Fluorine-18-fluorodeoxyglucose uptake of bone marrow on PET/CT can predict prognosis in patients with colorectal cancer after curative surgical resection

Lee, Jeong Won; Baek, Moo Jun; Ahn, Tae Sung; Lee, Sang Mi

doi:10.1097/meg.0000000000001018

Cited by 24 publications

(34 citation statements)

References 31 publications

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“…In several types of cancer, increased FDG avidity of the bone marrow seemed to be associated with prognostic factors such as lower overall survival rate and higher cancer recurrence rate [9][10][11][12][13][14]. In our cohort of patients with bacteremia, BLR or SLR was not associated with a total duration of hospital stay, ICU admission, or mortality.…”

Section: Discussionmentioning

confidence: 52%

“…The bone marrow and spleen are generally regarded as "hypermetabolic" when their FDG avidity exceeds that of the liver (bone marrow/liver ratio or spleen/liver ratio > 1.0) [8]. Hypermetabolism of the bone marrow or spleen has been associated with laboratory values such as C-reactive protein or hemoglobin and even prognosis in patients with several types of cancer [9][10][11][12][13][14] and autoimmune disease [15,16]. However, the clinical and pathophysiological meaning of hypermetabolism of the bone marrow and spleen in patients with bacteremia is limited.…”

Section: Introductionmentioning

confidence: 99%

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Clinical implications of increased uptake in bone marrow and spleen on FDG-PET in patients with bacteremia

Pijl

Kwee

Slart

et al. 2020

Eur J Nucl Med Mol Imaging

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Purpose To investigate which clinical factors and laboratory values are associated with high FDG uptake in the bone marrow and spleen on 2-deoxy-2-[18F]fluoro-d-glucose (FDG) positron emission tomography (PET)/computed tomography (CT) in patients with bacteremia. Methods One hundred forty-five consecutive retrospective patients with bacteremia who underwent FDG-PET/CT between 2010 and 2017 were included. Mean standard uptake values (SUVmean) of FDG in bone marrow, liver, and spleen were measured. Bone marrow-to-liver SUV ratios (BLR) and spleen-to-liver SUV ratios (SLR) were calculated. Linear regression analyses were performed to examine the association of BLR and SLR with age, gender, hemoglobin, leukocyte count, platelets, glucose level, C-reactive protein (CRP), microorganism, days of antibiotic treatment before FDG-PET/CT, infection focus, use of immunosuppressive drugs, duration of hospital stay (after FDG-PET/CT), ICU admission, and mortality. Results C-reactive protein (p = 0.006), a cardiovascular or musculoskeletal focus of infection (p = 0.000 for both), and bacteremia caused by Gram-negative bacteria (p = 0.002) were independently and positively associated with BLR, while age (p = 0.000) and glucose level before FDG-PET/CT (p = 0.004) were independently and negatively associated with BLR. For SLR, CRP (p = 0.001) and a cardiovascular focus of infection (p = 0.020) were independently and positively associated with SLR, while age (p = 0.002) and glucose level before FDG-PET/CT (p = 0.016) were independently and negatively associated with SLR. Conclusion High FDG uptake in the bone marrow is associated with a higher inflammatory response and younger age in patients with bacteremia. In patients with high FDG uptake in the bone marrow, a cardiovascular or musculoskeletal focus of infection is more likely than other foci, and the infection is more often caused by Gram-negative species. High splenic FDG uptake is associated with a higher inflammatory response as well, and a cardiovascular focus of infection is also more likely in case of high splenic FDG uptake.

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Section: Discussionmentioning

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Clinical implications of increased uptake in bone marrow and spleen on FDG-PET in patients with bacteremia

Pijl

Kwee

Slart

et al. 2020

Eur J Nucl Med Mol Imaging

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“…The present study found that BLR measured on pre- F]FDG uptake of BM in a significant portion of patients with malignant diseases, even in those without concurrent infectious or hematologic diseases [23,24]. Previous studies reported that BM SUV and BLR have significant positive correlations with white blood cell counts, serum C-reactive protein level, NLR, PLR, and transforming growth factor (TGF)-beta [14,[16][17][18][19][24][25][26]. A number of previous studies have demonstrated that PET parameters of BM were significant predictors for survival in various kinds of cancers including small cell lung cancer, non-small cell lung cancer, gastric cancer, cervical cancer, colorectal cancer, lymphoma, malignant pleural mesothelioma, melanoma, and head and neck cancer [14, 17-19, 23-25, 27-32].…”

Section: Discussionmentioning

confidence: 72%

“…Because [ 18 F]FDG uptake of BM mainly reflects glucose metabolism of immune cells, increased [ 18 F]FDG uptake of BM in patients with malignant diseases is considered to be due to BM activation caused by host inflammatory response [15,16]. In various malignant diseases, [ 18 F]FDG uptake of BM has shown significant correlations with serum inflammatory markers and clinical outcomes [14,[17][18][19][20]. However, in patients with breast cancer, only a single study have evaluated the clinical implication of [ 18 F]FDG uptake of the reticuloendothelial system including BM and the spleen [21], and the prognostic potential of [ 18 F]FDG uptake of BM for predicting distant recurrence has not been reported yet.…”

