Elevated tumor-to-liver standardized uptake value ratio (TLR) from preoperative 18F-FDG PET/CT predicts poor prognosis of patients with clear cell renal cell carcinoma after nephrectomy

Wu, Chengyuan; Cui, Yonggang; Zhao, Yanyan; Chen, Xueqi; Liao, Xin; Di, Lijuan; Liu, Yin; Li, Meng; Wang, Rongfu

doi:10.1016/j.ejrad.2020.109218

Cited by 7 publications

(6 citation statements)

References 28 publications

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“…Previous studies reported low accuracy for FDG-PET in RCC but indicated semiquantitative PET parameters to be associated with survival. [3][4][5][6] We found an association between PET avidity and histologic grading, which suggested that PET positivity was associated with more aggressive disease and poor prognosis. Our study indicated that PET metabolism informs on prognosis in RCC, which renders PET imaging a putative marker to guide treatment decisions in RCC.…”

Section: Discussionmentioning

confidence: 63%

FDG-PET Positivity and Overall Survival in Renal Cell Carcinoma

et al. 2022

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Section: Discussionmentioning

confidence: 63%

FDG-PET Positivity and Overall Survival in Renal Cell Carcinoma

et al. 2022

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“…Unlike in HCCs, the predictive or prognostic value of variable 18 F-FDG uptake remains to be elucidated in RCCs. In a recent report, patients with clear cell RCCs with a preoperatively elevated tumour to liver SUV ratio (TLR) on 18 F-FDG PET/CT had significantly unfavourable survival outcomes after nephrectomy 17 . Of SUV max and TLR on 18 F-FDG PET/CT, primary tumour size, pTNM stage, WHO/ISUP grade, venous tumour thrombus, and adjuvant therapy, pTNM stage and TLR were independent prognostic predictors for disease-free survival.…”

Section: Discussionmentioning

confidence: 99%

“…Accordingly, current NCCN clinical practice guidelines do not recommend FDG PET/CT alone to diagnose RCCs or follow-up for evidence of recurrence after surgery 1 . Nevertheless, several previous studies have reported the usefulness of 18 F-FDG uptake in RCCs for predicting aggressive tumour features such as high International Society of Urological Pathology (ISUP) grade, distant metastases, and poor patient survival 11 , 13 – 17 . From a practical point of view, primary tumour detection may be beyond the scope of 18 F-FDG PET/CT in RCCs; however, it could assist with the biological characterisation of RCCs based on the metabolic reprogramming found in individual RCCs.…”

Section: Introductionmentioning

confidence: 99%

Metabolic tumour volume on 18F-FDG PET/CT predicts extended pathological T stages in patients with renal cell carcinoma at staging

Kim

Lee

et al. 2021

Sci Rep

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We evaluated the predictive value of 18F-fluorodeoxyglucose (FDG) uptake on positron emission tomography/CT (PET/CT) for extended pathological T (pT) stages (≥ pT3a) in Renal cell carcinoma (RCC) patients at staging. Thirty-eight RCC patients who underwent 18F-FDG PET/CT at staging, followed by radical nephrectomy between September 2016 and September 2018, were included in this prospective study. Patients were classified into two groups (limited pT stage: stage T1/2, n = 17; extended pT stage: T3/4, n = 21). Univariate and multivariate logistic regression analyses were performed to identify clinicopathological and metabolic variables to predict extended pT stages. 18F-FDG metabolic parameters were compared in relation to International Society of Urological Pathology (ISUP) grade and lymphovascular invasion (LVI). In univariate analysis, maximum standardised uptake value, metabolic tumour volume (MTV), and ISUP grade were significant. In multivariate analysis, MTV was the only significant factor of extended pT stages. With a cut-off MTV of 21.2, an area under the curve was 0.944, which was higher than 0.824 for clinical T stages (p = 0.037). In addition, high MTV, but not tumour size, was significantly correlated with aggressive pathologic features (ISUP grade and LVI). High glycolytic tumour volume on 18F-FDG PET/CT in RCC patients at staging is predictive of extended pT stages which could aid decision-making regarding the best type of surgery.

