Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 7, 2017; 23(13): 2385-2395
Published online Apr 7, 2017. doi: 10.3748/wjg.v23.i13.2385
Clinical implication of FDG uptake of bone marrow on PET/CT in gastric cancer patients with surgical resection
Jeong Won Lee, Moon-Soo Lee, Il Kwon Chung, Myoung Won Son, Young Sin Cho, Sang Mi Lee
Jeong Won Lee, Department of Nuclear Medicine, Institute of Integrative Medicine, Catholic Kwandong University College of Medicine, International St. Mary’s Hospital, Incheon 404-834, South Korea
Moon-Soo Lee, Myoung Won Son, Department of Surgery, Soonchunhyang University Hospital, Cheonan, Chuncheongnam-do 330-721, South Korea
Il Kwon Chung, Young Sin Cho, Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Hospital, Cheonan, Chuncheongnam-do 330-721, South Korea
Sang Mi Lee, Department of Nuclear Medicine, Soonchunhyang University Hospital, Cheonen, Chuncheongnam-do 330-721, South Korea
Author contributions: Lee JW and Lee SM designed the study, analyzed the data and wrote the paper; Lee MS and Chung IK performed data analysis and revised the paper; Son MW and Cho YS collected the data and revised the paper; all authors have read and approved the final version of the paper.
Supported by Soonchunhyang University Research Fund and Research Fund of Catholic Kwandong University International St. Mary’s Hospital.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of Soonchunhyang University Cheonan Hospital (IRB No. 2016-12-009).
Informed consent statement: Due to the retrospective nature of the study, informed consent of the patients was not required because the study analyzed anonymous clinical data of the patients.
Conflict-of-interest statement: None of the authors have any study-related conflicts of interest to disclose.
Data sharing statement: No additional date are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sang Mi Lee, MD, PhD, Assistant Professor, Department of Nuclear Medicine, Soonchunhyang University Hospital, 23-20 Byeongmyeong-dong, Dongnam-gu, Cheonan, Chuncheongnam-do 330-721, South Korea. gareen@naver.com
Telephone: +82-41-5703540 Fax: +81-41-5724655
Received: January 11, 2017
Peer-review started: January 12, 2017
First decision: February 23, 2017
Revised: March 1, 2017
Accepted: March 15, 2017
Article in press: March 15, 2017
Published online: April 7, 2017
Processing time: 84 Days and 22.8 Hours
Abstract
AIM

To determine the relationship between F-18 fluorodeoxyglucose (FDG) uptake of bone marrow (BM) on positron emission tomography/computed tomography (PET/CT) and clinical factors and to assess the prognostic value of FDG uptake of BM in gastric carcinoma.

METHODS

We retrospectively enrolled 309 gastric cancer patients who underwent staging FDG PET/CT and curative surgical resection. FDG uptake of primary tumor was visually classified as positive or negative FDG uptake. Mean FDG uptake of BM (BM SUV) and BM-to-liver uptake ratio (BLR) were measured. The relationships of BM SUV or BLR with clinical factors were evaluated. The prognostic values of BM SUV, BLR, and other clinical factors for predicting recurrence-free survival (RFS) and overall survival (OS) were assessed.

RESULTS

Of 309 patients, 38 patients (12.3%) experienced cancer recurrence and 18 patients (5.8%) died. Patients with advanced gastric cancer, positive FDG uptake, and recurrence had higher values of BM SUV and BLR than those with early gastric cancer, negative FDG uptake, and no recurrence (P < 0.05). BM SUV and BLR were significantly correlated with hemoglobin level, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio (P < 0.05). On multivariate analysis, multiple tumors, T stage, lymph node metastasis, tumor involvement of resection margin, and BLR were significantly associated with RFS (P < 0.05). T stage, lymph node metastasis, hemoglobin level, and BLR were significantly associated with OS (P < 0.05).

CONCLUSION

BLR on PET/CT was an independent prognostic factor for RFS and OS in gastric cancer patients with curative surgical resection.

Keywords: F-18 fluorodeoxyglucose; Positron emission tomography; Prognosis; Bone marrow; Gastric cancer

Core tip: This study evaluated the prognostic value of F-18 fluorodeoxyglucose (FDG) uptake of bone marrow (BM) on positron emission tomography/computed tomography (PET/CT) in gastric cancer patients with curative surgical resection. FDG uptake of BM was correlated with serum inflammatory markers. It was also significantly associated with worse prognosis. FDG uptake of BM on PET/CT could reflect the degree of systemic inflammatory response to cancer and provide information on the prognosis of patients with gastric cancer after curative surgical resection.