Prognostic Value of Intratumor Metabolic Heterogeneity Parameters on ¹⁸F‐FDG PET/CT for Patients with Colorectal Cancer

Abstract

Purpose. Intratumor metabolic heterogeneity parameters on 18F-2-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography-computed tomography (PET-CT) have been proven to be predictors of the clinical prognosis of cancer patients. The study aimed to examine the correlation between 18F-FDG PET-CT-defined heterogeneity parameters and the prognostic significance in patients with colorectal cancer. Methods. The study included 188 patients with colorectal cancer who received surgery and 18F-FDG PET/CT examinations. Preoperative 18F-FDG PET/CT conventional and metabolic heterogeneity parameters were collected, including maximum, peak, and mean standardized uptake value (SUVmax, SUVpeak, and SUVmean), metabolic tumor volume (MTV), total lesion glycolysis (TLG), heterogeneity index-1 (HI-1) and heterogeneity index-2 (HI-2), and clinicopathological information. Correlations between these parameters and patient survival outcomes were inferred. Results. The associations between 18F-FDG PET/CT parameters and clinical outcomes were analyzed. Tumor thrombus ( P < 0.001 ), tumor stage ( P = 0.001 ), MTV ( P = 0.003 ), HI-1 ( P = 0.032 ), and HI-2 ( P = 0.001 ) differed between the two groups with and without recurrence. Multivariate analysis showed that, in the radical surgery group, HI-2 (HR = 1.10, 95% CI: 1.04–1.17, P = 0.001 ), tumor stage (HR = 20.65, 95% CI: 4.81–88.62, P < 0.001 ), and regional lymph nodes status (HR = 0.16, 95% CI: 0.04–0.57, P = 0.005 ) were independent variables significantly correlated with progression-free survival (PFS) and HI-2 (HR = 1.16, 95% CI: 1.07–1.26, P < 0.001 ) was an independent variable affecting overall survival (OS). In the palliative surgery group, HI-2 (HR = 1.03, 95% CI: 1.01–1.06, P = 0.020 ) was an independent variable affecting PFS, and all the parameters were not statistically significant for OS. Conclusion. HI-2, tumor stage, and regional lymph nodes status might predict the outcomes of colorectal cancer more effectively than other 18F-FDG PET/CT defined parameters.

Relationship of FDG PET/CT imaging features with tumor immune microenvironment and prognosis in colorectal cancer: a retrospective study

“…MTV and TLG are the most notable volumetric metabolic parameters and are known to reflect the metabolic burden of cancerous lesions more accurately than the maximum SUV [ 27 ]. The CoV SUV is the ratio of the standard deviation of the SUV to the mean SUV, which reflects heterogeneity of FDG uptake [ 16 ]. The four SUV intensity histogram parameters, kurtosis, skewness, entropy, and uniformity, represent the shape, asymmetry, randomness, and homogeneity of the SUV distribution in the SUV intensity histogram [ 20 ].…”

“…MMP-11 is involved in extracellular matrix remodeling and contributes to tumor growth, invasion, and metastasis [ 32 ]. Regarding the clinical value of the CoV SUV, conflicting results have been shown in other types of cancers; however, in previous studies of colorectal cancer, patients with a high CoV SUV had a better response to chemoradiotherapy and a lower risk of recurrence than those with low values [ 16 , 33 ]. Considering the results of our study, it could be speculated that the high CoV SUV in colorectal cancer lesions on FDG PET/CT represented an unfavorable tumor microenvironment for tumor growth.…”

“…In patients with colorectal cancer, 2-deoxy-2-[ 18 F]fluoro-d-glucose (FDG) positron emission tomography/computed tomography (PET/CT) has shown a high diagnostic ability in case of distant metastasis of colorectal cancer, and has been recommended to assess ambiguous findings on conventional imaging examinations and to define the extent of metastatic disease [ 2 , 12 , 13 ]. Apart from its diagnostic role, PET/CT imaging features of colorectal cancer reflect the biological characteristics of the tumor and are significantly associated with clinical outcomes [ 14 – 16 ]. Furthermore, a previous study revealed that the degree of FDG uptake in the bone marrow (BM) and spleen, the major organs of the reticuloendothelial system, represented the degree of the host systemic inflammatory response and can be used to predict survival outcomes in patients with colorectal cancer [ 17 , 18 ].…”

Value of 18F-FDG-PET/CT radiomics combined clinical variables in differential diagnosis of malignant and benign vertebral compression fractures

“…Conventional metabolic parameters of PET/CT such as max and peak of SUV and SUL have been used to quantify intratumoral heterogeneity [29]. SUVmax is the most commonly used parameter to provide tumor metabolic activity in PET/CT.…”

Prediction value of 18F-FDG PET/CT intratumor metabolic heterogeneity parameters for recurrence after radical surgery of stage II/III colorectal cancer

“…In addition, we counted the coefficient of variation (CV) and heterogeneity index (HI) as heterogeneity parameters. CV is the ratio of the standard deviation of SUV to SUVmean, which reflects the variation degree of SUV ( 15 ). CV2.5 with 2.5 of SUV as the threshold and CV40% with 40% of the SUVmax as the threshold were measured.…”