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“…The inclusion criteria were as follows [ 15 – 17 ]: (1) newly diagnosed RCC by primary tumor pathological analyses, (2) radical nephrectomy or combined with tumor thrombectomy (for patients with VTT) performed at our hospital, and (3) 18 F-FDG PET/CT performed before operation and systematic treatment initiation. The additional inclusion criterion for prognosis analysis was available follow-up data for more than 6 months after operation for the patients without disease progression.…”

Section: Methodsmentioning

confidence: 99%

“…As depicted previously [ 17 ], follow-up surveillance after surgery included abdomen ultrasonography or abdomen CT, chest X-ray, and laboratory data, which were regularly collected every 3 months for the first 2 years, then every 6 months until the fifth year, and annually afterward. Disease-free survival (DFS) was defined as the date from operation to recurrence and/or metastasis proven by radiology or pathology, death of any cause, or censored at the last follow-up [ 17 ]. Recurrence was defined as locoregional recurrence or progression of the initial distant metastases according to the Response Evaluation Criteria in Solid Tumor (RECIST) guideline (version 1.1) [ 16 ].…”

Section: Methodsmentioning

confidence: 99%

Diagnostic performance and prognostic value of preoperative 18F-FDG PET/CT in renal cell carcinoma patients with venous tumor thrombus

et al. 2022

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Background To observe the diagnostic efficacy of preoperative fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) upon venous tumor thrombus (VTT) in patients with renal cell carcinoma (RCC), and investigate the prognostic value of imaging parameters integrated with clinicopathological characteristics in patients with VTT after nephrectomy with tumor thrombectomy. Methods Patients with newly diagnosed RCC who underwent 18F-FDG PET/CT were reviewed retrospectively. The diagnostic efficacy of 18F-FDG PET/CT in VTT was analyzed. Logistic regression analysis was carried out to identify the clinical variables and PET/CT variables (including maximum standardized uptake value (SUVmax) of primary tumor, VTT SUVmax and primary tumor size) for differentiating early VTT (Mayo 0-II) from advanced VTT (Mayo III-IV). Cox proportional hazard analyses were used to evaluate clinicopathological factors and PET/CT factors (including distant metastasis, primary tumor SUVmax, VTT SUVmax and primary tumor size) for disease-free survival (DFS) in patients with VTT after operation. Results A total of 174 eligible patients were included in this study, including 114 men (65.5%) and 60 women (34.5%), with a median age of 58 years (range, 16–81 years). The distribution of pathological tumor stage (T stage) was 56 (T1), 17 (T2), 95 (T3), and 6 cases (T4), respectively. According to WHO/ISUP grade, except for 4 cases of chromophobe cell RCC, there were 14 patients (8.0%) of grade 1, 59 patients (33.9%) of grade 2, 74 patients (42.5%) of grade 3 and 23 patients (13.2%) of grade 4. The median maximum diameter of the primary tumor on PET/CT was 7.3 cm (5.0–9.5 cm). The distal metastasis was observed in 46 patients (26.4%). Sixty-one cases (35.1%) were confirmed with VTT by pathology. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 18F-FDG PET/CT imaging were 96.7, 99.1, 98.3, 98.3, and 98.2%, in detecting VTT, respectively, and 70.0, 100.0, 94.9, 100.0, and 94.2%, in evaluating the level of VTT, respectively. Elevated VTT SUVmax (≥5.20) could significantly distinguish the early VTT group and advanced VTT group (P = 0.010). In the prognosis analysis, elevated VTT SUVmax (≥4.30) (P = 0.018, HR 3.123, 95% CI 1.212–8.044) and distant metastasis (P = 0.013, HR 3.344, 95% CI 1.293–8.649) were significantly independent predictors for DFS. Conclusion Preoperative 18F-FDG PET/CT has a high diagnostic efficacy in detecting VTT and evaluating its level in RCC patients. Those patients with elevated VTT SUVmax should be carefully monitored to detect the possibility of disease progression after operation.

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Elevated tumor-to-liver standardized uptake value ratio (TLR) from preoperative 18F-FDG PET/CT predicts poor prognosis of patients with clear cell renal cell carcinoma after nephrectomy

Cited by 7 publications

References 28 publications

FDG-PET Positivity and Overall Survival in Renal Cell Carcinoma

FDG-PET Positivity and Overall Survival in Renal Cell Carcinoma

Metabolic tumour volume on 18F-FDG PET/CT predicts extended pathological T stages in patients with renal cell carcinoma at staging

Diagnostic performance and prognostic value of preoperative 18F-FDG PET/CT in renal cell carcinoma patients with venous tumor thrombus

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