retrospective study analyzed 243 patients with stage II-III gastric cancer who underwent curative surgery. CT-attenuation values of SAT (SAT HU) and VAT (VAT HU) were measured from non-contrast-enhanced abdominopelvic CT images taken pre-operatively and 6 months post-operatively. Changes in SAT HU (ΔSAT HU) and VAT HU (ΔVAT HU) between the two CT scans were calculated. The prognostic value of these variables for predicting survival outcomes was assessed. RESULTS Correlation analyses showed that both ΔSAT HU and ΔVAT HU were significantly positively correlated with T stage, TNM stage, and tumor size (p < 0.05). In the multivariate survival analysis, ΔVAT HU emerged as an independent significant predictor for RFS (p = 0.002, hazard ratio, 2.437), peritoneal RFS (p = 0.023, hazard ratio, 2.457), and OS (p = 0.043, hazard ratio, 2.204) after adjusting for age, sex, histopathological classification, T stage, and N stage. Patients with high ΔVAT HU had worse RFS, peritoneal RFS, and OS compared to those with low ΔVAT HU. CONCLUSIONS Change in CT-attenuation of VAT following surgery was significantly correlated with tumor characteristics and was a significant predictor of RFS, peritoneal RFS, and OS in patients with stage II-III gastric cancer.
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Affiliation(s)
- Sang Mi Lee
- Department of Nuclear Medicine, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea
| | - Geum Jong Song
- Department of Surgery, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea
| | - Myoung Won Son
- Department of Surgery, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea
| | - Jong Hyuk Yun
- Department of Surgery, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea
| | - Moon-Soo Lee
- Department of Surgery, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea
| | - Jeong Won Lee
- Department of Nuclear Medicine, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea
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Iida S, Matsumoto Y, Toyozumi T, Otsuka R, Shiraishi T, Morishita H, Makiyama T, Nishioka Y, Yamada M, Hirata A, Hayano K, Ohira G, Kano M, Matsubara H. High Subcutaneous Adipose Tissue Radiodensity Predicts Poor Prognosis in Patients With Gastric Cancer. CANCER DIAGNOSIS & PROGNOSIS 2024; 4:754-761. [PMID: 39502618 PMCID: PMC11534057 DOI: 10.21873/cdp.10392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Revised: 08/26/2024] [Accepted: 08/28/2024] [Indexed: 11/08/2024]
Abstract
Background/Aim Although the impact of body composition on cancer treatment outcomes of patients with cancer has been increasingly reported, it is still unclear whether the radiodensity of subcutaneous adipose tissue (SAT) on computed tomography (CT) images has a prognostic impact on patients with gastric cancer. We measured muscle and SAT profiles on CT and performed an integrated analysis with clinicopathologic factors. Patients and Methods We retrospectively analyzed 230 patients with gastric cancer who underwent gastrectomy between June 2016 and December 2020. SAT radiodensity (SAT-R), and skeletal muscle index (SMI) were measured in preoperative CT images. These were compared with clinicopathologic factors, overall survival (OS), and recurrence-free survival (RFS). Results High SAT-R was significantly associated with older age (p=0.003) and lower BMI, lymphocyte, hemoglobin, γ-GTP, cholinesterase, albumin, and triglyceride values (p<0.001, <0.001, 0.027, 0.032, <0.001, 0.001, and <0.001, respectively). In the univariate analysis, high SAT-R, and low SMI were significantly associated with poor OS (p=0.003 and <0.001) and poor RFS (p=0.014 and 0.011). In the multivariate analysis by Cox proportional hazard model, high SAT-R and low SMI were identified as independent prognostic factors for poor OS (p=0.037 and 0.007). Conclusion High SAT-R on preoperative CT was associated with poor OS in patients with gastric cancer after gastrectomy. SAT-R has a potential to be a novel prognostic marker for surgically treated patients with gastric cancer.
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Affiliation(s)
- Shinichiro Iida
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yasunori Matsumoto
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takeshi Toyozumi
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Ryota Otsuka
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Tadashi Shiraishi
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hiroki Morishita
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Tenshi Makiyama
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yuri Nishioka
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Masanari Yamada
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Atsushi Hirata
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Koichi Hayano
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Gaku Ohira
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Masayuki Kano
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
- Division of Gastroenterological Surgery, Chiba Cancer Center, Chiba, Japan
| | - Hisahiro Matsubara
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
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Gunchick V, Brown E, Liu J, Locasale JW, Philip PA, Wang SC, Su GL, Sahai V. Morphomics, Survival, and Metabolites in Patients With Metastatic Pancreatic Cancer. JAMA Netw Open 2024; 7:e2440047. [PMID: 39418020 PMCID: PMC11581562 DOI: 10.1001/jamanetworkopen.2024.40047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 08/26/2024] [Indexed: 10/19/2024] Open
Abstract
Importance Associations of body mass index (BMI) with survival in pancreatic ductal adenocarcinoma (PDA) have substantial variability in literature, potentially due to heterogeneous patient populations and retrospective analyses. Additionally, BMI may inadequately describe body composition (ie, morphomics; including subcutaneous and visceral fats, muscle, and fascia), which might have independent biological roles and associations with survival. Objective To study the associations of BMI and morphomics with survival and metabolomics in metastatic PDA. Design, Setting, and Participants This cohort study prospectively collected patient data, imaging, and serum on the phase 3 trial (Avenger500), which investigated the efficacy and safety of 5-fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFIRINOX) versus modified FOLFIRINOX plus devimistat. The randomized trial accrued 528 patients with chemotherapy-naive, metastatic PDA from Europe, Israel, Korea, and the US between 2018 and 2020. In the present study, per-protocol patients with L1 to L4, T10 to T12 vertebral levels were evaluated. Data analysis occurred from January 2023 to April 2024. Exposure Patient data were collected by clinical staff. Morphomics were analyzed from baseline imaging. Metabolites were extracted from baseline serum. Main Outcome and Measures A multifaceted statistical approach evaluated associations of BMI and morphomics with progression-free survival (PFS) and overall survival (OS). Associations of morphomics with metabolites were also studied. Results Of the 528 initial patients, 476 (median [IQR] age, 63 [56-68] years; 280 male [58.8%]; median [IQR] BMI, 25.0 [22.1-25.9]) were evaluable for the present study. BMI (obese [≥30] compared with normal [18.5-24.9]) was not associated with OS (hazard ratio [HR], 0.90; 95% CI, 0.67-1.22; P for trend = .33). More subcutaneous fat was associated with longer OS (HR, 0.62; 95% CI, 0.41-0.94; P for trend = .02). Higher visceral fat density was associated with shorter PFS (HR, 1.74; 95% CI, 1.23-2.48; P for trend = .002) and OS (HR, 1.50; 95% CI, 1.12-2.00; P for trend = .008). A higher muscle-to-fascia ratio was associated with longer PFS (HR, 0.58; 95% CI, 0.40-0.84; P for trend = .005) and OS (HR, 0.56; 95% CI, 0.41-0.75; P for trend = 1.7 × 10-4). Subcutaneous fat was positively associated with long-chain fatty acid metabolism including pristanic acid, decanoylcarnitine, decenoylcarnitine, and octanoylcarnitine. Muscle-to-fascia was positively associated with metabolites including acetylcarnosine (β = 0.34; 95% CI, 0.21-0.47; P = 1.27 × 10-6). Conclusions and Relevance In cohort study of patients with metastatic PDA, BMI was not associated with survival. Higher visceral fat density, subcutaneous fat area, and muscle-to-fascia ratio were associated with survival independent of BMI. The latter 2 were associated with higher levels of animal product metabolism. These findings could represent novel focuses for prognostication and intervention to improve survival of patients with PDA.
