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

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.

journal_name

Eur J Nucl Med Mol Imaging

journal_title

European journal of nuclear medicine and molecular imaging

authors

Alongi P,Picchio M,Zattoni F,Spallino M,Gianolli L,Saladini G,Evangelista L

doi

10.1007/s00259-015-3159-6

subject

Has Abstract

pub_date

2016-03-01 00:00:00

pages

464-73

issue

eissn

1619-7070

issn

1619-7089

pii

10.1007/s00259-015-3159-6

journal_volume

pub_type

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