Skip to main content
Log in

Association between survival and maximum standardized uptake value of liver metastases detected by 18-fluoro-2-deoxy-d-glucose positron emission tomography-computed tomography in patients with adenocarcinoma of unknown primary origin

  • Original Article
  • Published:
Annals of Nuclear Medicine Aims and scope Submit manuscript

Abstract

Objective

The objective of this retrospective study is to investigate the association between survival and maximum standardized uptake values (SUVmax) of liver metastases detected by pre-treatment positron emission tomography-computed tomography (PET-CT) in patients with adenocarcinoma of unknown primary origin (ACUP).

Methods

A total of 58 patients with ACUP and liver metastases confirmed histopathologically by liver biopsy and pre-treatment PET-CT were included in this study. SUVmax values of the liver lesions were measured and their association with survival was investigated.

Results

The median age was 62 years; 63.8 % of the patients were males and 36.2 % were females. The median overall survival was calculated as 10.7 months (OS). The median SUVmax of the liver metastases was 8.6. Accordingly, two groups were established: one with values <8.6 and the other with ones ≥8.6. No differences were detected between the two groups with respect to general characteristics. Median OS was 13.2 months in the group with SUVmax <8.6 compared to 7.4 months in the group with SUVmax ≥8.6. This difference was statistically significant (p = 0.033). SUVmax (HR 1.104, 95 % CI 1.013–1.204, p = 0.025), age (HR 1.033, 95 % CI 1.002–1.064, p = 0.034), presence of chemotherapy (HR 2.296, 95 % CI 1.136–4.641, p = 0.021) and LDH level (HR 1.002, 95 % CI 1.001–1.003, p = 0.007) were identified as independent prognostic factors affecting survival in the multivariable analysis. This is the first report evaluating the impact of SUVmax for liver metastases on ACUP patient survival.

Conclusion

The SUVmax of liver metastases evaluated by PET-CT is a prognostic factor influencing survival of patients with ACUP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Greco FA, Hainsworth JD. Tumors of unknown origin. CA Cancer J Clin. 1992;42:96–115.

    Article  CAS  PubMed  Google Scholar 

  2. Ayoub JP, Hess KR, Abbruzzese MC, Lenzi R, Raber MN, Abbruzzese JL. Unknown primary tumors metastatic to liver. J Clin Oncol. 1998;16:2105–12.

    CAS  PubMed  Google Scholar 

  3. Podoloff DA, Ball DW, Ben-Josef E, Benson AB 3rd, Cohen SJ, Coleman RE, et al. NCCN task force: clinical utility of PET in a variety of tumor types. J Natl Compr Canc Netw. 2009;7(Suppl 2):1–26.

    Google Scholar 

  4. Poeppel TD, Krause BJ, Heusner TA, Boy C, Bockisch A, Antoch G. PET/CT for the staging and follow-up of patients with malignancies. Eur J Radiol. 2009;70:382–92.

    Article  CAS  PubMed  Google Scholar 

  5. Lee YY, Choi CH, Kim CJ, Kang H, Kim TJ, Lee JW, et al. The prognostic significance of the SUVmax (maximum standardized uptake value for F-18 fluorodeoxyglucose) of the cervical tumor in PET imaging for early cervical cancer: preliminary results. Gynecol Oncol. 2009;115:65–8.

    Article  PubMed  Google Scholar 

  6. Kitajima K, Kita M, Suzuki K, Senda M, Nakamoto Y, Sugimura K. Prognostic significance of SUVmax (maximum standardized uptake value) measured by [(18)F]FDG PET/CT in endometrial cancer. Eur J Nucl Med Mol Imaging. 2012;39:840–5.

    Article  PubMed  Google Scholar 

  7. De Cicco C, Gilardi L, Botteri E, Fracassi SL, Di Dia GA, Botta F, et al. Is [18F] fluorodeoxyglucose uptake by the primary tumor a prognostic factor in breast cancer? Breast. 2013;22:39–43.