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Affiliation(s)
- Valerie Gunchick
- Division of Epidemiology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Edward Brown
- Morphomics Analysis Group, University of Michigan, Ann Arbor
- Department of Surgery, University of Michigan, Ann Arbor
| | - Juan Liu
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina
| | - Jason W. Locasale
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina
| | - Philip A. Philip
- Department of Oncology, Wayne State University, School of Medicine, Karmanos Cancer Center, Detroit, Michigan
| | - Stewart C. Wang
- Morphomics Analysis Group, University of Michigan, Ann Arbor
- Department of Surgery, University of Michigan, Ann Arbor
| | - Grace L. Su
- Morphomics Analysis Group, University of Michigan, Ann Arbor
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor
- Gastroenterology Section, Veterans Administration Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Vaibhav Sahai
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor
- University of Michigan Rogel Cancer Center, Ann Arbor
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Sun Y, Deng M, Gevaert O, Aberle M, Olde Damink SW, van Dijk D, Rensen SS. Tumor metabolic activity is associated with subcutaneous adipose tissue radiodensity and survival in non-small cell lung cancer. Clin Nutr 2024; 43:1809-1815. [PMID: 38870661 DOI: 10.1016/j.clnu.2024.05.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 05/23/2024] [Accepted: 05/23/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Cachexia-associated body composition alterations and tumor metabolic activity are both associated with survival of cancer patients. Recently, subcutaneous adipose tissue properties have emerged as particularly prognostic body composition features. We hypothesized that tumors with higher metabolic activity instigate cachexia related peripheral metabolic alterations, and investigated whether tumor metabolic activity is associated with body composition and survival in patients with non-small-cell lung cancer (NSCLC), focusing on subcutaneous adipose tissue. METHODS A retrospective analysis was performed on a cohort of 173 patients with NSCLC. 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) scans obtained before treatment were used to analyze tumor metabolic activity (standardized uptake value (SUV) and SUV normalized by lean body mass (SUL)) as well as body composition variables (subcutaneous and visceral adipose tissue radiodensity (SAT/VAT radiodensity) and area; skeletal muscle radiodensity (SM radiodensity) and area). Subjects were divided into groups with high or low SAT radiodensity based on Youden Index of Receiver Operator Characteristics (ROC). Associations between tumor metabolic activity, body composition variables, and survival were analyzed by Mann-Whitney tests, Cox regression, and Kaplan-Meier analysis. RESULTS The overall prevalence of high SAT radiodensity was 50.9% (88/173). Patients with high SAT radiodensity had shorter survival compared with patients with low SAT radiodensity (mean: 45.3 vs. 50.5 months, p = 0.026). High SAT radiodensity was independently associated with shorter overall survival (multivariate Cox regression HR = 1.061, 95% CI: 1.022-1.101, p = 0.002). SAT radiodensity also correlated with tumor metabolic activity (SULpeak rs = 0.421, p = 0.029; SUVpeak rs = 0.370, p = 0.048). In contrast, the cross-sectional areas of SM, SAT, and VAT were not associated with tumor metabolic activity or survival. CONCLUSION Higher SAT radiodensity is associated with higher tumor metabolic activity and shorter survival in patients with NSCLC. This may suggest that tumors with higher metabolic activity induce subcutaneous adipose tissue alterations such as decreased lipid density, increased fibrosis, or browning.
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Affiliation(s)
- Yan Sun
- Department of Surgery and NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Min Deng
- Department of Surgery and NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Olivier Gevaert
- Stanford Center for Biomedical Informatics Research, Department of Medicine, Stanford University, USA; Stanford Center for Biomedical Informatics Research, Department of Biomedical Data Science, Stanford University, USA
| | - Merel Aberle
- Department of Surgery and NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Steven W Olde Damink
- Department of Surgery and NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands; Department of General, Visceral- and Transplantation Surgery, University Hospital Essen, Duisberg-Essen University, Germany
| | - David van Dijk
- Department of Surgery and NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Sander S Rensen
- Department of Surgery and NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.
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Lee JW, Yoo ID, Hong SP, Kang B, Kim JS, Kim YK, Bae SH, Jang SJ, Lee SM. Prognostic Impact of Visceral Adipose Tissue Imaging Parameters in Patients with Cholangiocarcinoma after Surgical Resection. Int J Mol Sci 2024; 25:3939. [PMID: 38612748 PMCID: PMC11011754 DOI: 10.3390/ijms25073939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/29/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
Visceral adiposity is known to be related to poor prognosis in patients with cholangiocarcinoma; however, the prognostic significance of the qualitative features of adipose tissue in cholangiocarcinoma has yet to be well defined. This study investigated the prognostic impact of adipose tissue imaging parameters reflecting the quantity and qualitative characteristics of subcutaneous (SAT) and visceral (VAT) adipose tissue on recurrence-free survival (RFS) and overall survival (OS) in 94 patients undergoing resection of cholangiocarcinoma. The area, mean computed tomography (CT) attenuation, and mean 2-deoxy-2-[18F]fluoro-D-glucose (FDG) uptake of SAT and VAT on positron emission tomography (PET)/CT for staging work-up were measured, and the relationship of these adipose tissue imaging parameters with clinicopathological factors and survival was assessed. TNM stage, histologic grade, lymphovascular invasion, and the size of cholangiocarcinoma showed positive correlations with adipose tissue imaging parameters. Multivariate survival analysis demonstrated that the visceral-to-subcutaneous adipose tissue area ratio (VSR) (p = 0.024; hazard ratio, 1.718) and mean FDG uptake of VAT (p = 0.033; hazard ratio, 9.781) were significant predictors for RFS, but all of the adipose tissue imaging parameters failed to show statistical significance for predicting OS. In addition to visceral adiposity, FDG uptake of VAT might be a promising prognostic parameter for predicting RFS in patients with cholangiocarcinoma.
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Affiliation(s)
- Jeong Won Lee
- Department of Nuclear Medicine, College of Medicine, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea; (J.W.L.); (I.D.Y.); (S.-p.H.)
| | - Ik Dong Yoo
- Department of Nuclear Medicine, College of Medicine, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea; (J.W.L.); (I.D.Y.); (S.-p.H.)
| | - Sun-pyo Hong
- Department of Nuclear Medicine, College of Medicine, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea; (J.W.L.); (I.D.Y.); (S.-p.H.)
| | - Beodeul Kang
- Division of Medical Oncology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam 13496, Republic of Korea (J.S.K.)
| | - Jung Sun Kim
- Division of Medical Oncology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam 13496, Republic of Korea (J.S.K.)
| | - Yung Kil Kim
- Department of Surgery, College of Medicine, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea; (Y.K.K.); (S.H.B.)
| | - Sang Ho Bae
- Department of Surgery, College of Medicine, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea; (Y.K.K.); (S.H.B.)
| | - Su Jin Jang
- Department of Nuclear Medicine, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam 13496, Republic of Korea
| | - Sang Mi Lee
- Department of Nuclear Medicine, College of Medicine, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea; (J.W.L.); (I.D.Y.); (S.-p.H.)
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Machado MAD, Moraes TF, Anjos BHL, Alencar NRG, Chang TMC, Santana BCRF, Menezes VO, Vieira LO, Brandão SCS, Salvino MA, Netto EM. Association between increased Subcutaneous Adipose Tissue Radiodensity and cancer mortality: Automated computation, comparison of cancer types, gender, and scanner bias. Appl Radiat Isot 2024; 205:111181. [PMID: 38244325 DOI: 10.1016/j.apradiso.2024.111181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 12/17/2023] [Accepted: 01/04/2024] [Indexed: 01/22/2024]
Abstract
PURPOSE Body composition analysis using computed tomography (CT) is proposed as a predictor of cancer mortality. An association between subcutaneous adipose tissue radiodensity (SATr) and cancer-specific mortality was established, while gender effects and equipment bias were estimated. METHODS 7,475 CT studies were selected from 17 cohorts containing CT images of untreated cancer patients who underwent follow-up for a period of 2.1-118.8 months. SATr measures were collected from published data (n = 6,718) or calculated according to CT images using a deep-learning network (n = 757). The association between SATr and mortality was ascertained for each cohort and gender using the p-value from either logistic regression or ROC analysis. The Kruskal-Wallis test was used to analyze differences between gender distributions, and automatic segmentation was evaluated using the Dice score and five-point Likert quality scale. Gender effect, scanner bias and changes in the Hounsfield unit (HU) to detect hazards were also estimated. RESULTS Higher SATr was associated with mortality in eight cancer types (p < 0.05). Automatic segmentation produced a score of 0.949 while the quality scale measurement was good to excellent. The extent of gender effect was 5.2 HU while the scanner bias was 10.3 HU. The minimum proposed HU change to detect a patient at risk of death was between 5.6 and 8.3 HU. CONCLUSIONS CT imaging provides valuable assessments of body composition as part of the staging process for several cancer types, saving both time and cost. Gender specific scales and scanner bias adjustments should be carried out to successfully implement SATr measures in clinical practice.
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Affiliation(s)
- Marcos A D Machado
- Department of Radiology, Complexo Hospitalar Universitário Prof. Edgard Santos/ Ebserh, Universidade Federal da Bahia, Salvador, Bahia, Zip code: 40.110-040, Brazil; Nuclear Medicine Department, São Rafael Hospital/ Rededor, Salvador, Bahia, Zip code: 41.253-190, Brazil; Nuclearis Corporation, Recife, Pernambuco, Zip code: 50.030-200, Brazil.
