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01-12-2016 | Nuclear Medicine

The predictive value of preoperative ¹⁸F-fluorodeoxyglucose PET for postoperative recurrence in patients with localized primary gastrointestinal stromal tumour

Authors: Kanae Kawai Miyake, Yuji Nakamoto, Yoshiki Mikami, Shiro Tanaka, Tatsuya Higashi, Eiji Tadamura, Tsuneo Saga, Shunsuke Minami, Kaori Togashi

Published in: European Radiology | Issue 12/2016

Abstract

Objectives

To assess the potential value of preoperative ¹⁸F-FDG PET to predict postoperative recurrence of solitary localized primary gastrointestinal stromal tumour (GIST) after radical resection.

Methods

A total of 46 patients with primary GIST who received preoperative ¹⁸F-FDG PET and underwent complete resection without neoadjuvant therapy were retrospectively studied. PET findings, including ring-shaped uptake and intense uptake, were compared with Joensuu risk grades using Fisher’s exact test. The prognostic value of the preoperative clinico-imaging variables—age ≥60 years, male, ring-shaped uptake, intense uptake, tumour size >5 cm, heterogeneous CT attenuation and lower gastrointestinal origin—and Joensuu high risk for recurrence-free survival was evaluated using log-rank test and multivariate Cox regression analysis.

Results

Ring-shaped uptake and intense uptake were significantly associated with Joensuu high risk. Univariate analysis showed that ring-shaped uptake, intense uptake, size >5 cm and Joensuu high risk were significantly associated with inferior recurrence-free survival. Multivariate analysis showed that ring-shaped uptake (P = 0.004) and Joensuu high risk (P = 0.021) were independent adverse prognostic factors of postoperative recurrence.

Conclusions

Ring-shaped uptake on preoperative ¹⁸F-FDG PET may be a potential predictor of postoperative tumour recurrence of localized primary GISTs.

Key points

• Clinical course of resectable solitary localized primary GISTs varies widely.

• Ring-shaped uptake is an independent adverse prognostic factor of postoperative recurrence.

• Preoperative ¹⁸ F-FDG PET may help predict postoperative recurrence of GISTs.

Miettinen M, Lasota J (2006) Gastrointestinal stromal tumors: review on morphology, molecular pathology, prognosis, and differential diagnosis. Arch Pathol Lab Med 130:1466–1478PubMed

Hirota S, Isozaki K, Moriyama Y et al (1998) Gain-of-function mutations of c-kit in human gastrointestinal stromal tumors. Science 279:577–580CrossRefPubMed

Demetri GD, von Mehren M, Antonescu CR et al (2010) NCCN Task Force report: update on the management of patients with gastrointestinal stromal tumors. J Natl Compr Canc Netw 8(Suppl 2):S1–S41PubMedPubMedCentral

DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan MF (2000) Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg 231:51–58CrossRefPubMedPubMedCentral

Dematteo RP, Ballman KV, Antonescu CR et al (2009) Adjuvant imatinib mesylate after resection of localised, primary gastrointestinal stromal tumour: a randomised, double-blind, placebo-controlled trial. Lancet 373:1097–1104CrossRefPubMedPubMedCentral

Joensuu H, Eriksson M, Sundby Hall K et al (2012) One vs three years of adjuvant imatinib for operable gastrointestinal stromal tumor: a randomized trial. JAMA 307:1265–1272CrossRefPubMed

ESMO/European Sarcoma Network Working Group (2012) Gastrointestinal stromal tumors: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 23(Suppl 7):vii49–vii55

Eisenberg BL, Smith KD (2011) Adjuvant and neoadjuvant therapy for primary GIST. Cancer Chemother Pharmacol 67(Suppl 1):S3–S8CrossRefPubMed

Jiang Y, Ming L, Montero AJ, Kimchi E, Nikfarjam M, Staveley-O’Carroll KF (2008) Optimizing imatinib mesylate treatment in gastrointestinal stromal tumors. Gastrointest Cancer Res 2:245–250PubMedPubMedCentral

10.

Andtbacka RH, Ng CS, Scaife CL et al (2007) Surgical resection of gastrointestinal stromal tumors after treatment with imatinib. Ann Surg Oncol 14:14–24CrossRefPubMed

11.

