Yonsei Med J.  2019 Jul;60(7):604-610. 10.3349/ymj.2019.60.7.604.

Significance of Metabolic Tumor Volume and Total Lesion Glycolysis Measured Using ¹⁸F-FDG PET/CT in Locally Advanced and Metastatic Gallbladder Carcinoma

• Chun YJ
• Jeung HC
• Park HS
• Park JS
• Rha SY
• Choi HJ
• Lee JH
• Jeon TJ

• KMID: 2450399
• DOI: http://doi.org/10.3349/ymj.2019.60.7.604

Abstract

PURPOSE
This study aimed to determine the prognostic value of new quantitative parameters of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT), including metabolic tumor volume (MTV), in patients with locally advanced and metastatic gallbladder cancer (GBC).
MATERIALS AND METHODS
In total, 83 patients initially diagnosed with locally advanced and metastatic GBC and who underwent 18F-FDG PET/CT at the time of initial diagnosis were retrospectively reviewed. The metabolic volume-based PET parameters of primary tumors and metastatic lesions were measured, including maximum and average standardized uptake values (SUV), MTV, and total lesion glycolysis. An overall survival (OS) analysis was performed using the Kaplan-Meier method with PET and clinical parameters. A Cox proportional hazards regression analysis was performed to determine independent prognostic factors.
RESULTS
In univariate analysis, pathologic differentiation (p<0.001), performance status (PS; p=0.003), C-reactive protein (CRP) level (p=0.009), and PET-related SUVmt max (the highest SUV among the metastatic lesions) (p=0.040) and MTVtotal (the sum of the MTVs of both the primary and metastatic lesions) (p=0.031), were significant for OS. In multivariate analysis, MTVtotal (hazard ratio: 2.07; 95% confidence interval: 1.23-3.48; p=0.006) remained significant for the prediction of OS, as did differentiation (p=0.001), PS (p=0.001), and CRP (p=0.039).
CONCLUSION
In locally advanced and metastatic GBC, volume-based PET/CT parameters of the total tumor burden of malignancy, such as MTVtotal, were found to be useful for the identification of patients with poor prognosis.

Keyword

Gallbladder neoplasms; metastasis; ¹⁸F-FDG PET/CT; metabolic tumor volume; prognosis

MeSH Terms

C-Reactive Protein
Diagnosis
Electrons
Fluorodeoxyglucose F18
Gallbladder Neoplasms
Gallbladder*
Glycolysis*
Humans
Methods
Multivariate Analysis
Neoplasm Metastasis
Positron-Emission Tomography and Computed Tomography*
Prognosis
Retrospective Studies
Tumor Burden*
C-Reactive Protein
Fluorodeoxyglucose F18

Figure

• 

  Fig. 1 Kaplan-Meier curves for overall survival based on significant prognostic factors, including (A) pathologic differentiation [HR=2.42 (well differentiated and moderately differentiated vs. poorly differentiated); p=0.001], (B) performance status [HR=2.28 (ECOG 0, 1 vs. 2, 3); p=0.001], (C) CRP [HR=1.73 (≤6 mg/dL vs. >6 mg/dL); p=0.039], and (D) MTVtotal [HR=2.07 (≤350.77 cm3 vs. >350.77 cm3); p=0.006] in gallbladder carcinoma. ECOG, Eastern Cooperative Oncology Group; CRP, C-reactive protein; MTVtotal, the sum of the MTVs of both the locally advanced and metastatic lesions; HR, hazard ratio.

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