| | - Thauan F Moraes
- Northeast Center for Strategic Technologies, Universidade Federal de Pernambuco, Recife, Pernambuco, Zip code: 50.740-545, Brazil
| | - Bruno H L Anjos
- Nuclearis Corporation, Recife, Pernambuco, Zip code: 50.030-200, Brazil
| | - Nadja R G Alencar
- Radiology and Nuclear Medicine Department, Hospital das Clínicas, Federal University of Pernambuco, Recife, Pernambuco, Zip code: 50.670-901, Brazil
| | - Tien-Man C Chang
- Nuclear Medicine Department, Instituto de Medicina Integrada Fernandes Figueira, Recife, Pernambuco, Zip code: 50.070-902, Brazil
| | - Bruno C R F Santana
- Nuclear Medicine Department, São Rafael Hospital/ Rededor, Salvador, Bahia, Zip code: 41.253-190, Brazil
| | - Vinicius O Menezes
- Nuclear Medicine Department, São Rafael Hospital/ Rededor, Salvador, Bahia, Zip code: 41.253-190, Brazil; Nuclearis Corporation, Recife, Pernambuco, Zip code: 50.030-200, Brazil; Radiology and Nuclear Medicine Department, Hospital das Clínicas, Federal University of Pernambuco/ Ebserh, Recife, Pernambuco, Zip code: 50.670-901, Brazil
| | - Lucas O Vieira
- Nuclear Medicine Department, São Rafael Hospital/ Rededor, Salvador, Bahia, Zip code: 41.253-190, Brazil
| | - Simone C S Brandão
- Radiology and Nuclear Medicine Department, Hospital das Clínicas, Federal University of Pernambuco, Recife, Pernambuco, Zip code: 50.670-901, Brazil
| | - Marco A Salvino
- Complexo Hospitalar Universitário Prof. Edgard Santos/ Ebserh, Universidade Federal da Bahia, Salvador, Bahia, Zip code: 40.110-040, Brazil; Hemathology Department, São Rafael Hospital, Salvador, Bahia, Zip code: 41.253-190, Brazil
| | - Eduardo M Netto
- Infectious Disease Research Laboratory, Complexo Hospitalar Universitário Prof. Edgard Santos/ Ebserh, Universidade Federal da Bahia, Salvador, Bahia, Zip code: 40.110-040, Brazil
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Huang W, Tao Z, Younis MH, Cai W, Kang L. Nuclear medicine radiomics in digestive system tumors: Concept, applications, challenges, and future perspectives. VIEW 2023; 4:20230032. [PMID: 38179181 PMCID: PMC10766416 DOI: 10.1002/viw.20230032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/20/2023] [Indexed: 01/06/2024] Open
Abstract
Radiomics aims to develop novel biomarkers and provide relevant deeper subvisual information about pathology, immunophenotype, and tumor microenvironment. It uses automated or semiautomated quantitative analysis of high-dimensional images to improve characterization, diagnosis, and prognosis. Recent years have seen a rapid increase in radiomics applications in nuclear medicine, leading to some promising research results in digestive system oncology, which have been driven by big data analysis and the development of artificial intelligence. Although radiomics advances one step further toward the non-invasive precision medical analysis, it is still a step away from clinical application and faces many challenges. This review article summarizes the available literature on digestive system tumors regarding radiomics in nuclear medicine. First, we describe the workflow and steps involved in radiomics analysis. Subsequently, we discuss the progress in clinical application regarding the utilization of radiomics for distinguishing between various diseases and evaluating their prognosis, and demonstrate how radiomics advances this field. Finally, we offer our viewpoint on how the field can progress by addressing the challenges facing clinical implementation.
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Affiliation(s)
- Wenpeng Huang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
| | - Zihao Tao
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
| | - Muhsin H. Younis
- Departments of Radiology and Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Weibo Cai
- Departments of Radiology and Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Lei Kang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
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Aleixo GFP, Wei W, Chen PH, Gandhi NS, Anwer F, Dean R, Hamilton BK, Hill BT, Jagadeesh D, Khouri J, Pohlman B, Sobecks R, Winter A, Caimi P, Majhail NS. The association of body composition and outcomes following autologous hematopoietic stem cell transplantation in patients with non-Hodgkin lymphoma. Bone Marrow Transplant 2023; 58:1384-1389. [PMID: 37699993 DOI: 10.1038/s41409-023-02104-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/18/2023] [Accepted: 08/31/2023] [Indexed: 09/14/2023]
Abstract
Recently there has been a growing interest in evaluating body composition as a marker for prognosis in cancer patients. The association of body composition parameters and outcomes has not been deeply investigated in patients with autologous hematopoietic stem cell transplantation (HSCT) recipients with non-Hodgkin lymphoma (NHL). We conducted a retrospective cohort study of 264 NHL patients who received autologous HSCT. PreHSCT abdominal CT scans at the levels of L3 were assessed for body composition measures. We evaluated sarcopenia, myosteatosis, high visceral adipose tissue (VAT) and high visceral adipose tissue density (VATD). Using multivariable Cox proportional regression, we analyzed the association of clinical and transplant-related characteristics with overall survival (OS), relapse-free survival (RFS), and non-relapse mortality (NRM). In a multivariate regression model, patients with higher VATD had worse OS (HR 1.78; 95% confidence intervals CI 1.08-2.95, p = 0.02) and worse NRM (HR 2.31 95% CI 1.08-4.95, p = 0.02) than with lower VATD. Patients with lower levels of VAT also had worse RFS (HR 1.49 95% CI 1.03-2.15, p = 0.03). Sarcopenia and myosteatosis were not associated with outcomes. High pre-transplant VATD was associated with lower OS and higher NRM, and low pre-transplant VAT was associated with worse RFS in patients with NHL undergoing autologous HSCT.
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Affiliation(s)
- Gabriel F P Aleixo
- Internal Medicine Residency Program, Cleveland Clinic, Cleveland, OH, USA
| | - Wei Wei
- Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Po-Hao Chen
- Department of Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Namita S Gandhi
- Department of Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Faiz Anwer
- Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Robert Dean
- Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Betty K Hamilton
- Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brian T Hill
- Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Deepa Jagadeesh
- Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jack Khouri
- Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brad Pohlman
- Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ronald Sobecks
- Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Allison Winter
- Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Paolo Caimi
- Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
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Karaçelik T, Kaya B, Korkmaz M, Karaağaç M, Araz M, Eryılmaz MK, Bozcuk HŞ, Artaç M. Prognostic Significance of Adipose Tissue Distribution and Metabolic Activity in PET/CT in Patients with Metastatic Colorectal Cancer. J Gastrointest Cancer 2023; 54:456-466. [PMID: 35404000 DOI: 10.1007/s12029-022-00819-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE In this study, we aimed to evaluate the prognostic significance of adipose tissue distribution and metabolic activity in PET/CT to predict survival in patients with metastatic colorectal cancer (mCRC). METHODS The volume, density (HU), and FDG uptake (standardized uptake value (SUV)) of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) and maximum FDG uptake of the tumor tissue were measured. Subcutaneous adipose tissue of volume-to-density ratio (SAT ratio) was calculated. RESULTS The median OS for the patients with SAT ratio value < -1.1 and ≥ -1.1 were 38.5 (95% CI 31.54-45.58) and 24.5 (95% CI 14.13-34.93) months, respectively (p = 0.05). During follow-up, 69 patients experienced disease progression. The median progression-free survival (PFS) was 11.03 months (95% CI: 9.11-12.95). Median PFS for patients with tumor SUV max value < 11.5 and ≥ 11.5 were 9.2 (95% CI 7.25-11.27) and 12.6 (95% CI 10.02-15.27) months, respectively (p = 0.14). Forty-eight patients received bevacizumab therapy. VAT SUV mean (HR: 0.09; 95% CI 0.01-0.52, p = 0.008) was significantly associated with PFS in patients receiving bevacizumab. SAT ratio was the significant parameter for the OS (HR: 0.58; 95% CI 0.33-1.01, p = 0.05) and PFS (HR: 1.99; 95% CI 1.02-3.91, p = 0.043). CONCLUSIONS SAT ratio was an independent prognostic factor for survival in patients with mCRC. Higher SAT volume is correlated with longer survival in mCRC patients.
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Affiliation(s)
- Tuba Karaçelik
- Department of Internal Medicine, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Buğra Kaya
- Department of Nuclear Medicine, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Mustafa Korkmaz
- Department of Medical Oncology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey.
| | - Mustafa Karaağaç
- Department of Medical Oncology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Murat Araz
- Department of Medical Oncology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Melek Karakurt Eryılmaz
- Department of Medical Oncology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Hakan Şat Bozcuk
- Department of Medical Oncology, Medical Park Antalya Hospital, Antalya, Turkey
| | - Mehmet Artaç
- Department of Medical Oncology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
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Yan SY, Yang YW, Jiang XY, Hu S, Su YY, Yao H, Hu CH. Fat quantification: Imaging methods and clinical applications in cancer. Eur J Radiol 2023; 164:110851. [PMID: 37148843 DOI: 10.1016/j.ejrad.2023.110851] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/19/2023] [Accepted: 04/24/2023] [Indexed: 05/08/2023]
Abstract
Recently, the study of the relationship between lipid metabolism and cancer has evolved. The characteristics of intratumoral and peritumoral fat are distinct and changeable during cancer development. Subcutaneous and visceral adipose tissue are also associated with cancer prognosis. In non-invasive imaging, fat quantification parameters such as controlled attenuation parameter, fat volume fraction, and proton density fat fraction from different imaging methods complement conventional images by providing concrete fat information. Therefore, measuring the changes of fat content for further understanding of cancer characteristics has been applied in both research and clinical settings. In this review, the authors summarize imaging advances in fat quantification and highlight their clinical applications in cancer precaution, auxiliary diagnosis and classification, therapy response monitoring, and prognosis.