    Article  PubMed  Google Scholar 

  8. Brown C, Howes B, Jamieson GG, Bartholomeusz D, Zingg U, Sullivan TR, et al. Accuracy of PET-CT in predicting survival in patients with esophageal cancer. World Surg. 2012;36:1089–95.

    Article  Google Scholar 

  9. Namura K, Minamimoto R, Yao M, Makiyama K, Murakami T, Sano F, et al. Impact of maximum standardized uptake value (SUVmax) evaluated by 18-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (18F-FDG-PET/CT) on survival for patients with advanced renal cell carcinoma: a preliminary report. BMC Cancer. 2010;3(10):667.

    Article  Google Scholar 

  10. Park JC, Lee JL, Cheoi K, Chung H, Yun MJ, Lee H, et al. Predictive value of pretreatment metabolic activity measured by fluorodeoxyglucose positron emission tomography in patients with metastatic advanced gastric cancer: the maximal SUV of the stomach is a prognostic factor. Eur J Nucl Med Mol Imaging. 2012;39:1107–16.

    Article  CAS  PubMed  Google Scholar 

  11. Rohren EM, Turkington TG, Coleman RE. Clinical applications of PET in oncology. Radiology. 2004;231:305–32.

    Article  PubMed  Google Scholar 

  12. Sasaki R, Komaki R, Macapinlac H, Erasmus J, Allen P, Forster K, et al. [18F]fluorodeoxyglucose uptake by positron emission tomography predicts outcome of non-small-cell lung cancer. J Clin Oncol. 2005;23:1136–43.

    Article  CAS  PubMed  Google Scholar 

  13. Downey RJ, Akhurst T, Gonen M, Vincent A, Bains MS, Larson S, et al. Preoperative F-18 fluorodeoxyglucose-positron emission tomography maximal standardized uptake value predicts survival after lung cancer resection. J Clin Oncol. 2004;22:3255–60.

    Article  PubMed  Google Scholar 

  14. Allal AS, Slosman DO, Kebdani T, Allaoua M, Lehmann W, Dulguerov P. Prediction of outcome in head-and-neck cancer patients using the standardized uptake value of 2-[18F]fluoro-2-deoxy-d-glucose. Int J Radiat Oncol Biol Phys. 2004;59:1295–300.

    Article  CAS  PubMed  Google Scholar 

  15. Demirci U, Coskun U, Akdemir UO, Benekli M, Kapucu O, Ozkan S, et al. The nodal Standard uptake value (SUV) as a prognostic factor in head and neck squamous cell cancer. Asian Pac J Cancer Prev. 2011;12:1817–20.

    PubMed  Google Scholar 

  16. Pan L, Gu P, Huang G, Xue H, Wu S. Prognostic significance of SUV on PET/CT in patients with esophageal cancer: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2009;21:1008–15.

    Article  PubMed  Google Scholar 

  17. Barber TW, Duong CP, Leong T, Bressel M, Drummond EG, Hicks RG. 18F-FDG PET/CT has a high impact on patient management and provides powerful prognostic stratification in the primary staging of esophageal cancer: a prospective study with mature survival data. J Nucl Med. 2012;53:864–71.

    Article  PubMed  Google Scholar 

  18. Song B, Lee S, Jeong SY, Chae YS, Lee WK, Ahn B, et al. 18F-FDG uptake by metastatic axillary lymph nodes on pretreatment PET/CT as a prognostic factor for recurrence in patients with invasive ductal breast cancer. J Nucl Med. 2012;53:1337–44.

    Article  CAS  PubMed  Google Scholar 

  19. Zhang J, Jia Z, Zhou M, Ragaz J, Zhang Y, Wang B, et al. The SUVmax for 18F-FDG Correlates with molecular subtype and survival of previously untreated metastatic breast cancer. Clin Nucl Med. 2013;38:256–62.