Eisenberg BL, Harris J, Blanke CD et al (2009) Phase II trial of neoadjuvant/adjuvant imatinib mesylate (IM) for advanced primary and metastatic/recurrent operable gastrointestinal stromal tumor (GIST): early results of RTOG 0132/ACRIN 6665. J Surg Oncol 99:42–47CrossRefPubMedPubMedCentral

12.

Bonvalot S, Eldweny H, Péchoux CL et al (2006) Impact of surgery on advanced gastrointestinal stromal tumors (GIST) in the imatinib era. Ann Surg Oncol 13:1596–1603CrossRefPubMed

13.

Xu J, Ling TL, Wang M, Zhao WY, Cao H (2015) Preoperative imatinib treatment in patients with advanced gastrointestinal stromal tumors: patient experiences and systematic review of 563 patients. Int Surg 100:860–869CrossRefPubMedPubMedCentral

14.

Hecker A, Hecker B, Bassaly B et al (2010) Dramatic regression and bleeding of a duodenal GIST during preoperative imatinib therapy: case report and review. World J Surg Oncol 8:47CrossRefPubMedPubMedCentral

15.

Fletcher CD, Berman JJ, Corless C et al (2002) Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol 33:459–565CrossRefPubMed

16.

Joensuu H (2008) Risk stratification of patients diagnosed with gastrointestinal stromal tumor. Hum Pathol 39:1411–1419CrossRefPubMed

17.

Rutkowski P, Bylina E, Wozniak A et al (2011) Validation of the Joensuu risk criteria for primary resectable gastrointestinal stromal tumour - the impact of tumour rupture on patient outcomes. Eur J Surg Oncol 37:890–896CrossRefPubMed

18.

Gold JS, Gönen M, Gutiérrez A et al (2009) Development and validation of a prognostic nomogram for recurrence-free survival after complete surgical resection of localised primary gastrointestinal stromal tumour: a retrospective analysis. Lancet Oncol 10:1045–1052CrossRefPubMedPubMedCentral

19.

Sepe PS, Moparty B, Pitman MB, Saltzman JR, Brugge WR (2009) EUS-guided FNA for the diagnosis of GI stromal cell tumors: sensitivity and cytologic yield. Gastrointest Endosc 70:254–261CrossRefPubMed

20.

Nishida T, Hirota S, Yanagisawa A et al (2008) Clinical practice guidelines for gastrointestinal stromal tumor (GIST) in Japan: english version. Int J Clin Oncol 13:416–430CrossRefPubMed

21.

Van den Abbeele AD (2008) The lessons of GIST-PET and PET/CT: a new paradigm for imaging. Oncologist 13(Suppl 2):8–13CrossRefPubMed

22.

Langer C, Gunawan B, Schüler P, Huber W, Füzesi L, Becker H (2003) Prognostic factors influencing surgical management and outcome of gastrointestinal stromal tumours. Br J Surg 90:332–339CrossRefPubMed

23.

Aparicio T, Boige V, Sabourin JC et al (2004) Prognostic factors after surgery of primary resectable gastrointestinal stromal tumours. Eur J Surg Oncol 30:1098–1103CrossRefPubMed

24.

Ryu MH, Kang YK, Jang SJ et al (2007) Prognostic significance of p53 gene mutations and protein overexpression in localized gastrointestinal stromal tumours. Histopathology 51:379–389CrossRefPubMed

25.

Kim TW, Lee H, Kang YK et al (2004) Prognostic significance of c-kit mutation in localized gastrointestinal stromal tumors. Clin Cancer Res 10:3076–3081CrossRefPubMed

26.

Tateishi U, Hasegawa T, Satake M, Moriyama N (2003) Gastrointestinal stromal tumor. Correlation of computed tomography findings with tumor grade and mortality. J Comput Assist Tomogr 27:792–798CrossRefPubMed

27.

Dematteo RP, Gold JS, Saran L et al (2008) Tumor mitotic rate, size, and location independently predict recurrence after resection of primary gastrointestinal stromal tumor (GIST). Cancer 112:608–615CrossRefPubMed

28.

Bell SW, Kempson RL, Hendrickson MR (1994) Problematic uterine smooth muscle neoplasms. A clinicopathologic study of 213 cases. Am J Surg Pathol 18:535–558CrossRefPubMed

29.