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Affiliation(s)
- Suo Yu Yan
- Department of Radiology, The First Affiliated Hospital to Soochow University, Suzhou 215006, PR China
| | - Yi Wen Yang
- Department of Radiology, The First Affiliated Hospital to Soochow University, Suzhou 215006, PR China
| | - Xin Yu Jiang
- Department of Radiology, The First Affiliated Hospital to Soochow University, Suzhou 215006, PR China
| | - Su Hu
- Department of Radiology, The First Affiliated Hospital to Soochow University, Suzhou 215006, PR China
| | - Yun Yan Su
- Department of Radiology, The First Affiliated Hospital to Soochow University, Suzhou 215006, PR China.
| | - Hui Yao
- Department of Radiology, The First Affiliated Hospital to Soochow University, Suzhou 215006, PR China; Department of General Surgery, The First Affiliated Hospital to Soochow University, Suzhou 215006, PR China.
| | - Chun Hong Hu
- Department of Radiology, The First Affiliated Hospital to Soochow University, Suzhou 215006, PR China.
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11
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Pellegrini M, Besutti G, Ottone M, Canovi S, Bonelli E, Venturelli F, Farì R, Damato A, Bonelli C, Pinto C, Ligabue G, Pattacini P, Giorgi Rossi P, El Ghoch M. Abdominal Fat Characteristics and Mortality in Rectal Cancer: A Retrospective Study. Nutrients 2023; 15:nu15020374. [PMID: 36678245 PMCID: PMC9864407 DOI: 10.3390/nu15020374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 01/14/2023] Open
Abstract
The aim of this study was to evaluate the association of adipose tissue characteristics with survival in rectal cancer patients. All consecutive patients, diagnosed with stage II-IV rectal cancer between 2010-2016 using baseline unenhanced Computed Tomography (CT), were included. Baseline total, subcutaneous and visceral adipose tissue areas (TAT, SAT, VAT) and densities (TATd, SATd, VATd) at third lumbar vertebra (L3) were retrospectively measured. The association of these tissues with cancer-specific and progression-free survival (CCS, PFS) was assessed by using competitive risk models adjusted by age, sex and stage. Among the 274 included patients (median age 70 years, 41.2% females), the protective effect of increasing adipose tissue area on survival could be due to random fluctuations (e.g., sub-distribution hazard ratio-SHR for one cm2 increase in SAT = 0.997; 95%confidence interval-CI = 0.994-1.000; p = 0.057, for CSS), while increasing density was associated with poorer survival (e.g., SHR for one Hounsfield Unit-HU increase in SATd = 1.03, 95% CI = 1.01-1.05, p = 0.002, for CSS). In models considering each adipose tissue area and respective density, the association with CSS tended to disappear for areas, while it did not change for TATd and SATd. No association was found with PFS. In conclusion, adipose tissue density influenced survival in rectal cancer patients, raising awareness on a routinely measurable variable that requires more research efforts.
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Affiliation(s)
- Massimo Pellegrini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Giulia Besutti
- Radiology Unit, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy
- Correspondence: ; Tel.: +39-0522296369
| | - Marta Ottone
- Epidemiology Unit, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Simone Canovi
- Clinical Chemistry and Endocrinology Laboratory, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Efrem Bonelli
- Radiology Unit, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
- Clinical Chemistry and Endocrinology Laboratory, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Francesco Venturelli
- Epidemiology Unit, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Roberto Farì
- Radiology Unit, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Angela Damato
- Oncology Department, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Candida Bonelli
- Oncology Department, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Carmine Pinto
- Oncology Department, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Guido Ligabue
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Pierpaolo Pattacini
- Radiology Unit, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Marwan El Ghoch
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, Riad El Solh, Beirut 11072809, Lebanon
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12
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Jia W, Wu Q, Yu X, Shen M, Zhang R, Li J, Zhao L, Huang G, Liu J. Prognostic values of ALDOB expression and 18F-FDG PET/CT in hepatocellular carcinoma. Front Oncol 2022; 12:1044902. [PMID: 36644641 PMCID: PMC9834807 DOI: 10.3389/fonc.2022.1044902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/25/2022] [Indexed: 12/13/2022] Open
Abstract
Purpose The glycolytic enzyme fructose 1,6-bisphosphate aldolase B (ALDOB) is aberrantly expressed and impacts the prognosis in hepatocellular carcinoma (HCC). Hepatic ALDOB loss leads to paradoxical upregulation of glucose metabolism, favoring hepatocellular carcinogenesis. Nevertheless, the relationship between ALDOB expression and 18F-fluorodeoxyglucose (18F-FDG) uptake, and their effects on HCC prognosis remain unclear. We evaluated whether ALDOB expression is associated with 18F-FDG uptake and their impacts on HCC prognosis prediction. Methods Changes in ALDOB expression levels and the prognostic values in HCC were analyzed using data from The Cancer Genome Atlas (TCGA) database. Ultimately, 34 patients with HCC who underwent 18F-FDG positron emission tomography/computed tomography (PET/CT) preoperatively were enrolled in this retrospective study. ALDOB expression was determined using immunohistochemistry (IHC) staining, and the maximum standardized uptake value (SUVmax) of HCC was calculated from the 18F-FDG PET/CT scans. The relationship between ALDOB expression and SUVmax was examined, and their impacts on overall survival were evaluated using Cox proportional hazards models and Kaplan-Meier survival analysis. ALDOB overexpression in HUH7 and 7721 cells was used to analyze its role in tumor metabolism. Results According to TCGA database, the ALDOB mRNA level was downregulated in HCC compared to normal tissue, and significantly shortened overall survival in HCC patients. ALDOB protein expression was similarly decreased in IHC findings in HCC than that in adjacent normal tissues (P<0.05) and was significantly associated with tumor size (P<0.001), high tumor-node-metastasis stage (P=0.022), and elevated SUVmax (P=0.009). ALDOB expression in HCC was inversely correlated with SUVmax (r=-0.454; P=0.012), and the optimal SUVmax cutoff value for predicting its expression was 4.15. Prognostically, low ALDOB expression or SUVmax ≥3.9 indicated shorter overall survival time in HCC. Moreover, COX regression analysis suggested high SUVmax as an independent prognostic risk factor for HCC (P=0.036). HCC patients with negative ALDOB expression and positive SUVmax (≥3.9) were correlated with worse prognosis. ALDOB overexpression in HCC cells significantly decreases 18F-FDG uptake and lactate production. Conclusion SUVmax in HCC patients is inversely correlated with ALDOB expression, and 18F-FDG PET/CT may be useful for ALDOB status prediction. The combined use of ALDOB expression and 18F-FDG PET/CT data can provide additional information on disease prognosis in HCC patients.
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13
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Cheng E, Caan BJ, Chen WY, Irwin ML, Prado CM, Cespedes Feliciano EM. Adipose tissue radiodensity and mortality among patients with nonmetastatic breast cancer. Clin Nutr 2022; 41:2607-2613. [PMID: 36306565 PMCID: PMC9722634 DOI: 10.1016/j.clnu.2022.09.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/02/2022] [Accepted: 09/26/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND & AIMS Computed tomography (CT) scans can measure quantity and distribution of adipose tissue, which are associated with breast cancer prognosis. As a novel prognostic marker, radiodensity of adipose tissue has been examined in multiple cancer types, but never in breast cancer. Lower density indicates larger adipocytes with greater lipid content, whereas higher density can reflect inflammation, fibrosis, vascularity, or even metabolic changes; and both may impact breast cancer prognosis. METHODS We included 2868 nonmetastatic patients with breast cancer diagnosed between January 2005 and December 2013 at Kaiser Permanente Northern California, an integrated healthcare system. From CT scans at diagnosis, we assessed the radiodensity of subcutaneous (SAT) and visceral adipose tissue (VAT) at the third lumbar vertebra and categorized their radiodensity into three levels: low (<1 standard deviation [SD] below the mean), middle (mean ± 1 SD), and high (>1 SD above the mean). Using multivariable Cox proportional hazards regression with adjustment for clinicopathological characteristics including body mass index, we calculated hazard ratios (HRs [95% confidence intervals]) for the associations of adipose tissue radiodensity with overall mortality and breast-cancer-specific mortality. RESULTS Median age at diagnosis of breast cancer was 56.0 years, most (63.3%) were non-Hispanic White and nearly half (45.6%) were stage II. Compared to middle SAT radiodensity, high SAT radiodensity was significantly associated with increased risk of overall mortality (HR: 1.45 [1.15-1.81]), non-significantly with breast-cancer-specific mortality (HR: 1.32 [0.95-1.84]). Neither low SAT radiodensity nor high or low VAT radiodensity was significantly associated with overall or breast-cancer-specific mortality. CONCLUSIONS High radiodensity of SAT at diagnosis of nonmetastatic breast cancer was associated with increased risk of overall mortality, independent of adiposity and other prognostic factors. Considering both radiodensity and quantity of adipose tissue at different locations could deepen understanding of the role of adiposity in breast cancer survival.
