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. 2022 Jan 30:2022:2586245.
doi: 10.1155/2022/2586245. eCollection 2022.

Prognostic Value of Intratumor Metabolic Heterogeneity Parameters on 18F-FDG PET/CT for Patients with Colorectal Cancer

Xin Liu  1   2 , Kun Xiang  3   4 , Guang-Yong Geng  5 , Shi-Cun Wang  2 , Ming Ni  2 , Yi-Fan Zhang  2 , Hai-Feng Pan  3   4 , Wei-Fu Lv  1
Affiliations

Prognostic Value of Intratumor Metabolic Heterogeneity Parameters on 18F-FDG PET/CT for Patients with Colorectal Cancer

Xin Liu et al. Contrast Media Mol Imaging. .

Abstract

Purpose: Intratumor metabolic heterogeneity parameters on 18F-2-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography-computed tomography (PET-CT) have been proven to be predictors of the clinical prognosis of cancer patients. The study aimed to examine the correlation between 18F-FDG PET-CT-defined heterogeneity parameters and the prognostic significance in patients with colorectal cancer.

Methods: The study included 188 patients with colorectal cancer who received surgery and 18F-FDG PET/CT examinations. Preoperative 18F-FDG PET/CT conventional and metabolic heterogeneity parameters were collected, including maximum, peak, and mean standardized uptake value (SUVmax, SUVpeak, and SUVmean), metabolic tumor volume (MTV), total lesion glycolysis (TLG), heterogeneity index-1 (HI-1) and heterogeneity index-2 (HI-2), and clinicopathological information. Correlations between these parameters and patient survival outcomes were inferred.

Results: The associations between 18F-FDG PET/CT parameters and clinical outcomes were analyzed. Tumor thrombus (P < 0.001), tumor stage (P=0.001), MTV (P=0.003), HI-1 (P=0.032), and HI-2 (P=0.001) differed between the two groups with and without recurrence. Multivariate analysis showed that, in the radical surgery group, HI-2 (HR = 1.10, 95% CI: 1.04-1.17, P=0.001), tumor stage (HR = 20.65, 95% CI: 4.81-88.62, P < 0.001), and regional lymph nodes status (HR = 0.16, 95% CI: 0.04-0.57, P=0.005) were independent variables significantly correlated with progression-free survival (PFS) and HI-2 (HR = 1.16, 95% CI: 1.07-1.26, P < 0.001) was an independent variable affecting overall survival (OS). In the palliative surgery group, HI-2 (HR = 1.03, 95% CI: 1.01-1.06, P=0.020) was an independent variable affecting PFS, and all the parameters were not statistically significant for OS.

Conclusion: HI-2, tumor stage, and regional lymph nodes status might predict the outcomes of colorectal cancer more effectively than other 18F-FDG PET/CT defined parameters.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart of patient screening.
Figure 2
Figure 2
Process of measuring metabolic heterogeneity indices on 18F-FDG PET/CT. Fused PET/CT image showing an 18F-FDG avid tumor in the colon. A circle (pink) was drawn to include the whole tumor, and an isocontour volume of interest (VOI; pink) was automatically generated by using a 40% SUVmax cutoff (a). Heterogeneity index-1 was defined as the coefficient of variance, which was calculated as the SD of the SUV divided by SUVmean. Metabolic tumor volume (MTV) was assessed according to three thresholds (SUV 2.5, 3.0, and 3.5, resp.), and linear regression analysis was performed to find the slope. Heterogeneity index-2 was the negative form of the slope (b).
Figure 3
Figure 3
Kaplan–Meier curves for comparing prognosis according to HI-2 (a). Kaplan–Meier curves of PFS stratified by HI-2 (cutoff 15.59) in the radical treatment group (b). Kaplan–Meier curves for comparing OS according to HI-2 (cutoff 26.41) in the radical treatment group (c). In the palliative treatment group, patients with higher HI-2 (cutoff 15.69) had more severe prognosis.
See this image and copyright information in PMC

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