    Article  PubMed  Google Scholar 

  20. Miyazaki Y, Nawa Y, Miyagawa M, Kohashi S, Nakase K, Yasukawa M, et al. Maximum standard uptake value of 18F-fluorodeoxyglucose positron emission tomography is a prognostic factor for progression-free survival of newly diagnosed patients with diffuse large B cell lymphoma. Ann Hematol. 2013;92:239–44.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Safar V, Dupuis J, Itti E, Jardin F, Fruchart C, Bardet S, et al. Interim 18F-fluorodeoxyglucose positron emission tomography scan in diffuse large B-cell lymphoma treated with anthracycline-based chemotherapy plus rituximab. J Clin Oncol. 2012;30:184–90.

    Article  CAS  PubMed  Google Scholar 

  22. Zinzani PL, Rigacci L, Stefoni V, Broccoli A, Puccini B, Castagnoli A, et al. Early interim 18F-FDG PET in Hodgkin’s lymphoma: evaluation on 304 patients. Eur J Nucl Med Mol Imaging. 2012;39:4–12.

    Article  PubMed  Google Scholar 

  23. Kwee TC, Kwee RM. Combined FDG-PET/CT for the detection of unknown primary tumors: systematic review and meta-analysis. Eur Radiol. 2009;19:731–44.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Sève P, Billotey C, Broussolle C, Dumontet C, Mackey JR. The role of 2-deoxy-2-[F-18]fluoro-d-glucose positron emission tomography in disseminated carcinoma of unknown primary site. Cancer. 2007;109:292–9.

    Article  PubMed  Google Scholar 

  25. Kubota R, Yamada S, Kubota K, Ishiwata K, Tamahashi N, Ido T. Intratumoral distribution of fluorine-18-fluorodeoxyglucose in vivo: high accumulation in macrophages and granulation tissues studied by microautoradiography. J Nucl Med. 1992;33:1972–80.

    CAS  PubMed  Google Scholar 

  26. Cook GJ, Fogelman I, Maisey MN. Normal physiological and benign pathological variants of 18-fluoro-2-deoxyglucose positron-emission tomography scanning: potential for error in interpretation. Semin Nucl Med. 1996;26:308–14.

    Article  CAS  PubMed  Google Scholar 

  27. Westerterp M, Pruim J, Oyen W, Hoekstra O, Paans A, Visser E, et al. Quantification of FDG PET studies using standardized uptake values in multi-centre trials: effects of image reconstruction, resolution and ROI definition parameters. Eur J Nucl Med Mol Imaging. 2007;34:392–404.

    Article  PubMed  Google Scholar 

  28. Breuer N, Behrendt FF, Heinzel A, Mottaghy FM, Palmowski M, Verburg FA. Prognostic relevance of 18F-FDG PET/CT in carcinoma of unknown primary. Clin Nucl Med. 2014;39:131–5.

    PubMed  Google Scholar 

  29. Lazaridis G, Pentheroudakis G, Fountzilas G, Pavlidis N. Liver metastases from cancer of unknown primary. Cancer Treat Rev. 2008;34:693–700.

    Article  PubMed  Google Scholar 

  30. Culine S, Kramar A, Saghatchian M, Bugat R, Lesimple T, Lortholary A, et al. French study group on carcinomas of unknown primary: development and validation of a prognostic model to predict the length of survival in patients with carcinomas of an unknown primary site. J Clin Oncol. 2002;20:4679–83.

    Article  PubMed  Google Scholar 

  31. Pavlidis N, Fizazi K. Cancer of unknown primary (CUP). Crit Rev Oncol Hematol. 2009;69:271–8.

    Article  PubMed  Google Scholar 

  32. Pouessel D, Thezenas S, Culine S, Becht C, Senesse P, Ychou M. Hepatic metastases from carcinomas of unknown primary site. Gastroenterol Clin Biol. 2005;29:1224–32.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None of the authors has any proprietary interests or conflicts of interest related to this submission.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Efnan Algin.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Algin, E., Ozet, A., Gumusay, O. et al. Association between survival and maximum standardized uptake value of liver metastases detected by 18-fluoro-2-deoxy-d-glucose positron emission tomography-computed tomography in patients with adenocarcinoma of unknown primary origin. Ann Nucl Med 28, 891–896 (2014). https://doi.org/10.1007/s12149-014-0896-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12149-014-0896-8

Keywords

Navigation