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Affiliation(s)
- En Cheng
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Bette J Caan
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Wendy Y Chen
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, United States
| | - Melinda L Irwin
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Connecticut, United States
| | - Carla M Prado
- Human Nutrition Research Unit, Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
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14
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Ahn H, Song GJ, Jang SH, Son MW, Lee HJ, Lee MS, Lee JH, Oh MH, Jeong GC, Yun JH, Lee SM, Lee JW. Predicting the Recurrence of Gastric Cancer Using the Textural Features of Perigastric Adipose Tissue on [ 18F]FDG PET/CT. Int J Mol Sci 2022; 23:ijms231911985. [PMID: 36233285 PMCID: PMC9569486 DOI: 10.3390/ijms231911985] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/01/2022] [Accepted: 10/08/2022] [Indexed: 12/05/2022] Open
Abstract
This study aimed to assess the relationship between the histopathological and textural features of perigastric adipose tissue (AT) on 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) and to evaluate the prognostic significance of perigastric AT textural features in predicting recurrence-free survival (RFS) in patients with gastric cancer. Sixty-nine patients with gastric cancer who underwent staging [18F]FDG PET/CT and subsequent curative surgery were retrospectively reviewed. Textural features of perigastric AT were extracted from PET images. On histopathological analysis, CD4, CD8, and CD163 cell infiltration and matrix metalloproteinase-11 and interleukin-6 (IL-6) expression in perigastric AT were graded. The degree of CD163 cell infiltration in perigastric AT was significantly correlated with the mean standardized uptake value (SUV), SUV histogram entropy, grey-level co-occurrence matrix (GLCM) energy, and GLCM entropy of perigastric AT. The degree of IL-6 expression in the perigastric AT was significantly correlated with the mean and median SUVs of perigastric AT. In multivariate survival analysis, GLCM entropy, GLCM dissimilarity, and GLCM homogeneity of perigastric AT were significant predictors of RFS. The textural features of perigastric AT on [18F]FDG PET/CT significantly correlated with inflammatory response in perigastric AT and were significant prognostic factors for predicting RFS in patients with gastric cancer.
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Affiliation(s)
- Hyein Ahn
- Department of Pathology, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Korea
| | - Geum Jong Song
- Department of Surgery, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Korea
| | - Si-Hyong Jang
- Department of Pathology, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Korea
| | - Myoung Won Son
- Department of Surgery, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Korea
| | - Hyun Ju Lee
- Department of Pathology, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Korea
| | - Moon-Soo Lee
- Department of Surgery, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Korea
| | - Ji-Hye Lee
- Department of Pathology, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Korea
| | - Mee-Hye Oh
- Department of Pathology, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Korea
| | - Geum Cheol Jeong
- Department of Nuclear Medicine, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Korea
| | - Jong Hyuk Yun
- Department of Surgery, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Korea
| | - Sang Mi Lee
- Department of Nuclear Medicine, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Korea
- Correspondence: (S.M.L.); (J.W.L.); Tel.: +82-41-570-3540 (S.M.L.); +82-32-290-2975 (J.W.L.)
| | - Jeong Won Lee
- Department of Nuclear Medicine, College of Medicine, Catholic Kwandong University, International St. Mary’s Hospital, 25 Simgok-ro 100-gil, Seo-gu, Incheon 22711, Korea
- Correspondence: (S.M.L.); (J.W.L.); Tel.: +82-41-570-3540 (S.M.L.); +82-32-290-2975 (J.W.L.)
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Cheng E, Kirley J, Cespedes Feliciano EM, Caan BJ. Adiposity and cancer survival: a systematic review and meta-analysis. Cancer Causes Control 2022; 33:1219-1246. [PMID: 35971021 PMCID: PMC10101770 DOI: 10.1007/s10552-022-01613-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 07/07/2022] [Indexed: 10/28/2022]
Abstract
PURPOSE The increasing availability of clinical imaging tests (especially CT and MRI) that directly quantify adipose tissue has led to a rapid increase in studies examining the relationship of visceral, subcutaneous, and overall adiposity to cancer survival. To summarize this emerging body of literature, we conducted a systematic review and meta-analysis of imaging-measured as well as anthropometric proxies for adipose tissue distribution and cancer survival across a wide range of cancer types. METHODS Using keywords related to adiposity, cancer, and survival, we conducted a systematic search of the literature in PubMed and MEDLINE, Embase, and Web of Science Core Collection databases from database inception to 30 June 2021. We used a random-effect method to calculate pooled hazard ratios (HR) and corresponding 95% confidence intervals (CI) within each cancer type and tested for heterogeneity using Cochran's Q test and the I2 test. RESULTS We included 203 records for this review, of which 128 records were utilized for quantitative analysis among 10 cancer types: breast, colorectal, gastroesophageal, head and neck, hepatocellular carcinoma, lung, ovarian, pancreatic, prostate, and renal cancer. We found that imaging-measured visceral, subcutaneous, and total adiposity were not significantly associated with increased risk of overall mortality, death from primary cancer, or cancer progression among patients diagnosed with these 10 cancer types; however, we found significant or high heterogeneity for many cancer types. For example, heterogeneity was similarly high when the pooled HRs (95% CI) for overall mortality associated with visceral adiposity were essentially null as in 1.03 (0.55, 1.92; I2 = 58%) for breast, 0.99 (0.81, 1.21; I2 = 71%) for colorectal, versus when they demonstrated a potential increased risk 1.17 (0.85, 1.60; I2 = 78%) for hepatocellular carcinoma and 1.62 (0.90, 2.95; I2 = 84%) for renal cancer. CONCLUSION Greater adiposity at diagnosis (directly measured by imaging) is not associated with worse survival among cancer survivors. However, heterogeneity and other potential limitations were noted across studies, suggesting differences in study design and adiposity measurement approaches, making interpretation of meta-analyses challenging. Future work to standardize imaging measurements and data analyses will strengthen research on the role of adiposity in cancer survival.
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Affiliation(s)
- En Cheng
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Jocelyn Kirley
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | | | - Bette J Caan
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
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Bongers MER, Groot OQ, Buckless CG, Kapoor ND, Twining PK, Schwab JH, Torriani M, Bredella MA. Body composition predictors of mortality on computed tomography in patients with spinal metastases undergoing surgical treatment. Spine J 2022; 22:595-604. [PMID: 34699994 PMCID: PMC8957497 DOI: 10.1016/j.spinee.2021.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/28/2021] [Accepted: 10/12/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Although survival of patients with spinal metastases has improved over the last decades due to advances in multi-modal therapy, there are currently no reliable predictors of mortality. Body composition measurements obtained using computed tomography (CT) have been recently proposed as biomarkers for survival in patients with and without cancer. Patients with cancer routinely undergo CT for staging or surveillance of therapy. Body composition assessed using opportunistic CTs might be used to determine survival in patients with spinal metastases. PURPOSE The purpose of this study was to determine the value of body composition measures obtained on opportunistic abdomen CTs to predict 90-day and 1-year mortality in patients with spinal metastases undergoing surgery. We hypothesized that low muscle and abdominal fat mass were positive predictors of mortality. STUDY DESIGN Retrospective study at a single tertiary care center in the United States. PATIENT SAMPLE This retrospective study included 196 patients between 2001 and 2016 that were 18 years of age or older, underwent surgical treatment for spinal metastases, and had a preoperative CT of the abdomen within three months prior to surgery. OUTCOME MEASURES Ninety-day and 1-year mortality by any cause. METHODS Quantification of cross-sectional areas (CSA) and CT attenuation of abdominal subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and paraspinous and abdominal skeletal muscle were performed on CT images at the level of L4 using an in-house automated algorithm. Sarcopenia was determined by total muscle CSA (cm2) divided by height squared (m2) with cutoff values of <52.4 cm2/m2 for men and <38.5 cm2/m2 for women. Bivariate and multivariate Cox proportional-hazard analyses were used to determine the associations between body compositions and 90-day and 1-year mortality. RESULTS The median age was 62 years (interquartile range=53-70). The mortality rate for 90-day was 24% and 1-year 54%. The presence of sarcopenia was associated with an increased 1-year mortality rate of 66% compared with a 1-year mortality rate of 41% in patients without sarcopenia (hazard ratio, 1.68; 95% confidence interval, 1.08-2.61; p=.02) after adjusting for various clinical factors including primary tumor type, ECOG performance status, additional metastases, neurology status, and systemic therapy. Additional analysis showed an association between sarcopenia and increased 1-year mortality when controlling for the prognostic modified Bauer score (HR, 1.58; 95%CI, 1.04-2.40; p=.03). Abdominal fat CSAs or muscle attenuation were not independently associated with mortality. CONCLUSIONS The presence of sarcopenia is associated with an increased risk of 1-year mortality for patients surgically treated for spinal metastases. Sarcopenia retained an independent association with mortality when controlling for the prognostic modified Bauer score. This implies that body composition measurements such as sarcopenia could serve as novel biomarkers for prediction of mortality and may supplement other existing prognostic tools to improve shared decision making for patients with spinal metastases that are contemplating surgical treatment.
