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Annals of Nuclear Medicine
Published in: Annals of Nuclear Medicine 8/2013

01-10-2013 | Original Article

Prognostic implication of extrarenal metabolic tumor burden in advanced renal cell carcinoma treated with targeted therapy after nephrectomy

Authors: Hai-Jeon Yoon, Jin Chul Paeng, Cheol Kwak, Yong Hyun Park, Tae Min Kim, Se-Hoon Lee, June-Key Chung, E. Edmund Kim, Dong Soo Lee

Published in: Annals of Nuclear Medicine | Issue 8/2013

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Abstract

Objective

In the era of targeted therapy for advanced renal cell carcinoma (RCC), appropriate prognosis prediction is necessary for optimal therapy with or without cytoreductive surgery. We evaluated prognostic implication of extrarenal metabolic tumor burden in nephrectomized patients with advanced RCC.

Methods

Forty-four patients with advanced RCC who underwent 18F-fluorodeoxyglucose PET/CT were retrospectively enrolled. The patients were treated with nephrectomy and targeted therapy. On PET/CT image of each patient, maximal standardized uptake value (SUVmax) of lesions were measured, and metabolic tumor burden was measured as total lesion glycolysis (TLG) by multiplying tumor volume and mean SUV. An overall TLG was calculated as the sum of those of all lesions. The prognostic value of PET parameters (SUVmax and TLG), and established major clinical factors (serum hemoglobin and corrected calcium, and number of metastatic sites) were tested with regard to overall survival.

Results

Among 44 patients, 8 died during mean follow-up time of 21.9 ± 17.7 months. On FDG PET/CT, a total of 250 lesions were analyzed. In univariate analyses, SUVmax, TLG, number of metastatic sites, serum hemoglobin and corrected calcium were significant prognostic factors. Among them, TLG remained as an independent prognostic factor in a multivariate analysis (P = 0.038). In subgroup analyses, TLG was still a significant prognostic factor in patients treated with sunitinib only and in patients on the first staging as well as restaging.

Conclusions

Extrarenal metabolic tumor burden is a significant prognostic factor in advanced RCC patients treated with targeted therapy. In selection of candidates for cytoreductive surgery, the measurement of metabolic tumor burden may be effective.
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Metadata
Title
Prognostic implication of extrarenal metabolic tumor burden in advanced renal cell carcinoma treated with targeted therapy after nephrectomy
Authors
Hai-Jeon Yoon
Jin Chul Paeng
Cheol Kwak
Yong Hyun Park
Tae Min Kim
Se-Hoon Lee
June-Key Chung
E. Edmund Kim
Dong Soo Lee
Publication date
01-10-2013
Publisher
Springer Japan
Published in
Annals of Nuclear Medicine / Issue 8/2013
Print ISSN: 0914-7187
Electronic ISSN: 1864-6433
DOI
https://doi.org/10.1007/s12149-013-0742-4

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