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European Journal of Nuclear Medicine and Molecular Imaging

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01-03-2016 | Original Article

Recurrent renal cell carcinoma: clinical and prognostic value of FDG PET/CT

Authors: Pierpaolo Alongi, Maria Picchio, Fabio Zattoni, Marianna Spallino, Luigi Gianolli, Giorgio Saladini, Laura Evangelista

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 3/2016

Abstract

Purpose

The purpose of our study was 1) to evaluate the diagnostic performance of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT), 2) to assess the impact of FDG PET/CT on treatment decision-making, and 3) to estimate the prognostic value of FDG PET/CT in the restaging process among patients with renal cell carcinoma (RCC).

Methods

From the FDG PET/CT databases of San Raffaele Hospital in Milan, Italy, and the Veneto Institute of Oncology in Padua, Italy, we selected 104 patients with a certain diagnosis of RCC after surgery, and for whom at least 24 months of post-surgical FDG PET/CT, clinical, and instrumental follow-up data was available. The sensitivity and specificity of FDG PET/CT were assessed by histology and/or other imaging as standard of reference. Progression-free survival (PFS) and overall survival (OS) were computed using the Kaplan–Meier method. Univariate and multivariate Cox proportional hazards models were used to identify predictors of outcome.

Results

FDG PET/CT resulted in a positive diagnosis in 58 patients and a negative diagnosis in 46 patients. Sensitivity and specificity were 74 % and 80 %, respectively. FDG PET/CT findings influenced therapeutic management in 45/104 cases (43 %). After a median follow-up period of 37 months (± standard deviation 12.9), 51 (49 %) patients had recurrence of disease, and 26 (25 %) had died. In analysis of OS, positive versus negative FDG PET/CT was associated with worse cumulative survival rates over a 5-year period (19 % vs. 69 %, respectively; p <0.05). Similarly, a positive FDG PET/CT correlated with a lower 3-year PFS rate. In addition, univariate and multivariate analysis revealed that a positive scan, alone or in combination with disease stage III–IV or nuclear grading 3–4, was associated with high risk of progression (multivariate analysis = hazard ratios [HRs] of 4.01, 3.7, and 2.8, respectively; all p < 0.05).

Conclusions

FDG PET/CT is a valuable tool both in treatment decision-making and for predicting survival and progression in patients affected by RCC.

Escudier B, Porta C, Schmidinger M, Algaba F, Patard JJ, Khoo V, et al. Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2014;25 Suppl 3:iii49–56.PubMedCrossRef

Ferlay J, Autier P, Boniol M, Heanue M, Colombet M, Boyle P. Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol. 2007;18:581–92.PubMedCrossRef

Motzer RJ, Hutson TE, Tomczak P, et al. Overall survival and updated results for sunitinib compared with interferon alfa in patients with metastatic renal cell carcinoma. J Clin Oncol. 2009;27:3584–90.PubMedPubMedCentralCrossRef

Rini BI, Campbell SC, Escudier B. Renal cell carcinoma. Lancet. 2009;373:1119–32.PubMedCrossRef

Robson CJ, Churchill BM, Anderson W. The results of radical nephrectomy for renal cell carcinoma. J Urol. 1969;101:297–301.PubMed

Van Brussel JP, Mickisch GH. Prognostic factors in renal cell and bladder cancer. BJU Int. 1999;83:902–8. quiz 908–9.PubMedCrossRef

Naito S, Yamamoto N, Takayama T, Muramoto M, Shinohara N, Nishiyama K, et al. Prognosis of Japanese metastatic renal cell carcinoma patients in the cytokine era: a cooperative group report of 1463 patients. Eur Urol. 2010;57:317–25.PubMedCrossRef

Van der Poel HG, Roukema JA, Horenblas S, van Geel AN, Debruyne FM. Metastasectomy in renal cell carcinoma: A multicenter retrospective analysis. Eur Urol. 1999;35:197–203.PubMedCrossRef

Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17:1471–4.PubMedCrossRef

10.

Leibovich BC, Blute ML, Cheville JC, Lohse CM, Frank I, Kwon ED, et al. Prediction of progression after radical nephrectomy for patients with clear cell renal cell carcinoma: a stratification tool for prospective clinical trials. Cancer. 2003;97:1663–71.PubMedCrossRef

11.

Patard J-J, Kim HL, Lam JS, Dorey FJ, Pantuck AJ, Zisman A, et al. Use of the University of California Los Angeles integrated staging system to predict survival in renal cell carcinoma: an international multicenter study. J Clin Oncol. 2004;22:3316–22.PubMedCrossRef

12.

Safaei A, Figlin R, Hoh CK, Silverman DH, Seltzer M, Phelps ME, et al. The usefulness of F-18 deoxyglucose whole-body positron emission tomography (PET) for re-staging of renal cell cancer. Clin Nephrol. 2002;57:56–62.PubMedCrossRef

13.