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Affiliation(s)
- Michiel E R Bongers
- Department of Orthopaedic Surgery - Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, Yawkey 3A, 55 Fruit St, Boston, MA 02114, USA
| | - Olivier Q Groot
- Department of Orthopaedic Surgery - Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, Yawkey 3A, 55 Fruit St, Boston, MA 02114, USA
| | - Colleen G Buckless
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit St, Boston, MA 02114, USA
| | - Neal D Kapoor
- Department of Orthopaedic Surgery - Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, Yawkey 3A, 55 Fruit St, Boston, MA 02114, USA
| | - Peter K Twining
- Department of Orthopaedic Surgery - Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, Yawkey 3A, 55 Fruit St, Boston, MA 02114, USA
| | - Joseph H Schwab
- Department of Orthopaedic Surgery - Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, Yawkey 3A, 55 Fruit St, Boston, MA 02114, USA
| | - Martin Torriani
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit St, Boston, MA 02114, USA
| | - Miriam A Bredella
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit St, Boston, MA 02114, USA.
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Xie Z, Zhang H. Analysis of the Diagnosis Model of Peripheral Non-Small-Cell Lung Cancer under Computed Tomography Images. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:3107965. [PMID: 35222880 PMCID: PMC8881128 DOI: 10.1155/2022/3107965] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/23/2021] [Accepted: 08/11/2021] [Indexed: 11/17/2022]
Abstract
This study aimed to explore the effect of deep learning models on lung CT image lung parenchymal segmentation (LPS) and the application value of CT image texture features in the diagnosis of peripheral non-small-cell lung cancer (NSCLC). Data of peripheral lung cancer (PLC) patients was collected retrospectively and was divided into peripheral SCLC group and peripheral NSCLC group according to the pathological examination results, ResNet50 model and feature pyramid network (FPN) algorithm were undertaken to improve the Mask-RCNN model, and after the MaZda software extracted the texture features of the CT images of PLC patients, the Fisher coefficient was used to reduce the dimensionality, and the texture features of the CT images were analyzed and compared. The results showed that the average Dice coefficients of the 2D CH algorithm, Faster-RCNN, Mask-RCNN, and the algorithm proposed in the validation set were 0.882, 0.953, 0.961, and 0.986, respectively. The accuracy rates were 88.3%, 93.5%, 94.4%, and 97.2%. The average segmentation speeds in lung CT images were 0.289 s/sheet, 0.115 s/sheet, 0.108 s/sheet, and 0.089 s/sheet. The improved deep learning model showed higher accuracy, better robustness, and faster speed than other algorithms in the LPS of CT images. In summary, deep learning can achieve the LPS of CT images and show excellent segmentation efficiency. The texture parameters of GLCM in CT images have excellent differential diagnosis performance for NSCLC and SCLC and potential clinical application value.
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Affiliation(s)
- Zhonghai Xie
- Huzhou Central Hospital, Huzhou 313000, Zhejiang, China
| | - Huaizhong Zhang
- Lishui City People's Hospital, Lishui 323000, Zhejiang, China
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Clinical Significance of Peritumoral Adipose Tissue PET/CT Imaging Features for Predicting Axillary Lymph Node Metastasis in Patients with Breast Cancer. J Pers Med 2021; 11:jpm11101029. [PMID: 34683170 PMCID: PMC8540268 DOI: 10.3390/jpm11101029] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/07/2021] [Accepted: 10/13/2021] [Indexed: 12/12/2022] Open
Abstract
We investigated whether textural parameters of peritumoral breast adipose tissue (AT) based on F-18 fluorodeoxyglucose (FDG) PET/CT could predict axillary lymph node metastasis in patients with breast cancer. A total of 326 breast cancer patients with preoperative FDG PET/CT were retrospectively enrolled. PET/CT images were visually assessed and the maximum FDG uptake of axillary lymph nodes (LN SUVmax) was measured. From peritumoral breast AT, 38 textural features of PET imaging were extracted. The diagnostic ability of PET based on visual analysis, LN SUVmax, and textural features of peritumoral breast AT for predicting axillary lymph node metastasis were assessed using the area under the receiver operating characteristic curve (AUC) values. Among the 38 peritumoral breast AT textural features, grey-level co-occurrence matrix (GLCM) entropy showed the highest AUC value (0.830) for predicting axillary lymph node metastasis. The value of GLCM entropy was higher than that of visual analysis (0.739; p < 0.05) and the AUC value was comparable to that of LN SUVmax (0.793; p > 0.05). In the subgroup analysis of patients with negative findings on visual analysis, GLCM entropy still showed a high diagnostic ability (AUC: 0.759) in predicting lymph node metastasis. The findings suggest a potential diagnostic role of PET/CT imaging features of peritumoral breast AT in predicting axillary lymph node metastasis in patients with breast cancer.
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Han J, Harrison L, Patzelt L, Wu M, Junker D, Herzig S, Berriel Diaz M, Karampinos DC. Imaging modalities for diagnosis and monitoring of cancer cachexia. EJNMMI Res 2021; 11:94. [PMID: 34557972 PMCID: PMC8460705 DOI: 10.1186/s13550-021-00834-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 09/06/2021] [Indexed: 12/23/2022] Open
Abstract
Cachexia, a multifactorial wasting syndrome, is highly prevalent among advanced-stage cancer patients. Unlike weight loss in healthy humans, the progressive loss of body weight in cancer cachexia primarily implicates lean body mass, caused by an aberrant metabolism and systemic inflammation. This may lead to disease aggravation, poorer quality of life, and increased mortality. Timely detection is, therefore, crucial, as is the careful monitoring of cancer progression, in an effort to improve management, facilitate individual treatment and minimize disease complications. A detailed analysis of body composition and tissue changes using imaging modalities—that is, computed tomography, magnetic resonance imaging, (18F) fluoro-2-deoxy-d-glucose (18FDG) PET and dual-energy X-ray absorptiometry—shows great premise for charting the course of cachexia. Quantitative and qualitative changes to adipose tissue, organs, and muscle compartments, particularly of the trunk and extremities, could present important biomarkers for phenotyping cachexia and determining its onset in patients. In this review, we present and compare the imaging techniques that have been used in the setting of cancer cachexia. Their individual limitations, drawbacks in the face of clinical routine care, and relevance in oncology are also discussed.
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Affiliation(s)
- Jessie Han
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts Der Isar, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Luke Harrison
- Institute for Diabetes and Cancer, Helmholtz Center Munich, 85764, Neuherberg, Germany.,German Center for Diabetes Research (DZD), 85764, Neuherberg, Germany
| | - Lisa Patzelt
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts Der Isar, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Mingming Wu
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts Der Isar, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Daniela Junker
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts Der Isar, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Stephan Herzig
- Institute for Diabetes and Cancer, Helmholtz Center Munich, 85764, Neuherberg, Germany.,German Center for Diabetes Research (DZD), 85764, Neuherberg, Germany.,Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, Heidelberg, Germany.,Chair of Molecular Metabolic Control, Technical University of Munich, Munich, Germany
| | - Mauricio Berriel Diaz
- Institute for Diabetes and Cancer, Helmholtz Center Munich, 85764, Neuherberg, Germany.,German Center for Diabetes Research (DZD), 85764, Neuherberg, Germany
| | - Dimitrios C Karampinos
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts Der Isar, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
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Lee JW, Park SH, Ahn H, Lee SM, Jang SJ. Predicting Survival in Patients with Pancreatic Cancer by Integrating Bone Marrow FDG Uptake and Radiomic Features of Primary Tumor in PET/CT. Cancers (Basel) 2021; 13:cancers13143563. [PMID: 34298775 PMCID: PMC8304187 DOI: 10.3390/cancers13143563] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/07/2021] [Accepted: 07/14/2021] [Indexed: 12/13/2022] Open
Abstract
Simple Summary FDG uptake of bone marrow (BM) is known to reflect the degree of host inflammatory response to cancer cells and showed significant association with survival in diverse kinds of cancers. The aim of this retrospective study was to evaluate the prognostic significance of FDG uptake of BM and to investigate whether integrating FDG uptake of BM and radiomic features of primary tumors could improve the prediction of overall survival (OS) in patients with pancreatic cancer. In multivariable survival analysis, along with total lesion glycolysis (TLG) and first-order entropy of primary tumor lesions, FDG uptake of BM was an independent predictor of OS. We designed a PET/CT scoring system based on the cumulative scores of tumor factors (TLG and first-order entropy) and host factors (FDG uptake of BM). This scoring system was able to stratify the patients with three distinct prognostic groups independent of clinical stage and treatment modality. Abstract The purpose of this study was to evaluate the prognostic significance of FDG uptake of bone marrow (BM SUV) and to investigate its role combined with radiomic features of primary tumors in improving the prediction of overall survival (OS) in patients with pancreatic cancer. We retrospectively enrolled 65 pancreatic cancer patients with staging FDG PET/CT. BM SUV and conventional imaging parameters of primary tumors including total lesion glycolysis (TLG) were measured. First-order and higher-order textural features of primary cancer were extracted using PET textural analysis. Associations of PET/CT parameters of bone marrow (BM) and primary cancer with OS were assessed. BM SUV as well as TLG and first-order entropy of pancreatic cancer were significant independent predictors of OS in multivariable analysis. A PET/CT scoring system based on the cumulative scores of these three independent predictors enabled patient stratification into three distinct prognostic groups. The scoring system yielded a good prognostic stratification based on subgroup analysis irrespective of tumor stage and treatment modality. BM SUV was an independent predictor of OS in pancreatic cancer patients. The PET/CT scoring system that integrated PET/CT parameters of primary tumors and BM can provide prognostic information in pancreatic cancer independent of tumor stage and treatment.
