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Preoperative FDG-Positive Lymph Nodes Predict the Postoperative Prognosis in Resectable Biliary Tract Cancers

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

F-18 fluorodeoxyglucose-positron emission tomography (FDG-PET) has been used to diagnose and stage various cancers. In regard to biliary tract cancer (BTC), due to cholangitis it is difficult to evaluate FDG uptake caused by cancer. We previously showed that FDG-positive lymph nodes (LNs) of resectable BTC had a possibility of predicting postoperative prognosis.

Objective

This study aimed to validate the usability of FDG-PET for LNs using another cohort and to investigate in detail the relationship between FDG-positive LNs and the prognosis of BTC.

Methods

We measured the preoperative maximum standardized uptake value (SUVmax) at each of the 190 surgically dissected LN areas in 67 patients and investigated the prognosis using our previously determined SUVmax cut-off values of ≥ 2.8.

Results

Regarding the prognosis of patients with resectable BTC, a LN SUVmax ≥ 2.8 [PET N (+)] was a poor prognostic factor for recurrence-free survival (RFS) compared with a LN SUVmax < 2.8 [PET N (−)]. It was confirmed that the hazard ratio forest plot [PET N (+)/PET N (−)] for RFS indicated a similar tendency among subcategories. Moreover, we investigated patients with pN0 disease and demonstrated that the PET N (+) group also had a significantly worse RFS outcome compared with the PET N (−) group. Recurrence of the PET N (+) group has significantly occurred more often in LNs than that of the PET N (−) group.

Conclusion

High LN SUVmax was confirmed to be the preoperatively diagnosed prognostic risk factor for RFS in resectable BTC and could be helpful for clinical decision making regarding the perioperative treatment strategy.

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References

  1. Bridgewater JA, Goodman KA, Kalyan A, Mulcahy MF. Biliary tract cancer: epidemiology, radiotherapy, and molecular profiling. Am Soc Clin Oncol Educ Book. 2016;35:e194–203.

    Article  Google Scholar 

  2. Colvin H, Mizushima T, Eguchi H, Takiguchi S, Doki Y, Mori M. Gastroenterological surgery in Japan: the past, the present and the future. Ann Gastroenterol Surg. 2017;1(1):5–10.

    Article  Google Scholar 

  3. Yamamoto T, Sugiura T, Mizuno T, Okamura Y, Aramaki T, Endo M, et al. Preoperative FDG-PET predicts early recurrence and a poor prognosis after resection of pancreatic adenocarcinoma. Ann Surg Oncol. 2015;22(2):677–84.

    Article  Google Scholar 

  4. Song BI, Kim HW, Won KS, Ryu SW, Sohn SS, Kang YN. Preoperative standardized uptake value of metastatic lymph nodes measured by 18F-FDG PET/CT improves the prediction of prognosis in gastric cancer. Medicine (Baltimore). 2015;94(26):e1037.

    Article  Google Scholar 

  5. Li J, Kuehl H, Grabellus F, Muller SP, Radunz S, Antoch G, et al. Preoperative assessment of hilar cholangiocarcinoma by dual-modality PET/CT. J Surg Oncol. 2008;98(6):438–43.

    Article  Google Scholar 

  6. Furukawa H, Ikuma H, Asakura-Yokoe K, Uesaka K. Preoperative staging of biliary carcinoma using 18F-fluorodeoxyglucose PET: prospective comparison with PET+CT, MDCT and histopathology. Eur Radiol. 2008;18(12):2841–7.

    Article  Google Scholar 

  7. Kim JY, Kim MH, Lee TY, Hwang CY, Kim JS, Yun SC, et al. Clinical role of 18F-FDG PET-CT in suspected and potentially operable cholangiocarcinoma: a prospective study compared with conventional imaging. Am J Gastroenterol. 2008;103(5):1145–51.

    Article  Google Scholar 

  8. Petrowsky H, Wildbrett P, Husarik DB, Hany TF, Tam S, Jochum W, et al. impact of integrated positron emission tomography and computed tomography on staging and management of gallbladder cancer and cholangiocarcinoma. J Hepatol. 2006;45(1):43–50.

    Article  Google Scholar 

  9. Anderson CD, Rice MH, Pinson CW, Chapman WC, Chari RS, Delbeke D. Fluorodeoxyglucose PET imaging in the evaluation of gallbladder carcinoma and cholangiocarcinoma. J Gastrointest Surg. 2004;8(1):90–7.

    Article  Google Scholar 

  10. Moon CM, Bang S, Chung JB, Park SW, Song SY, Yun M, et al. Usefulness of 18F-fluorodeoxyglucose positron emission tomography in differential diagnosis and staging of cholangiocarcinomas. J Gastroenterol Hepatol. 2008;23(5):759–65.

    Article  Google Scholar 

  11. Nishiyama Y, Yamamoto Y, Kimura N, Miki A, Sasakawa Y, Wakabayashi H, et al. Comparison of early and delayed FDG PET for evaluation of biliary stricture. Nucl Med Commun. 2007;28(12):914–9.

    Article  Google Scholar 

  12. Kobayashi S, Nagano H, Hoshino H, Wada H, Marubashi S, Eguchi H, et al. Diagnostic value of FDG-PET for lymph node metastasis and outcome of surgery for biliary cancer. J Surg Oncol. 2011;103(3):223–9.

    Article  Google Scholar 

  13. Kobayashi S, Nagano H, Marubashi S, Wada H, Eguchi H, Takeda Y, et al. Multidetector computed tomography for preoperative prediction of postsurgical prognosis of patients with extrahepatic biliary cancer. J Surg Oncol. 2010;101(5):376–83.

