FDG PET/CT as a prognostic biomarker in the era of molecular-targeting therapies: max SUVmax predicts survival of patients with advanced renal cell carcinoma

Abstract

BackgroundVarious molecular-targeting therapies have become available for the treatment of advanced renal cell carcinoma (RCC). Accurate prognostication is desirable for choosing the appropriate treatment for individual patients. 18F-2-fluoro-2-deoxyglucose positron-emission tomography/computed tomography (FDG PET/CT) is a non-invasive tool for evaluating glucose accumulation, which can be an index of biological characteristics of cancer. We prospectively evaluated FDG PET/CT as a prognostic indicator in patients with advanced RCC.MethodsA total of 101 patients slated for different systematic therapies for advanced RCC were enrolled between 2008 and 2014. A total of 61 patients had recurrent RCC (58 metastatic and 3 regional) and 40 patients had stage IV RCC (36 metastatic and 4 locoregional). Sixteen patients had not undergone nephrectomy. Pre-treatment FDG PET/CT was performed, and the max SUVmax (the highest SUV measurement in each patient) was recorded. The max SUVmax was compared with different clinical risk factors as prognostic indicators. The median observation period was 18 months (range 1–70 months).ResultsThe max SUVmax of the 101 subjects ranged from undetectable to 23.0 (median 6.9). Patients with high max SUVmax had a poor prognosis. Multivariate analysis with standard risk factors revealed that max SUVmax was an independent predictor of survival (p < 0.001; hazard ratio 1.265; 95 % confidence interval 1.159–1.380). A cutoff of 8.8 for max SUVmax advocated in our previous report was highly significant (p < 0.0001). When we subclassified the max SUVmax values, the median overall survival of subjects with max SUVmax < 7.0 was 41.9 months. That of subjects with max SUVmax between 7.0 and 12.0 was 20.6 months. That of subjects with max SUVmax ≥ 12.0 was 4.2 months. The differences were statistically significant.ConclusionsPretreatment max SUVmax assessed by FDG PET/CT is a useful prognostic marker for patients with advanced RCC, providing helpful information for clinical decision making.

Utility of the maximum standardized uptake value on positron emission tomography for predicting therapeutic effect in recurrent gynecological malignancies: A preliminary study

“…SUVmax measured using PET could predict prognosis in various cancers, such as liver, kidney, pancreas, and breast cancer . In gynecological cancers, the SUVmax has also been reported to be useful for predicting the prognosis or the aggressiveness of cancers.…”

“…SUVmax measured using PET could predict prognosis in various cancers, such as liver, kidney, pancreas, and breast cancer. [13][14][15][16] In gynecological cancers, the SUVmax has also been reported to be useful for Figure 5 Maximum standardized uptake value (SUVmax) by type of therapy in patients with complete remission (CR)/ partial remission (PR). In the patients treated with radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) in those with CR/PR, the SUVmax was higher than in those treated with computed tomography (CT), but there was no statistically significant difference (P = 0.0857).…”

The acceleration of glucose accumulation in renal cell carcinoma assessed by FDG PET/CT demonstrated acquisition of resistance to tyrosine kinase inhibitor therapy

“…PET/CT images were obtained using a single PET/CT system (Aquiduo 16; Toshiba Medical Systems, Tokyo, Japan) at the Yokohaha City University Hospital. The details about the condition of PET/CT examination and methods how to determine Standardized uptake value (SUV) were described in our previous report [10]. The highest SUV in an individual RCC lesion and the highest SUV in all RCC tumors of an individual patient were defined as SUVmax and max SUVmax, respectively.…”

“…We first found that pretreatment maximum SUVmax (max SUVmax), which was the highest SUV in all RCC lesions in individual patients, could predict the survival of patients with advanced RCC [9, 10]. Subsequently, we reported that patients with RCC whose max SUVmax decreased 20% or more one month after beginning TKI treatment showed long progression-free survival (PFS) [11].…”

Renal cell carcinoma: the search for a reliable biomarker

“…However, FDG PET/CT has shown some ability to predict survival in patients with advanced RCC. Nakaigawa et al demonstrated in 101 patients with advanced RCC (metastatic or locoregional disease) that the standardized uptake value (SUV) max on FDG PET/CT prior to systemic therapy independently predicted overall survival (OS) (8). Similarly, median SUV max on a baseline FDG PET/CT prior to systemic TT significantly predicted OS and progression free survival (PFS) in patients with advanced RCC (9).…”