Tryggvason G, Gíslason HG, Magnússon MK, Jónasson JG (2005) Gastrointestinal stromal tumors in Iceland, 1990-2003: the Icelandic GIST study, a population-based incidence and pathologic risk stratification study. Int J Cancer 117:289–293CrossRefPubMed

30.

Unalp HR, Derici H, Kamer E, Bozdag AD, Tarcan E, Onal MA (2009) Gastrointestinal stromal tumours: outcomes of surgical management and analysis of prognostic variables. Can J Surg 52:31–38PubMedPubMedCentral

31.

Singer S, Rubin BP, Lux ML et al (2002) Prognostic value of Kit mutation type, mitotic activity, and histologic subtype in gastrointestinal stromal tumors. J Clin Oncol 20:3898–3905CrossRefPubMed

32.

Kamiyama Y, Aihara R, Nakabayashi T et al (2005) 18F-fluorodeoxyglucose positron emission tomography: useful technique for predicting malignant potential of gastrointestinal stromal tumors. World J Surg 29:1429–1435CrossRefPubMed

33.

Yamada M, Niwa Y, Matsuura T et al (2007) Gastric GIST malignancy evaluated by 18FDG-PET as compared with EUS-FNA and endoscopic biopsy. Scand J Gastroenterol 42:633–641CrossRefPubMed

34.

Otomi Y, Otsuka H, Morita N et al (2010) Relationship between FDG uptake and the pathological risk category in gastrointestinal stromal tumors. J Med Invest 57:270–274CrossRefPubMed

35.

Park JW, Cho CH, Jeong DS, Chae HD (2011) Role of F-fluoro-2-deoxyglucose positron emission tomography in gastric GIST: predicting malignant potential pre-operatively. J Gastric Cancer 11:173–179CrossRefPubMedPubMedCentral

36.

Fendler WP, Chalkidis RP, Ilhan H et al (2015) Evaluation of several FDG PET parameters for prediction of soft tissue tumour grade at primary diagnosis and recurrence. Eur Radiol 25:2214–2221CrossRefPubMed

37.

Van den Abbeele AD, Gatsonis C, de Vries DJ et al (2012) ACRIN 6665/RTOG 0132 phase II trial of neoadjuvant imatinib mesylate for operable malignant gastrointestinal stromal tumor: monitoring with 18F-FDG PET and correlation with genotype and GLUT4 expression. J Nucl Med 53:567–574CrossRefPubMedPubMedCentral

38.

Tarn C, Skorobogatko YV, Taguchi T, Eisenberg B, von Mehren M, Godwin AK (2006) Therapeutic effect of imatinib in gastrointestinal stromal tumors: AKT signaling dependent and independent mechanisms. Cancer Res 66:5477–5486CrossRefPubMed

39.

Miettinen M, Sobin LH, Lasoda J (2005) Gastrointestinal stromal tumors of the stomach: a clinicopathologic, immunohistochemical, and molecular genetic study of 1765 cases with long-term follow-up. Am J Surg Pathol 29:52–68CrossRefPubMed

40.

Meignan M, Gallamini A, Meignan M, Gallamini A, Haioun C (2009) Report on the first international workshop on interim-PET-scan in lymphoma. Leuk Lymphoma 50:1257–1260CrossRefPubMed

41.

Biggi A, Gallamini A, Chauvie S et al (2013) International validation study for interim PET in ABVD-treated, advanced-stage Hodgkin lymphoma: interpretation criteria and concordance rate among reviewers. J Nucl Med 54:683–690CrossRefPubMed

Title: The predictive value of preoperative 18F-fluorodeoxyglucose PET for postoperative recurrence in patients with localized primary gastrointestinal stromal tumour
Authors: Kanae Kawai Miyake
Yuji Nakamoto
Yoshiki Mikami
Shiro Tanaka
Tatsuya Higashi
Eiji Tadamura
Tsuneo Saga
Shunsuke Minami
Kaori Togashi
Publication date: 01-12-2016
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 12/2016
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-016-4242-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The predictive value of preoperative ¹⁸F-fluorodeoxyglucose PET for postoperative recurrence in patients with localized primary gastrointestinal stromal tumour

Abstract

Objectives

Methods

Results

Conclusions

Key points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key points

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