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. 2022 Aug 15;14(16):3936.
doi: 10.3390/cancers14163936.

Relationship of FDG PET/CT Textural Features with the Tumor Microenvironment and Recurrence Risks in Patients with Advanced Gastric Cancers

Hyein Ahn  1 , Geum Jong Song  2 , Si-Hyong Jang  1 , Hyun Ju Lee  1 , Moon-Soo Lee  2 , Ji-Hye Lee  1 , Mee-Hye Oh  1 , Geum Cheol Jeong  3 , Sang Mi Lee  3 , Jeong Won Lee  4
Affiliations

Relationship of FDG PET/CT Textural Features with the Tumor Microenvironment and Recurrence Risks in Patients with Advanced Gastric Cancers

Hyein Ahn et al. Cancers (Basel). .

Abstract

The relationship between 2-deoxy-2-[18F]fluoro-D-glucose (FDG) positron emission tomography/computed tomography (PET/CT) textural features and histopathological findings in gastric cancer has not been fully evaluated. We investigated the relationship between the textural features of primary tumors on FDG PET/CT with histopathological findings and recurrence-free survival (RFS) in patients with advanced gastric cancer (AGC). Fifty-six patients with AGC who underwent FDG PET/CT for staging work-ups were retrospectively enrolled. Conventional parameters and the first- and second-order textural features of AGC were extracted using PET textural analysis. Upon histopathological analysis, along with histopathological classification and staging, the degree of CD4, CD8, and CD163 cell infiltrations and expressions of interleukin-6 and matrix-metalloproteinase-11 (MMP-11) in the primary tumor were assessed. The histopathological classification, Lauren classification, lymph node metastasis, CD8 T lymphocyte and CD163 macrophage infiltrations, and MMP-11 expression were significantly associated with the textural features of AGC. The multivariate survival analysis showed that increased FDG uptake and intra-tumoral metabolic heterogeneity were significantly associated with an increased risk of recurrence after curative surgery. Textural features of AGC on FDG PET/CT showed significant correlations with the inflammatory response in the tumor microenvironment and histopathological features of AGC, and they showed significant prognostic values for predicting RFS.

Keywords: F-18 fluorodeoxyglucose; positron emission tomography; prognosis; textural feature.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Maximal intensity projection image (a) and transaxial PET (b), CT (c), and fused PET/CT (d,e) images of FDG PET/CT showing an example of VOI for extracting textural features of gastric cancer. A 76-year-old man underwent FDG PET/CT for staging work-up of gastric cancer in the stomach antrum. The cancer lesion was histopathologically classified as tubular adenocarcinoma, the intestinal type, and showed intensely increased FDG uptake on PET/CT images with a maximum SUV of 8.28 (arrows on (a,b,d)). A VOI was manually drawn around the gastric cancer lesion, and an area that showed a higher SUV than the threshold SUV of 3.45 determined by the modified Nestle’s adaptive threshold method was automatically selected within the VOI (blue color area in (e)). The PET/CT textural features of the gastric cancer lesion were extracted from this area.
Figure 2
Figure 2
Representative images of immunohistochemical staining of CD4 ((a,f), ×200), CD8 ((b,g), ×200), CD163 ((c,h), ×200), MMP-11 ((d,i), ×200), and IL-6 ((e,j), ×200) in the tumor tissue. Examples of a score range of 0-1 are shown in (a–e), and examples of a score range of 2–3 are shown in (f–j).
Figure 3
Figure 3
Cumulative RFS curves according to the cut-off values of maximum SUV (a), SUV histogram entropy (b), GLCM contrast (c), GLCM dissimilarity (d), GLCM entropy (e), and GLCM homogeneity (f). p-values are the results of the log-rank test.
See this image and copyright information in PMC

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