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Does high [18F]FDG uptake always mean poor prognosis? Colon cancer with high-level microsatellite instability is associated with high [18F]FDG uptake on PET/CT

  • Oncology
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

High-level microsatellite instability (MSI-high) is generally associated with higher F-18 fluorodeoxyglucose ([18F]FDG) uptake than stable microsatellite (MSI-stable) tumors. However, MSI-high tumors have better prognosis, which is in contrast with general understanding that high [18F]FDG uptake correlates with poor prognosis. This study evaluated metastasis incidence with MSI status and [18F]FDG uptake.

Methods

We retrospectively reviewed 108 right-side colon cancer patients who underwent preoperative [18F]FDG PET/CT and postoperative MSI evaluations using a standard polymerase chain reaction at five Bethesda guidelines panel loci. The maximum standard uptake value (SUVmax), SUVmax tumor-to-liver ratio (TLR), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary tumor were measured using SUV 2.5 cut-off threshold. Student’s t-test or Mann-Whitney U test was performed for continuous variables, and χ2 test or Fisher’s exact test was performed for categorical variables (p value of  < 0.05 for statistical significance). Medical records were reviewed for metastasis incidence.

Results

Our study population had 66 MSI-stable and 42 MSI-high tumors. [18F]FDG uptake was higher in MSI-high tumors than MSI-stable tumors (TLR, median (Q1, Q3): 7.95 (6.06, 10.54) vs. 6.08 (4.09, 8.82), p = 0.021). Multivariable subgroup analysis demonstrated that higher [18F]FDG uptake was associated with higher risks of distant metastasis in MSI-stable tumors (SUVmax: p = 0.025, MTV: p = 0.008, TLG: p = 0.019) but not in MSI-high tumors.

Conclusion

MSI-high colon cancer is associated with high [18F]FDG uptake, but unlike MSI-stable tumors, the degree of [18F]FDG uptake does not correlate with the rate of distant metastasis.

Clinical relevance statement

MSI status should be considered during PET/CT assessment of colon cancer patients, as the degree of [18F]FDG uptake might not reflect metastatic potential in MSI-high tumors.

Key Points

• High-level microsatellite instability (MSI-high) tumor is a prognostic factor for distant metastasis.

• MSI-high colon cancers had a tendency of demonstrating higher [18F]FDG uptake compared to MSI-stable tumors.

• Although higher [18F]FDG uptake is known to represent higher risks of distant metastasis, the degree of [18F]FDG uptake in MSI-high tumors did not correlate with the rate at which distant metastasis occurred.

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Abbreviations

[18F]FDG:

F-18 fluorodeoxyglucose

AUC:

Area under the curve

CIs:

Confidence intervals

HIF-1:

Hypoxia-induced factor-1

LVI:

Lymphovascular invasion

MSI-high:

High-level microsatellite instability

MTV:

Metabolic tumor volume

ORs:

Odds ratios

PET/CT:

Positron emission tomography/computed tomography

ROC:

Receiver operating characteristic

Sen:

Sensitivity

SLR:

Spleen-to-liver ratio

Spe:

Specificity

SUVmax:

Maximum standard uptake value

SUVmean:

Mean standardized uptake value

TLG:

Total lesion glycolysis

TLR:

Tumor-to-liver ratio

TNM staging:

Tumor node and metastasis staging

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Funding

This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (NRF-2016R1D1A1B01014677).

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Author notes

  1. Honsoul Kim and Arthur Cho contributed equally.

Authors and Affiliations

  1. Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea

    Jongtae Cha, Won Jun Kang & Arthur Cho

  2. Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Samsung Life Building (B, 7th floor) 115 Irwon-ro, Gangnam-gu, Seoul, 06355, Republic of Korea

    Honsoul Kim

  3. Department of Health Science and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea

    Honsoul Kim

  4. Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea

    Hye Jung Shin & Myeongjee Lee

  5. Department of Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea

    Seowoong Jun

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Corresponding authors

Correspondence to Honsoul Kim or Arthur Cho.

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Guarantor

The scientific guarantor of this publication is Arthur Cho, MD, PhD.

Conflict of interest

The authors declare no competing interests.

Statistics and biometry

Two of the authors have significant statistical expertise: Hye Jung Shin, Myeongjee Lee.

Informed consent

Written informed consent was waived by the institutional review board.

Ethical approval

This study was approved by the institutional review board of Severance Hospital (IRB No. 4–2021-1559), and the requirement for informed consent was waived due to its retrospective nature.

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• retrospective

• cross-sectional study

• performed at one institution

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Cha, J., Kim, H., Shin, H.J. et al. Does high [18F]FDG uptake always mean poor prognosis? Colon cancer with high-level microsatellite instability is associated with high [18F]FDG uptake on PET/CT. Eur Radiol 33, 7450–7460 (2023). https://doi.org/10.1007/s00330-023-09832-5

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