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. 2025 Sep;55(9):1295-1302.
doi: 10.1007/s00595-025-03029-7. Epub 2025 Mar 28.

18F-fluorodeoxyglucose positron emission tomography-computed tomography as a prognostic marker of imatinib-resistant gastrointestinal stromal tumors

Kota Kawabata  1 , Tsuyoshi Takahashi  2 , Toshirou Nishida  3 , Yukinori Kurokawa  1 , Kazuyoshi Yamamoto  1 , Takuro Saito  1 , Kota Momose  1 , Kotaro Yamashita  1 , Koji Tanaka  1 , Tomoki Makino  1 , Ryohei Kawabata  4 , Atsushi Takeno  5 , Kiyokazu Nakajima  1 , Hidetoshi Eguchi  1 , Yuichiro Doki  1
Affiliations

18F-fluorodeoxyglucose positron emission tomography-computed tomography as a prognostic marker of imatinib-resistant gastrointestinal stromal tumors

Kota Kawabata et al. Surg Today. 2025 Sep.

Abstract

Purpose: Unresectable or metastatic GISTs often develop resistance to imatinib, but the effectiveness of other drugs is limited. Thus, surgical treatment can be considered, especially for partial resistance. FDG-PET/CT is used for the diagnosis and evaluation of GISTs. We conducted this study to establish whether FDG-PET/CT findings could guide treatment decisions and predict the prognosis of patients with imatinib-resistant GISTs.

Methods: We analyzed data retrospectively from 45 patients with imatinib-resistant GISTs that were assessed via FDG-PET/CT at our institution between 2003 and 2021. The patients were classified as having low (n = 18) or high (n = 27) SUVmax, with a cutoff value of 5.0.

Results: The overall survival (OS) of the patients with low SUVmax after the diagnosis of imatinib resistance was significantly prolonged. Multivariate analysis identified SUVmax as an independent poor prognostic factor. In 23 patients with resected imatinib-resistant lesions, a close correlation was found between the SUVmax by preoperative FDG-PET/CT and the mitotic rate. A higher SUVmax was associated with a higher mitotic rate. Patients with a low SUVmax (n = 11) had significantly longer postoperative imatinib failure-free survival than those with a high SUVmax (n = 12).

Conclusions: FDG-PET/CT assessment and diagnosis might reveal the pathological grades of imatinib-resistant GISTs and act as a prognostic marker.

Keywords: Gastrointestinal stromal tumor; Imatinib resistance; Maximum standardized uptake value; Positron emission tomography-computed tomography; Surgical treatment.

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Conflict of interest statement

Declarations. Conflict of interest: We have no conflicts of interest to declare. Ethics approval and consent to participate: The Human Ethics Review Committee of Osaka University Graduate School of Medicine approved the protocol for this retrospective study (Approval ID: 22316). All procedures complied with the ethical standards of the institutional and national committees responsible for ethical human experimentation and the Declaration of Helsinki (2013 amendment). All patients provided written informed consent to participate in this study and to the publication of this report.

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