Metabolic Signature on ¹⁸F-FDG PET/CT, HER2 Status, and Survival in Gastric Adenocarcinomas

Abstract

The human epidermal growth factor 2 (HER2)-overexpressing (HER2-positive [HER21]) gastric (GC) and gastroesophageal junction adenocarcinomas (GEJC) are felt to represent a more aggressive form of disease, which may correlate to increased metabolic activity. Whether tumor SUV max measured by 18 F-FDG PET/CT could be a preoperative parameter used to predict HER2 status of GC/GEJC is unknown. Methods: Pathology reports of HER21 GC/GEJC biopsies and resections from 31 patients were reviewed and compared with HER2-negative (HER2−) cases distributed evenly over the same time period. We analyzed their SUV max intensity and then compared the HER2 status and SUV max parameters and their association with survival. Results: After matching for age and sex, there was no difference in SUV max between HER21 and HER2− cases (9.7 and 8.4, respectively; P 5 0.6). No difference was seen between HER21 and HER2− cases in tumor histology (81% and 57% intestinal type, respectively; P 5 0.11), size (2.6 and 3.8 cm, respectively; P 5 0.12), differentiation (47% and 68% poorly differentiated, respectively; P 5 0.06), or presence of lymph node metastasis (60% and 40%, respectively; P 5 0.3). Although there was no difference in survival demonstrated by HER21 and HER2− cases, there was a significant difference in survival between SUV max above (12.2 mo) and below (30 mo) the median SUV max (6.6, P 5 0.01). Conclusion: Our study shows that SUV max is not associated with HER2 status of GC/GEJC. Independent of HER2 overexpression, patients with a high SUV max demonstrate a worse overall survival, suggesting that metabolic signature is a better predictor of biologic tumor aggressiveness than its histologic signature.

The correlation between molecular pathological profiles and metabolic parameters of 18F-FDG PET/CT in patients with gastroesophageal junction cancer

“…Specifically, while some studies have reported that the SUV max is significantly lower in HER2positive group than in the HER2-negative group [10], others have drawn the opposite conclusion [33]. Consistent with results reported by Celli et al [34], our data demonstrate that there is no significant difference in SUV max between HER2 + and HER2− groups, implying that this marker cannot be used to predict the HER2 expression status of GEJC on initial staging.…”

Snail Enhances Glycolysis in the Epithelial-Mesenchymal Transition Process by Targeting FBP1 in Gastric Cancer

“…As positron emission tomography (PET) technology using 18F-fluoro-2-deoxyglucose (FDG) is a manifestation of glycolysis in vivo [16, 17], the SUVmax has been widely used as a surrogate marker for the prognosis of disease in numerous types of cancer, including gastric cancer [18]. To confirm the relationship between Snail and glucose metabolism, we further analyzed the correlation between the Snail IHC staining and the PET/CT SUVmax data from gastric cancer patients.…”

Radiomic signature of 18F fluorodeoxyglucose PET/CT for prediction of gastric cancer survival and chemotherapeutic benefits

“…Previous studies have explored the relations between SUVmax and GC outcomes. Celli et al showed that patients with a high SUVmax demonstrated a worse overall survival, and metabolic signature of 18 F-FDG PET/CT is a better predictor of biologic tumor aggressiveness than histologic signature 8. Also, SUVmax was significantly higher in the HER2-negative group than in the HER2-positive group 53.…”

“…Imaging with fluorine 18 ( 18 F) fluorodeoxyglucose (FDG) positron emission tomography (PET) is a well-established method for staging GC, because it allows detection of distant metastases and lymph nodes involved 7. Conventional PET imaging metrics such as maximum standardized uptake value (SUVmax) and total lesion glycolysis (TLG) have been reported to be valuable prognostic factors in patients with GC 8, 9. Recent studies showed that metabolically active tumor volume (MATV) is a prognostic factor in patients with GC 10.…”