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Affiliation(s)
- Jeong Won Lee
- Department of Nuclear Medicine, Catholic Kwandong University College of Medicine, International St. Mary’s Hospital, Incheon 22711, Korea;
| | - Sang-Heum Park
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Korea;
| | - Hyein Ahn
- Department of Pathology, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Korea;
| | - Sang Mi Lee
- Department of Nuclear Medicine, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Korea
- Correspondence: (S.M.L.); (S.J.J.); Tel.: +82-41-570-3540 (S.M.L.); +82-31-780-5687 (S.J.J.)
| | - Su Jin Jang
- Department of Nuclear Medicine, CHA Bundang Medical Center, CHA University, Seongnam-si 13496, Korea
- Correspondence: (S.M.L.); (S.J.J.); Tel.: +82-41-570-3540 (S.M.L.); +82-31-780-5687 (S.J.J.)
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Kapoor ND, Twining PK, Groot OQ, Pielkenrood BJ, Bongers MER, Newman ET, Verlaan JJ, Schwab JH. Adipose tissue density on CT as a prognostic factor in patients with cancer: a systematic review. Acta Oncol 2020; 59:1488-1495. [PMID: 32730106 DOI: 10.1080/0284186x.2020.1800087] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Predicting oncologic outcomes is essential for optimizing the treatment for patients with cancer. This review examines the feasibility of using Computed Tomography (CT) images of fat density as a prognostic factor in patients with cancer. METHODS A systematic literature search was performed in PubMed, Embase and Cochrane up to March 2020. All studies that mentioned using subcutaneous or visceral adipose tissue (SAT and VAT, respectively) CT characteristics as a prognostic factor for patients with cancer were included. The primary endpoints were any disease-related outcomes in patients with cancer. RESULTS After screening 1043 studies, ten studies reporting a total of 23 - ten for SAT and thirteen for VAT - comparisons on survival, tumor recurrence and postsurgical infection were included. All ten studies included different types of malignancy: six localized, two metastatic disease, and two both. Five different anatomic landmarks were used to uniformly measure fat density on CT: lumbar (L)4 (n = 4), L3 (n = 2), L4-L5 intervertebral space (n = 2), L5-S1 intervertebral space (n = 1), and the abdomen (n = 1). Overall, six of ten SAT comparisons (60%) and six of thirteen VAT comparisons (46%) reported a significant (p < .05) association of increased SAT or VAT density with an adverse outcome. All remaining nonsignificant comparisons, except one, deviated in the same direction of being predictive for adverse outcomes but failed to reach significance. The median hazard ratio (HR) for the nine SAT and thirteen VAT associations where HRs were given were 1.45 (95% confidence interval [CI] 1.01-1.97) and 1.90 (95% CI 1.12-2.74), respectively. The binomial sign test and Fisher's method both reported a significant association between both SAT and VAT and adverse outcomes. CONCLUSION This review may support the feasibility of using SAT or VAT on CT as a prognostic tool for patients with cancer in predicting adverse outcomes such as survival and tumor recurrence. Future research should standardize radiologic protocol in prospective homogeneous series of patients on each cancer diagnosis group in order to establish accurate parameters to help physicians use CT scan defined characteristics in clinical practice.
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Affiliation(s)
- N. D. Kapoor
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital – Harvard Medical School, Boston, MA, USA
| | - P. K. Twining
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital – Harvard Medical School, Boston, MA, USA
| | - O. Q. Groot
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital – Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - B. J. Pielkenrood
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - M. E. R. Bongers
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital – Harvard Medical School, Boston, MA, USA
| | - E. T. Newman
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital – Harvard Medical School, Boston, MA, USA
| | - J. J. Verlaan
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - J. H. Schwab
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital – Harvard Medical School, Boston, MA, USA
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Prognostic Value of CT-Attenuation and 18F-Fluorodeoxyglucose Uptake of Periprostatic Adipose Tissue in Patients with Prostate Cancer. J Pers Med 2020; 10:jpm10040185. [PMID: 33105555 PMCID: PMC7711777 DOI: 10.3390/jpm10040185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 02/08/2023] Open
Abstract
This study aimed to assess the prognostic value of computed tomography (CT)-attenuation and 18F-fluorodeoxyglucose (FDG) uptake of periprostatic adipose tissue (PPAT) for predicting disease progression-free survival (DPFS) in patients with prostate cancer. Seventy-seven patients with prostate cancer who underwent staging FDG positron emission tomography (PET)/CT were retrospectively reviewed. CT-attenuation (HU) and FDG uptake (SUV) of PPAT were measured from the PET/CT images. The relationships between these PPAT parameters and clinical factors were assessed, and a Cox proportional hazard regression test was performed to evaluate the prognostic significance of PPAT HU and SUV. PPAT HU and SUV showed significant positive correlations with tumor stage and serum prostate-specific antigen level (PSA) (p < 0.05). Patients with high PPAT HU and SUV had significantly worse DPFS than those with low PPAT HU and SUV (p < 0.05). In multivariate analysis, PPAT SUV was a significant predictor of DPFS after adjusting for tumor stage, serum PSA, and tumor SUV (p = 0.003; hazard ratio, 1.50; 95% confidence interval, 1.15–1.96). CT-attenuation and FDG uptake of PPAT showed significant association with disease progression in patients with prostate cancer. These imaging findings may be evidence of the role of PPAT in prostate cancer progression.
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23
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Fat density is a novel prognostic marker in patients with esophageal cancer. Clin Nutr ESPEN 2020; 39:124-130. [PMID: 32859305 DOI: 10.1016/j.clnesp.2020.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS While long-term obesity is a well-known risk factor for esophageal adenocarcinoma (ADC), recent weight loss represents a significant concern in esophageal cancer (EC), in relation with dysphagia and disease aggressiveness. These phenomenons may diversely impact the adipose tissue density, suggested in other cancer settings as an important prognostic biomarker. The analysis of body mass composition (BMC) parameters, including adipose tissue attenuation is studied here in a population of EC operated with curative intent. METHODS BMC was retrospectively evaluated on Computed-Tomography (CT)-scan images from fluorodeoxyglucose (FDG)-positron-emitting (PET)/CT scans performed as a diagnostic procedure in a cohort of 145 EC patients operated with curative intent The mean subcutaneous (SFD) and visceral fat (VFD) density along with the index (area/height2) (SF index (SFI), VF index (VFI)) were assessed on two adjacent slides at the third lumbar vertebra level by two independent investigators. Overall survival (OS) was calculated from the date of the baseline FDG-PET/CT scan. RESULTS Inter-observer correlations are excellent for all BMC parameters (r = 0.94-0.99). As expected, weight loss is associated with worse outcome. We show that low SFD (HR 0.5 (95% CI: 0.3-0.7), p < 0.001) and low VFD (HR 0.6 (95% CI: 0.4-0.9), p = 0.04) at diagnosis are associated with better OS. In contrast, body mass index (BMI) fails to show any relevance in predicting survival. CONCLUSIONS Adipose tissue density is an important prognostic factor in EC.
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Relationship Between Changes in Myocardial F-18 Fluorodeoxyglucose Uptake and Radiation Dose After Adjuvant Three-Dimensional Conformal Radiotherapy in Patients with Breast Cancer. J Clin Med 2020; 9:jcm9030666. [PMID: 32131475 PMCID: PMC7141354 DOI: 10.3390/jcm9030666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 02/24/2020] [Accepted: 02/28/2020] [Indexed: 12/28/2022] Open
Abstract
This study aimed to assess the relationship between radiation dose and changes in the irradiated myocardial F-18 fluorodeoxyglucose (FDG) uptake after radiotherapy (RT) in breast cancer patients. The data of 55 patients with left and 48 patients with right breast cancer who underwent curative surgical resection and adjuvant three-dimensional conformal RT and staging (PET1), post-adjuvant chemotherapy (PET2), post-RT (PET3), and surveillance (PET4) FDG positron emission tomography/computed tomography (PET/CT) were retrospectively reviewed. The median interval between PET1 and curative surgical resection, between the end of adjuvant chemotherapy and PET2, between the end of RT and PET3, and between the end of RT and PET4 were five days, 13 days, 132 days, and 353 days, respectively. The myocardial-to-blood pool uptake ratio was measured in all patients. For patients with left breast cancer, the 30 Gy- (30 Gy) and 47.5 Gy-irradiated myocardium-to-low-irradiated myocardium (47.5 Gy) FDG uptake ratios were additionally measured. There were no differences in the myocardial-to-blood pool uptake ratios between left and right breast cancer on all PET scans. For left breast cancer, higher 30 Gy and 47.5 Gy uptake ratios were observed on PET3 than on PET1 and PET2. Both uptake ratios decreased on PET4 compared to PET3, but, were still higher compared to PET1. On PET3 and PET4, the 47.5 Gy were higher than the 30 Gy uptake ratios, while there were no differences between them on PET1 and PET2. Although the whole myocardium FDG uptake showed no significant change, the irradiated myocardium FDG uptake significantly increased after RT and was related to radiation dose to the myocardium in breast cancer patients. These results might be an imaging evidence that supports the increased risk of heart disease after RT in patients with left breast cancer.
