Primary Tumor Maximum Standardized Uptake Value Measured on18 F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography Is a Prognostic Value for Survival in Bile Duct and Gallbladder Cancer

Ji Yong Lee; Hong Joo Kim; Seo Hyung Yim; Dong Suk Shin; Jung Hee Yu; Deok Yun Ju; Jung Ho Park; Dong Il Park; Yong Kyun Cho; Chong Il Sohn; Woo Kyu Jeon; Byung Ik Kim

doi:10.4166/kjg.2013.62.4.227

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Lee, Kim, Yim, Shin, Yu, Ju, Park, Park, Cho, Sohn, Jeon, and Kim: Primary Tumor Maximum Standardized Uptake Value Measured on18 F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography Is a Prognostic Value for Survival in Bile Duct and Gallbladder Cancer

Original Article

Korean J Gastroenterol 2013;62(4):227-233.

Published online: 4 October 2013

DOI: https://doi.org/10.4166/kjg.2013.62.4.227

Primary Tumor Maximum Standardized Uptake Value Measured on¹⁸ F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography Is a Prognostic Value for Survival in Bile Duct and Gallbladder Cancer

Ji Yong Lee, Hong Joo Kim, Seo Hyung Yim, Dong Suk Shin, Jung Hee Yu, Deok Yun Ju, Jung Ho Park, Dong Il Park, Yong Kyun Cho, Chong Il Sohn, Woo Kyu Jeon, Byung Ik Kim

Department of Internal Medicine, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Correspondence to: Hong Joo Kim, Department of Internal Medicine, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul 110-746, Korea. Tel: +82-2-2001-2060, Fax: +82-2-2001-2049, E-mail: hongjoo3.kim@samsung.com

Received 22 June 2013 Revised 8 August 2013 Accepted 9 August 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Few studies have assessed the prognostic value of the primary tumor maximum standardized uptake value (SUV_max) measured by 2-[¹⁸ F]-fluoro-2-deoxy-D-glucose PET-CT for patients with bile duct and gallbladder cancer.

Methods

A retrospective analysis of 61 patients with confirmed bile duct and gallbladder cancer who underwent FDG PET-CT in Kangbuk Samsung Medical Center (Seoul, Korea) from April 2008 to April 2011. Prognostic significance of SUV_max and other clinicopathological variables was assessed.

Results

Twenty-three patients were diagnosed as common bile duct cancer, 17 as hilar bile duct cancer, 12 as intrahepatic bile duct cancer, and nine as gallbladder cancer. In univariate analysis, diagnosis of intrahepatic cholangiocarcinoma and gallbladder cancer, mass forming type, poorly differentiated cell type, nonsurgical treatment, advanced American Joint Committee on Cancer (AJCC) staging and primary tumor SUV_max were significant predictors of poor overall survival. In multivariate analysis adjusted for age and sex, primary tumor SUV_max (hazard ratio [HR], 4.526; 95% CI, 1.813–11.299), advanced AJCC staging (HR, 4.843; 95% CI, 1.760–13.328), and nonsurgical treatment (HR, 6.029; 95% CI, 1.989–18.271) were independently associated with poor overall survival.

Conclusions

Primary tumor SUV_max measured by FDG PET-CT is an independent and significant prognostic factor for overall survival in bile duct and gallbladder cancer.

Keywords: Prognosis, Fluorodeoxyglucose F18, Positron-emission tomography and computed tomography, Bile duct neoplasms, Gallbladder neoplasms

References

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Fig. 1.

Univariate analysis of the patient population, tumor characteristics, and overall survival. Kaplan-Meier survival curves with log rank comparisons between each group of final diagnosis (A), morphological type (B), histologic grade (C), treatment method (D), American Joint Committee on Cancer stage (E) and primary tumor standardized uptake value (SUV_max) (F). Log rank p-values were <0.05 for each comparison, respectively.

Fig. 2.

Axial FDG PET-CT images of two patients with common bile duct cancer who received nonsurgical treatment. Primary tumor maximum standardized uptake value is 3.1 (arrow) in 69-year-old man who was alive 26 months after diagnosis (A), and 9.9 (arrow) in 76-year-old man who died 10 months after diagnosis (B), respectively.

Table 1.

Baseline Clinicopathologic Characteristics of the Patients

Characteristic	Data
Total number	61 (100.0)
Age (yr)	68.5±8.9
Gender (male)	32 (52.5)
Final diagnosis
CBDC	23 (37.7)
Hilar	17 (27.9)
IBDC	12 (19.7)
GBC	9 (14.8)
Morphologic type
Mass forming	31 (50.8)
Periductal infiltrating	30 (49.2)
Intraductal growing	0 (0)
Tumor differentiation
Well differentiated	16 (45.7)
Moderately differentiated	13 (37.1)
Poorly differentiated	6 (17.1)
AJCC stage
Early (I/II)	49 (80.3)
Advanced (III/IV)	12 (19.7)
Primary tumor size (cm)	4.3±3.1
Diagnostic sensitivity of FDG PET-CT	51 (83.6)
SUV_max of primary tumor	6.4±4.6
Cholangitis	7 (11.5)

Values are presented as mean±SD or n (%).

CBDC, common bile duct cancer; IBDC, intrahepatic bile duct cancer; GBC, gallbladder cancer; AJCC, American Joint Committee on Cancer; FDG PET-CT, 2-[¹⁸ F]-fluoro-2-deoxy-D-glucose PET-CT; SUV_max, maximum standardized uptake value.

Table 2.

Cox Proportional Hazard Regression Analysis of Factors Associated with Overall Survival of Bile Duct and Gallbladder Cancer

Factor	Patient (n)	Unadjusted			Adjusted^a
Factor	Patient (n)	HR	95% CI	p-value	HR	95% CI	p-value
Primary tumor SUV_max
<5.5	32	1			1
≥5.5	29	3.927	1.968–7.836	＜0.001	4.526	1.813–11.299	0.001
AJCC stage
Early (I/II)	49	1			1
Advanced (III/IV)	12	10.646	4.428–25.596	＜0.001	4.843	1.760–13.328	0.002
Treatment
Surgical	14	1			1
Nonsurgical	47	4.053	1.559–10.537	0.004	6.029	1.989–18.271	0.001
Morphology
Mass forming	31	1			1
Periductal infiltrating	30	0.418	0.217–0.803	0.009	0.828	0.335–2.050	0.684
Age (yr)
≥65	41	1			1
＜65	20	0.544	0.262–1.128	0.102	1.017	0.976–1.061	0.417
Sex
Male	32	1			1
Female	29	1.424	0.744–2.726	0.286	1.19	0.566–2.504	0.646
Diagnosis
CBDC	23	1
Hilar	17	2.159	0.889–5.242	0.089
IBDC	12	6.354	2.520–16.019	＜0.001
GBC	9	4.153	1.585–10.883	0.004
Histology
Well	16	1
Moderate	13	2.651	0.979–7.182	0.055
Poor	6	27.532	6.494–116.730	＜0.001

HR, hazard ratio; SUV_max, maximum standardized uptake value; AJCC, American Joint Committee on Cancer; CBDC, common bile duct cancer; IBDC, intrahepatic bile duct cancer; GBC, gallbladder cancer.

^a Multivariate analysis.

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