Nakatani K, Nakamoto Y, Saga T, Higashi T, Togashi K. The potential clinical value of FDG-PET for recurrent renal cell carcinoma. Eur J Radiol. 2011;79:29–35.PubMedCrossRef

14.

Kang DE, White RL, Zuger JH, Sasser HC, Teigland CM. Clinical use of fluorodeoxyglucose F 18 positron emission tomography for detection of renal cell carcinoma. J Urol. 2004;171:1806–9.PubMedCrossRef

15.

Wang H-Y, Ding H-J, Chen J-H, Chao C-H, Lu Y-Y, Lin W-Y, et al. Meta-analysis of the diagnostic performance of [18F]FDG-PET and PET/CT in renal cell carcinoma. Cancer Imaging. 2012;12:464–74.PubMedPubMedCentralCrossRef

16.

Boellaard R, O’Doherty MJ, Weber WA, Mottaghy FM, Lonsdale MN, Stroobants SG, et al. FDG PET and PET/CT: EANM procedure guidelines for tumour PET imaging: version 1.0. Eur J Nucl Med Mol Imaging. 2010;37:181–200.PubMedPubMedCentralCrossRef

17.

Wahl RL, Harney J, Hutchins G, Grossman HB. Imaging of renal cancer using positron emission tomography with 2-deoxy-2-(18F)-fluoro-D-glucose: pilot animal and human studies. J Urol. 1991;146:1470–4.PubMed

18.

Ramdave S, Thomas GW, Berlangieri SU, Bolton DM, Davis I, Danguy HT, et al. Clinical role of F-18 fluorodeoxyglucose positron emission tomography for detection and management of renal cell carcinoma. J Urol. 2001;166:825–30.PubMedCrossRef

19.

Fuccio C, Ceci F, Castellucci P, Spinapolice EG, Palumbo R, D’Ambrosio D, et al. Restaging clear cell renal carcinoma with 18F-FDG PET/CT. Clin Nucl Med. 2014;39:e320–4.PubMedCrossRef

20.

Mueller-Lisse UG, Mueller-Lisse UL, Meindl T, Coppenrath E, Degenhart C, Graser A, et al. Staging of renal cell carcinoma. Eur Radiol. 2007;17:2268–77.PubMedCrossRef

21.

Miyakita H, Tokunaga M, Onda H, Usui Y, Kinoshita H, Kawamura N, et al. Significance of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) for detection of renal cell carcinoma and immunohistochemical glucose transporter 1 (GLUT-1) expression in the cancer. Int J Urol. 2002;9:15–8.PubMedCrossRef

22.

Bertagna F, Motta F, Bertoli M, Bosio G, Fisogni S, Tardanico R, et al. Role of F18-FDG-PET/CT in restaging patients affected by renal carcinoma. Nucl Med Rev Cent East Eur. 2013;16:3–8.PubMedCrossRef

23.

Wu H, Yen RF, Shen YY, Kao CH, Lin CC, Lee CC. Comparing whole body 18F-2-deoxyglucose positron emission tomography and technetium-99m methylene diphosphate bone scan to detect bone metastases in patients with renal cell carcinomas - a preliminary report. J Cancer Res Clin Oncol. 2002;128:503–6.PubMedCrossRef

24.

Platzek I, Zastrow S, Deppe PE, Grimm MO, Wirth M, Laniado M, et al. Whole-body MRI in follow-up of patients with renal cell carcinoma. Acta Radiol. 2010;51:581–9.PubMedCrossRef

25.

Aide N, Cappele O, Bottet P, Bensadoun H, Regeasse A, Comoz F, et al. Efficiency of [(18)F]FDG PET in characterising renal cancer and detecting distant metastases: a comparison with CT. Eur J Nucl Med Mol Imaging. 2003;9:1236–45.CrossRef

26.

Ljungberg B, Bensalah K, Bex A, Canfield S, Dabestani S, Giles RH, et al. Guidelines on Renal Cell Carcinoma. Eur Urol. 2015;67:913–24.PubMedCrossRef

27.

Escudier B, Porta C, Schmidinger M, Algaba F, Patard JJ, Khoo V, et al. ESMO Guidelines Working Group. Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2014;25 Suppl 3:49–56.CrossRef

28.

Van der Mijn JC, Mier JW, Broxterman HJ, Verheul HM. Predictive biomarkers in renal cell cancer: insights in drug resistance mechanisms. Drug Resist Updat. 2014;17:77–88.PubMedCrossRef

Title: Recurrent renal cell carcinoma: clinical and prognostic value of FDG PET/CT
Authors: Pierpaolo Alongi
Maria Picchio
Fabio Zattoni
Marianna Spallino
Luigi Gianolli
Giorgio Saladini
Laura Evangelista
Publication date: 01-03-2016
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 3/2016
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-015-3159-6

At a glance: The STEP trials

Springer Medicine

Recurrent renal cell carcinoma: clinical and prognostic value of FDG PET/CT

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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