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Significance of CT attenuation and F-18 fluorodeoxyglucose uptake of visceral adipose tissue for predicting survival in gastric cancer patients after curative surgical resection. Gastric Cancer 2020; 23:273-284. [PMID: 31485803 PMCID: PMC7031193 DOI: 10.1007/s10120-019-01001-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 08/14/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the prognostic significance of computed tomography (CT) attenuation and F-18 fluorodeoxyglucose (FDG) uptake of visceral adipose tissue (VAT) to predict peritoneal recurrence-free survival (RFS) as well as RFS and overall survival (OS) in patients with advanced gastric cancer (AGC). METHODS We retrospectively enrolled 117 patients with AGC who underwent staging FDG positron emission tomography (PET)/CT and subsequent curative surgical resection. CT attenuation and FDG uptake (SUV) of VAT and maximum FDG uptake of primary tumor (SUVmaxT) were measured from PET/CT images. The relationship of VAT attenuation and SUV with clinico-histopathologic factors and survival was assessed. RESULTS There was a significant positive correlation between VAT attenuation and SUV (p < 0.001, r = 0.799). In correlation analyses, both VAT attenuation and SUV showed significant positive correlations with T stage, TNM stage, tumor size, and platelet-to-lymphocyte ratio (p < 0.05), and patients who experienced recurrence during the first 3-year after surgery had significantly higher VAT attenuation and SUV than those who had no recurrence (p < 0.05). Patients with high VAT attenuation and SUV showed significantly worse RFS, peritoneal RFS, and OS than those with low values (p < 0.05). On multivariate survival analysis, VAT attenuation was significantly associated with peritoneal RFS and OS and VAT SUV was significantly associated with OS (p < 0.05). CONCLUSIONS CT attenuation and FDG uptake of VAT on staging FDG PET/CT were correlated with tumor characteristics and were significant predictive factors for peritoneal RFS and OS in patients with AGC.
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Lee JW, Kim SY, Lee HJ, Han SW, Lee JE, Lee SM. Prognostic Significance of Abdominal-to-Gluteofemoral Adipose Tissue Distribution in Patients with Breast Cancer. J Clin Med 2019; 8:jcm8091358. [PMID: 31480613 PMCID: PMC6781262 DOI: 10.3390/jcm8091358] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 08/22/2019] [Indexed: 12/24/2022] Open
Abstract
This study aimed to evaluate the association between abdominal-to-gluteofemoral adipose tissue (AT) distribution and recurrence-free survival (RFS) in breast cancer patients. Staging F-18 fluorodexoyglucose (FDG) positron emission tomography/computed tomography (PET/CT) images of 336 women with breast cancer were retrospectively analyzed. From CT images, the volume and CT-attenuation of visceral adipose tissue (VAT), abdominal subcutaneous adipose tissue (SAT), and gluteofemoral AT were measured and the ratio of abdomen-to-gluteofemoral AT volume (AG volume ratio) was calculated. The relationships between adipose tissue parameters and RFS were assessed. Through univariate analysis, abdominal SAT volume, gluteofemoral AT volume, and AG volume ratio were significantly associated with RFS. An increase in abdominal SAT volume and AG volume ratio were associated with an increased risk of recurrence, whereas increased gluteofemoral AT volume was associated with a decreased risk of recurrence. On multivariate analysis, abdominal SAT volume, gluteofemoral AT volume, and AG volume ratio were found to be significant predictors of RFS after adjusting for clinic-histological factors. Irrespective of obesity, patients with a high AG volume ratio showed a higher recurrence rate than those with a low AG volume ratio. Increased abdominal SAT volume and decreased gluteofemoral AT volume were related to poor RFS in breast cancer patients.
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Affiliation(s)
- Jeong Won Lee
- Department of Nuclear Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, 25 Simgok-ro 100 beon-gil, Seo-gu, Incheon 22711, Korea
| | - Sung Yong Kim
- Department of Surgery, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan, Chungcheongnam-do 31151, Korea
| | - Hyun Ju Lee
- Department of Pathology, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan, Chungcheongnam-do 31151, Korea
| | - Sun Wook Han
- Department of Surgery, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan, Chungcheongnam-do 31151, Korea
| | - Jong Eun Lee
- Department of Surgery, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan, Chungcheongnam-do 31151, Korea
| | - Sang Mi Lee
- Department of Nuclear Medicine, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan, Chungcheongnam-do 31151, Korea.
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Lee JW, Kim SY, Lee HJ, Han SW, Lee JE, Lee SM. Prognostic Significance of CT-Attenuation of Tumor-Adjacent Breast Adipose Tissue in Breast Cancer Patients with Surgical Resection. Cancers (Basel) 2019; 11:E1135. [PMID: 31398863 PMCID: PMC6721593 DOI: 10.3390/cancers11081135] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/03/2019] [Accepted: 08/06/2019] [Indexed: 02/06/2023] Open
Abstract
The purpose of this study was to evaluate the prognostic significance of computed tomography (CT)-attenuation of tumor-adjacent breast adipose tissue for predicting recurrence-free survival (RFS) in patients with breast cancer. We retrospectively enrolled 287 breast cancer patients who underwent pretreatment 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT. From non-contrast-enhanced CT images of PET/CT, CT-attenuation values of tumor-adjacent breast adipose tissue (TAT HU) and contralateral breast adipose tissue (CAT HU) were measured. Difference (HU difference) and percent difference (HU difference %) in CT-attenuation values between TAT HU and CAT HU were calculated. The relationships of these breast adipose tissue parameters with tumor factors and RFS were assessed. TAT HU was significantly higher than CAT HU (p < 0.001). TAT HU, HU difference, and HU difference % showed significant correlations with T stage and estrogen receptor and progesterone receptor status (p < 0.05), whereas CAT HU had no significant relationships with tumor factors (p > 0.05). Patients with high TAT HU, HU difference, and HU difference % had significantly worse RFS than those with low values (p < 0.001). In multivariate analysis, TAT HU and HU difference % were significantly associated with RFS after adjusting for clinico-pathologic factors (p < 0.05). CT-attenuation of tumor-adjacent breast adipose tissue was significantly associated with RFS in patients with breast cancer. The findings seem to support the close contact between breast cancer cells and tumor-adjacent adipocytes observed with imaging studies.
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Affiliation(s)
- Jeong Won Lee
- Department of Nuclear Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, 25 Simgok-ro 100 beon-gil, Seo-gu, Incheon 22711, Korea
| | - Sung Yong Kim
- Department of Surgery, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan, Chungcheongnam-do 31151, Korea
| | - Hyun Ju Lee
- Department of Pathology, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan, Chungcheongnam-do 31151, Korea
| | - Sun Wook Han
- Department of Surgery, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan, Chungcheongnam-do 31151, Korea
| | - Jong Eun Lee
- Department of Surgery, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan, Chungcheongnam-do 31151, Korea
| | - Sang Mi Lee
- Department of Nuclear Medicine, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan, Chungcheongnam-do 31151, Korea.
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Lee SM, Kim HS, Lee S, Lee JW. Emerging role of 18F-fluorodeoxyglucose positron emission tomography for guiding management of hepatocellular carcinoma. World J Gastroenterol 2019; 25:1289-1306. [PMID: 30918424 PMCID: PMC6429342 DOI: 10.3748/wjg.v25.i11.1289] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 02/25/2019] [Accepted: 03/02/2019] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of major causes of cancer mortality worldwide. For decades, 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) has been widely used for staging, predicting prognosis, and detecting cancer recurrence in various types of malignant diseases. Due to low sensitivity of FDG PET for detecting intrahepatic HCC lesions, the clinical value of FDG PET in HCC patients has been limited. However, recent studies with diverse analytic methods have shown that FDG PET has promising role in aiding management of HCC patients. In this review, we will discuss the clinical role of FDG PET for staging, predicting prognosis, and evaluating treatment response in HCC. Further, we will focus on recent clinical studies regarding implication of volumetric FDG PET parameters, the significance of FDG uptake in HCC for selecting treatment and predicting treatment response, and the use of radiomics of FDG PET in HCC.
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Affiliation(s)
- Sang Mi Lee
- Department of Nuclear Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Chungcheongnam-do 31151, South Korea
| | - Hong Soo Kim
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Chungcheongnam-do 31151, South Korea
| | - Sangheun Lee
- Division of Hepatology, Department of Internal medicine, Catholic Kwandong University College of Medicine, International St. Mary’s Hospital, Incheon 22711, South Korea
- Institute for Health and Life Science, Catholic Kwandong University College of Medicine, International St. Mary’s Hospital, Incheon 22711, South Korea
| | - Jeong Won Lee
- Department of Nuclear Medicine, Catholic Kwandong University College of Medicine, International St. Mary’s Hospital, Incheon 22711, South Korea
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