    Article  Google Scholar 

  14. Miyazaki M, Ohtsuka M, Miyakawa S, Nagino M, Yamamoto M, Kokudo N, et al. Classification of biliary tract cancers established by the Japanese Society of Hepato-Biliary-Pancreatic Surgery: 3 (rd) English edition. J Hepatobiliary Pancreat Sci. 2015;22(3):181–96.

    Article  Google Scholar 

  15. Sakai D, Kanai M, Kobayashi S, Eguchi H, Baba H, Seo S, et al. Randomized phase III study of gemcitabine, cisplatin plus S-1 (GCS) versus gemcitabine, cisplatin (GC) for advanced biliary tract cancer (KHBO1401-MITSUBA). Ann Oncol. 2018;29(Suppl 8):VIII20.

    Google Scholar 

  16. Lee HY, Lee SW, Lee KS, Jeong JY, Choi JY, Kwon OJ, et al. Role of CT and PET imaging in predicting tumor recurrence and survival in patients with lung adenocarcinoma: a comparison with the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society Classification of Lung Adenocarcinoma. J Thorac Oncol. 2015;10(12):1785–94.

    Article  CAS  Google Scholar 

  17. Alakus H, Batur M, Schmidt M, Drebber U, Baldus SE, Vallbohmer D, et al. Variable 18F-fluorodeoxyglucose uptake in gastric cancer is associated with different levels of GLUT-1 expression. Nucl Med Commun. 2010;31(6):532–8.

    Article  CAS  Google Scholar 

  18. Carvalho KC, Cunha IW, Rocha RM, Ayala FR, Cajaiba MM, Begnami MD, et al. GLUT1 expression in malignant tumors and its use as an immunodiagnostic marker. Clinics (Sao Paulo). 2011;66(6):965–72.

    Article  Google Scholar 

  19. Yamada A, Oguchi K, Fukushima M, Imai Y, Kadoya M. Evaluation of 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography in gastric carcinoma: relation to histological subtypes, depth of tumor invasion, and glucose transporter-1 expression. Ann Nucl Med. 2006;20(9):597–604.

    Article  CAS  Google Scholar 

  20. Kubo Y, Aishima S, Tanaka Y, Shindo K, Mizuuchi Y, Abe K, et al. Different expression of glucose transporters in the progression of intrahepatic cholangiocarcinoma. Hum Pathol. 2014;45(8):1610–7.

    Article  CAS  Google Scholar 

  21. Ma KW, Cheung TT, She WH, Chok KSH, Chan ACY, Dai WC, et al. Diagnostic and Prognostic role of 18-FDG PET/CT in the management of resectable biliary tract cancer. World J Surg. 2018;42(3):823–34.

    Article  Google Scholar 

  22. Kanai M, Hatano E, Kobayashi S, Fujiwara Y, Marubashi S, Miyamoto A, et al. A multi-institution phase II study of gemcitabine/cisplatin/S-1 (GCS) combination chemotherapy for patients with advanced biliary tract cancer (KHBO 1002). Cancer Chemother Pharmacol. 2015;75(2):293–300.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan

    Masahiko Kubo MD, PhD, Shogo Kobayashi MD, PhD, Kunihito Gotoh MD, PhD, Hirotoshi Takayama MD, Yoshifumi Iwagami MD, PhD, Daisaku Yamada MD, PhD, Yoshito Tomimaru MD, PhD, Hirofumi Akita MD, PhD, Takehiro Noda MD, PhD, Yuichiro Doki MD, PhD & Hidetoshi Eguchi MD, PhD

  2. Department of Nuclear Medicine and Tracer Kinetics, Graduate School of Medicine, Osaka University, Osaka, Japan

    Hiroki Kato MD, PhD

  3. Department of Molecular Imaging in Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan

    Eku Shimosegawa MD, PhD

Authors
  1. Masahiko Kubo MD, PhD
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  2. Shogo Kobayashi MD, PhD
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  3. Kunihito Gotoh MD, PhD
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  4. Hirotoshi Takayama MD
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  5. Yoshifumi Iwagami MD, PhD
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  6. Daisaku Yamada MD, PhD
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  7. Yoshito Tomimaru MD, PhD
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  8. Hirofumi Akita MD, PhD
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  9. Takehiro Noda MD, PhD
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  10. Hiroki Kato MD, PhD
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  11. Eku Shimosegawa MD, PhD
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  12. Yuichiro Doki MD, PhD
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  13. Hidetoshi Eguchi MD, PhD
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Corresponding author

Correspondence to Shogo Kobayashi MD, PhD.

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Disclosure

Masahiko Kubo, Shogo Kobayashi, Kunihito Gotoh, Hirotoshi Takayama, Yoshifumi Iwagami, Daisaku Yamada, Yoshito Tomimaru, Hirofumi Akita, Takehiro Noda, Hiroki Kato, Eku Shimosegawa, Yuichiro Doki, and Hidetoshi Eguchi have declared no conflicts of interest.

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Kubo, M., Kobayashi, S., Gotoh, K. et al. Preoperative FDG-Positive Lymph Nodes Predict the Postoperative Prognosis in Resectable Biliary Tract Cancers. Ann Surg Oncol 29, 935–944 (2022). https://doi.org/10.1245/s10434-021-10820-6

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  • DOI: https://doi.org/10.1245/s10434-021-10820-6

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