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

Affiliations
  • 1Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
  • 2Division of Medical Oncology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • 3Division of Medical Oncology, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea.
  • 4Cancer Prevention Center, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
  • 5Department of Nuclear Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. tjeonnm@yuhs.ac

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.


Reference

1. Strom BL, Soloway RD, Rios-Dalenz JL, Rodriguez-Martinez HA, West SL, Kinman JL, et al. Risk factors for gallbladder cancer. An international collaborative case-control study. Cancer. 1995; 76:1747–1756. PMID: 8625043.
Article
2. Randi G, Franceschi S, La Vecchia C. Gallbladder cancer worldwide: geographical distribution and risk factors. Int J Cancer. 2006; 118:1591–1602. PMID: 16397865.
Article
3. Corvera CU, Blumgart LH, Akhurst T, DeMatteo RP, D'Angelica M, Fong Y, et al. 18F-fluorodeoxyglucose positron emission tomography influences management decisions in patients with biliary cancer. J Am Coll Surg. 2008; 206:57–65. PMID: 18155569.
Article
4. Allal AS, Dulguerov P, Allaoua M, Haenggeli CA, El-Ghazi el A, Lehmann W, et al. Standardized uptake value of 2-[(18)F] fluoro-2-deoxy-D-glucose in predicting outcome in head and neck carcinomas treated by radiotherapy with or without chemotherapy. J Clin Oncol. 2002; 20:1398–1404. PMID: 11870185.
Article
5. Davies A, Tan C, Paschalides C, Barrington SF, O'Doherty M, Utley M, et al. FDG-PET maximum standardised uptake value is associated with variation in survival: analysis of 498 lung cancer patients. Lung Cancer. 2007; 55:75–78. PMID: 17084485.
Article
6. Hyun SH, Choi JY, Shim YM, Kim K, Lee SJ, Cho YS, et al. Prognostic value of metabolic tumor volume measured by 18F-fluorodeoxyglucose positron emission tomography in patients with esophageal carcinoma. Ann Surg Oncol. 2010; 17:115–122. PMID: 19826877.
Article
7. Lee HY, Hyun SH, Lee KS, Kim BT, Kim J, Shim YM, et al. Volume-based parameter of 18F-FDG PET/CT in malignant pleural mesothelioma: prediction of therapeutic response and prognostic implications. Ann Surg Oncol. 2010; 17:2787–2794. PMID: 20461469.
8. Moon SH, Choi JY, Lee HJ, Son YI, Baek CH, Ahn YC, et al. Prognostic value of 18F-FDG PET/CT in patients with squamous cell carcinoma of the tonsil: comparisons of volume-based metabolic parameters. Head Neck. 2013; 35:15–22. PMID: 22307893.
9. Lee P, Weerasuriya DK, Lavori PW, Quon A, Hara W, Maxim PG, et al. Metabolic tumor burden predicts for disease progression and death in lung cancer. Int J Radiat Oncol Biol Phys. 2007; 69:328–333. PMID: 17869659.
Article
10. Ciernik IF, Dizendorf E, Baumert BG, Reiner B, Burger C, Davis JB, et al. Radiation treatment planning with an integrated positron emission and computer tomography (PET/CT): a feasibility study. Int J Radiat Oncol Biol Phys. 2003; 57:853–863. PMID: 14529793.
Article
11. Ramos-Font C, Gómez-Rio M, Rodríguez-Fernández A, Jiménez-Heffernan A, Sánchez Sánchez R, Llamas-Elvira JM. Ability of FDG-PET/CT in the detection of gallbladder cancer. J Surg Oncol. 2014; 109:218–224. PMID: 24165875.
Article
12. Bos R, van Der Hoeven JJ, van Der Wall E, van Der Groep P, van Diest PJ, Comans EF, et al. Biologic correlates of (18)fluorodeoxyglucose uptake in human breast cancer measured by positron emission tomography. J Clin Oncol. 2002; 20:379–387. PMID: 11786564.
Article
13. Kurokawa T, Yoshida Y, Kawahara K, Tsuchida T, Okazawa H, Fujibayashi Y, et al. Expression of GLUT-1 glucose transfer, cellular proliferation activity and grade of tumor correlate with [F-18]-fluorodeoxyglucose uptake by positron emission tomography in epithelial tumors of the ovary. Int J Cancer. 2004; 109:926–932. PMID: 15027127.
Article
14. Chung JK, Lee YJ, Kim SK, Jeong JM, Lee DS, Lee MC. Comparison of [18F]fluorodeoxyglucose uptake with glucose transporter-1 expression and proliferation rate in human glioma and non-small-cell lung cancer. Nucl Med Commun. 2004; 25:11–17. PMID: 15061260.
Article
15. Donohue JH. Present status of the diagnosis and treatment of gallbladder carcinoma. J Hepatobiliary Pancreat Surg. 2001; 8:530–534. PMID: 11956904.
16. Donohue JH, Stewart AK, Menck HR. The National Cancer Data Base report on carcinoma of the gallbladder, 1989–1995. Cancer. 1998; 83:2618–2628. PMID: 9874470.
Article
17. Manfredi S, Benhamiche AM, Isambert N, Prost P, Jouve JL, Faivre J. Trends in incidence and management of gallbladder carcinoma: a population-based study in France. Cancer. 2000; 89:757–762. PMID: 10951337.
18. Furukawa H, Ikuma H, Asakura K, Uesaka K. Prognostic importance of standardized uptake value on F-18 fluorodeoxyglucose-positron emission tomography in biliary tract carcinoma. J Surg Oncol. 2009; 100:494–499. PMID: 19653260.
Article
19. Yoo J, Choi JY, Lee KT, Heo JS, Park SB, Moon SH, et al. Prognostic significance of volume-based metabolic parameters by (18)F-FDG PET/CT in gallbladder carcinoma. Nucl Med Mol Imaging. 2012; 46:201–206. PMID: 24900061.
Article
20. Maldonado A, González-Alenda FJ, Alonso M, Sierra JM. PET-CT in clinical oncology. Clin Transl Oncol. 2007; 9:494–505. PMID: 17720652.
Article
21. Fendler WP, Philippe Tiega DB, Ilhan H, Paprottka PM, Heinemann V, Jakobs TF, et al. Validation of several SUV-based parameters derived from 18F-FDG PET for prediction of survival after SIRT of hepatic metastases from colorectal cancer. J Nucl Med. 2013; 54:1202–1208. PMID: 23729697.
Article
22. Oh JR, Seo JH, Chong A, Min JJ, Song HC, Kim YC, et al. Whole-body metabolic tumour volume of 18F-FDG PET/CT improves the prediction of prognosis in small cell lung cancer. Eur J Nucl Med Mol Imaging. 2012; 39:925–935. PMID: 22270509.
Article
23. Ryu IS, Kim JS, Roh JL, Lee JH, Cho KJ, Choi SH, et al. Prognostic value of preoperative metabolic tumor volume and total lesion glycolysis measured by 18F-FDG PET/CT in salivary gland carcinomas. J Nucl Med. 2013; 54:1032–1038. PMID: 23670902.
Article
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