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confidence: 99%

[18F]FDG uptake of bone marrow on PET/CT for predicting distant recurrence in breast cancer patients after surgical resection

et al. 2020

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Background: The objective of this study was to investigate the prognostic value of 2-Deoxy-2-[ 18 F]fluoro-D-glucose ([ 18 F]FDG) uptake of bone marrow (BM) and metabolic parameters of primary tumor on positron emission tomography/computed tomography (PET/CT) for predicting distant recurrence in patients with breast cancer. Methods: Pretreatment [ 18 F]FDG PET/CT images of 345 breast cancer patients were retrospectively evaluated. Maximum standardized uptake value, metabolic tumor volume, and total lesion glycolysis (TLG) of primary breast cancer and bone marrow-to-liver uptake ratio (BLR) on PET/CT were measured. A Cox proportional hazard regression model was used to evaluate the prognostic potential of parameters for predicting recurrence-free survival (RFS) and distant RFS. For Kaplan-Meier analysis, the specific cutoff values pf BLR and TLG were determined by the maximal chi-square method. Results: The median follow-up duration of the enrolled patients was 48.7 months, and during follow-up, 36 patients (10.4%) experienced the cancer recurrence. BLR was significantly correlated with T stage, serum inflammatory markers, and recurrence pattern (p < 0.05). Patients with high BLR and TLG showed worse RFS and distant RFS than those with low BLR and TLG. On multivariate analysis, BLR was significantly associated with both RFS and distant RFS after adjusting for T stage, estrogen receptor status, and TLG (p = 0.001 for both). Only 0.5% of patients with TLG < 9.64 g and BLR < 0.91 experienced distant recurrence. However, patients with TLG ≥ 9.64 g and BLR ≥ 0.91 had a distant recurrence rate of 40.7%. Conclusions: BLR on pretreatment [ 18 F]FDG PET/CT were significant predictors for RFS and distant RFS in patients with breast cancer. By combining [ 18 F]FDG uptake of BM and volumetric PET/CT index of breast cancer, the risk of distant recurrence could be stratified.

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“…The remaining 10 articles had their bibliographies reviewed in a systematic manner. This identified a further 2 articles to be included in the final analysis, leading to final figure of 12 articles considered in the present systematic review (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31).…”

Section: Study Selection Processmentioning

confidence: 99%

The Relationship Between Tumor Glucose Metabolism and Host Systemic Inflammatory Responses in Patients with Cancer: A Systematic Review

et al. 2018

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One of the most important and long recognised characteristics of tumour cells is their dysregulated cellular energetics with anaerobic driven glucose uptake. In patients with cancer the prognostic value of the systemic inflammatory response has been well established and the recent combination of PET and CT scanning combines the assessment of tumour physiological activity with detailed anatomical localisation. The aim of this study was to carry out a systematic review of the assessment of the relationship between both the tumour and host inflammatory responses using PETCT. An extensive literature review using targeted subject headings was carried out in the US National Library of Medicine, the Excerpta Medica database and Cochrane Database of Systematic Reviews until the 31st March 2018. On completion of the online search, the title and abstracts of each identified study was examined for relevance. Studies with duplicate datasets, not available in English and that did not have full text availability were excluded. Full texts of relevant articles were obtained and were then examined to identify any further relevant articles. Twelve studies containing 2,588 patients were included in the final analysis. All of the included studies used the FDG tracer in PETCT imaging and had biochemical assessment of the systemic inflammatory response. The majority of studies showed a direct relationship between the tumour and bone marrow glucose uptake and host systemic inflammatory responses as measured by C-Reactive Protein (CRP) ( = 2), albumin ( = 2), White Cell Count (WCC) ( = 3), neutrophils ( = 2) and platelets ( = 2). The majority of the studies ( = 8) also showed a direct relationship between tumour and bone marrow glucose uptake and poor outcomes. This review suggests a direct relationship between the tumour and bone marrow glucose uptake and host systemic inflammation. This may suggest new approaches for more optimal therapeutic targeting and monitoring strategies in patients with cancer.

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Fluorine-18-fluorodeoxyglucose uptake of bone marrow on PET/CT can predict prognosis in patients with colorectal cancer after curative surgical resection

Abstract: Increased BM SUV was observed in patients with advanced stage and increased serum inflammatory markers. BM SUV was an independent predictor for RFS in colorectal cancer.

Cited by 24 publications

References 31 publications

Clinical implications of increased uptake in bone marrow and spleen on FDG-PET in patients with bacteremia

Clinical implications of increased uptake in bone marrow and spleen on FDG-PET in patients with bacteremia

[18F]FDG uptake of bone marrow on PET/CT for predicting distant recurrence in breast cancer patients after surgical resection

The Relationship Between Tumor Glucose Metabolism and Host Systemic Inflammatory Responses in Patients with Cancer: A Systematic Review

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