Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Apr 15, 2020; 12(4): 447-456
Published online Apr 15, 2020. doi: 10.4251/wjgo.v12.i4.447
Nomogram using F-18 fluorodeoxyglucose positron emission tomography/computed tomography for preoperative prediction of lymph node metastasis in gastric cancer
Bong-Il Song
Bong-Il Song, Department of Nuclear Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, South Korea
Author contributions: Bong-Il Song edited the manuscript.
Supported by National Research Foundation of Korea, No. 2017R1C1B5076640.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of Keimyung University Dongsan Medical Center (IRB No. 2018-06-028-003).
Informed consent statement: The patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: Song BI declare no relevant conflicts of interests.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Bong-Il Song, MD, Associate Professor, Department of Nuclear Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, 1095 Dalgubeol-daero, Dalseo-gu, Daegu 42601, South Korea. song@dsmc.or.kr
Received: December 27, 2019
Peer-review started: December 27, 2019
First decision: January 19, 2020
Revised: March 13, 2020
Accepted: March 25, 2020
Article in press: March 25, 2020
Published online: April 15, 2020
Processing time: 110 Days and 5.9 Hours
Abstract
BACKGROUND

Lymph node (LN) metastasis is an important prognostic factor in patients with gastric cancer (GC). However, the evaluation of LN metastasis status in the preoperative setting is not accurate. Therefore, precise preoperative prediction of LN metastasis status is crucial for optimal treatment in patients with GC.

AIM

To develop a preoperative nomogram for LN metastasis using F-18 fluorodeoxyglucose (F-18 FDG) positron emission tomography/computed tomography (PET/CT) and preoperative laboratory test findings in GC.

METHODS

In this study, the data of 566 GC patients who underwent preoperative F-18 FDG PET/CT and subsequent surgical resection were analyzed. The LN metastasis prediction model was developed in the training cohort and validated in the internal validation cohort. Routine preoperative laboratory tests, including albumin and carbohydrate antigen (CA) 19-9 were performed in all patients. Univariate and multivariable logistic regression was performed to validate the preoperative predictive indicators for LN metastasis.

RESULTS

Of the 566 patients, 232 (41%) had confirmed histopathologic LN metastasis. Univariate logistic regression revealed that the tumor location, blood hemoglobin, serum albumin levels, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, CA 19-9, maximum standardized uptake value (SUVmax) of the primary tumor (T_SUVmax), and SUVmax of LN (N_SUVmax) were significantly associated with LN metastasis. In multivariate analysis, T_SUVmax (OR = 1.08; 95%CI: 1.02–1.15; P = 0.011) and N_SUVmax (OR = 1.49; 95%CI: 1.19–1.97; P = 0.002) were found to be significant predictive factors for LN metastasis. The LN metastasis prediction model using T_SUVmax, N_SUVmax, serum albumin, and CA 19-9 yielded an area under the curve (AUC) of 0.733 (95%CI: 0.683–0.784, P = 0.025) in the training cohort and AUC of 0.756 (95%CI: 0.678–0.833, P < 0.001) in the test cohort.

CONCLUSION

T_SUVmax and N_SUVmax measured by preoperative F-18 FDG PET/CT are independent predictive factors for LN metastasis in GC.

Keywords: Gastric cancer; Lymph node metastasis; Positron emission tomography/computed tomography; Fluorodeoxyglucose; Prognostication; Standardized uptake value

Core tip: The maximum standardized uptake values of the primary tumor and lymph node (LN), measured by preoperative F-18 fluorodeoxyglucose positron emission tomography/computed tomography, are independent predictive factors for LN metastasis in patients with gastric cancer. Moreover, a nomogram using a combination of these metabolic information and laboratory parameters, such as serum albumin and carbohydrate antigen 19-9, for risk estimation of LN metastasis in gastric cancer was successfully developed in the training cohort and validated in the internal validation cohort.