The Role of Preoperative PET/CT in Predicting of Recurrence in Node Positive Advanced Gastric Cancer

초록

Background Regional lymph node (LN) status is the one of the most important prognostic factor for resectable advanced gastric carcinoma (AGC). 18-F-fluorodeoxyglucose (FDG) positron emission tomography (PET) is functional imaging tool. We aimed to evaluate the role of PET CT in predicting recurrence in resectable LN positive AGC. Method: Between 2003 and 2011, 102 consecutive patients (M:F 61:41, median age: 60y, range 31-79) who had received curative radical gastrectomy due to locoregional lymph node positive advanced gastric cancer and had underwent pre-operative 18-F-FDG PET/CT at single institute were collected and retrospectively analyzed. All these patients received radical total or subtotal gastrectomy with D2 dissection as curative aim. Results Only 47 patients showed increased LN FDG uptake (PET LN(+)) (46.1%). Number of involved LN was not differ between PET LN(+); 12.0 and PET LN(-); 14.3 group (p=.110) (range 4-46). Thirty-five patients confirmed recurrence among PET LN (+) patients (74.5%). However, there were only 19 recurred patients in PET LN (-) patients (19/55; 34.5%) (p<0.001). Median time to progression was also shorter in PET LN (+) patients (12.8mo) than PET LN (-) patients (15.9mo), but it was not statistically significant (p=.053). Conclusion Increased regional lymph node metabolism by 18 F-FDG PET/CT is one of the predictive factors concerning disease recurrence. There was a trend having shorter time to progression in PET LN (+) group. These results need to be validated in a larger prospective study to definitively establish the exact predicting role of PET CT in AGC.