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Chen X, Chen X, Zhao X, Pang X, Dai M, Sun Y, Wang M, Han J, Zhao Y. Subcutaneous adipose tissue [ 18F]FDG uptake and CT-derived body composition variables for predicting survival outcomes in patients with locally advanced gastric cancer. Eur J Nucl Med Mol Imaging 2025:10.1007/s00259-025-07296-x. [PMID: 40272500 DOI: 10.1007/s00259-025-07296-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2025] [Accepted: 04/21/2025] [Indexed: 04/25/2025]
Abstract
PURPOSE This study aimed to investigate the impact of glucose metabolism in subcutaneous adipose tissue (SAT) and skeletal muscle (SM) variables on overall survival (OS) in patients with locally advanced gastric cancer. METHODS A retrospective study was conducted on 110 patients with advanced gastric cancer who underwent baseline [18F]FDG PET/CT. Demographic, clinical, and survival data were collected. Mean standardized uptake value (SUVmean) of SAT as well as skeletal muscle, and body composition measurement, including SAT area, SAT radiodensity, SM area, and SM radiodensity, were assessed on PET/CT. SM area was normalized for patient stature, resulting in the skeletal muscle index (SMI). Patients were stratified into subgroups with high and low SAT uptake based on the optimum cut-off value of the SAT SUVmean. The univariate, multivariate regression analysis, Kaplan-Meier survival analysis, and Spearman's correlation analysis were employed to evaluate the associations among metabolic activity and CT-derived body composition variables as well as OS. RESULTS Out of 110 patients with an average age of 62.65 ± 13.25 years, 58 (52.73%) patients died during follow-up. Cox regression analysis identified TNM stage, SAT SUVmean, and SMI as independent prognostic factors for OS (all p < 0.05). Notably, patients with elevated SAT uptake exhibited significantly poorer long-term survival compared to those with low SAT uptake (p < 0.001). Correlation analyses revealed a moderate positive association between SAT SUVmean and SAT radiodensity (p < 0.001, r = 0.47), whereas a significant inverse correlation was observed between SAT SUVmean and SAT area (p < 0.001, r = -0.465). Additionally, stratification by combined SAT SUVmean and SMI profiles showed that patients with low SAT uptake and high SMI exhibited a better prognosis than those with high SAT uptake and/or low SMI (p = 0.004 and p < 0.001). CONCLUSION Increased [18F]FDG uptake in SAT was correlated with higher SAT radiodensity as well as lower SAT area, and shortened survival in patients with advanced gastric cancer, underscoring its potential as a biomarker for adverse outcomes.
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Affiliation(s)
- Xiaoshan Chen
- Department of Nuclear Medicine, The Fourth Hospital of Hebei Medical University, 12 Jiankang Road, Shijiazhuang, Hebei, 050011, China
| | - Xiaolin Chen
- Department of Nuclear Medicine, The Fourth Hospital of Hebei Medical University, 12 Jiankang Road, Shijiazhuang, Hebei, 050011, China
| | - Xinming Zhao
- Department of Nuclear Medicine, The Fourth Hospital of Hebei Medical University, 12 Jiankang Road, Shijiazhuang, Hebei, 050011, China.
- Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Shijiazhuang, Hebei, 050011, China.
| | - Xiao Pang
- Department of Nuclear Medicine, The Fourth Hospital of Hebei Medical University, 12 Jiankang Road, Shijiazhuang, Hebei, 050011, China
| | - Meng Dai
- Department of Nuclear Medicine, The Fourth Hospital of Hebei Medical University, 12 Jiankang Road, Shijiazhuang, Hebei, 050011, China
| | - Yuhan Sun
- Department of Nuclear Medicine, The Fourth Hospital of Hebei Medical University, 12 Jiankang Road, Shijiazhuang, Hebei, 050011, China
| | - Mengjiao Wang
- Department of Nuclear Medicine, The Fourth Hospital of Hebei Medical University, 12 Jiankang Road, Shijiazhuang, Hebei, 050011, China
| | - Jingya Han
- Department of Nuclear Medicine, The Fourth Hospital of Hebei Medical University, 12 Jiankang Road, Shijiazhuang, Hebei, 050011, China
- Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Shijiazhuang, Hebei, 050011, China
| | - Yan Zhao
- Department of Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050011, China.
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Acar Tayyar MN, Tamam MÖ, Babacan GB, Şahin MC, Özçevik H, Gürdal N, Atakır K. [ 18F]FDG PET/CT beyond staging: Prognostic significance of sarcopenia and adipose tissue metabolism in esophageal carcinomas. Rev Esp Med Nucl Imagen Mol 2024:500090. [PMID: 39732336 DOI: 10.1016/j.remnie.2024.500090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2024] [Accepted: 12/02/2024] [Indexed: 12/30/2024]
Abstract
AIM This study aimed to investigate the relationship between PET and CT parameters and sarcopenia, adipose tissue, and tumor metabolism in esophageal carcinoma (EC) and its impact on survival in EC. METHOD Our study included 122 EC patients who underwent PET/CT for staging. Muscle and adipose tissue characteristics were evaluated, including lumbar (L3) and cervical (C3) muscle areas, psoas major (PM) and sternocleidomastoid muscle (SCM) parameters, and PET parameters for visceral and subcutaneous adipose tissue (SAT). Sarcopenia was determined using CT images, with a threshold for muscle tissue at the L3 vertebral level, and its impact on overall survival (OS) was investigated. RESULTS Sarcopenia was detected in 48 patients. SULmax in the primary tumor (PT) was significantly higher in sarcopenic patients (SP). The frequency of distant metastasis was higher in SP and OS was significantly lower. In the locally advanced stage, sarcopenia status decreased survival. L3, PM, C3, and SCM muscle areas were highly correlated. Subcutaneous adipose tissue SUVmax was significantly increased in SP and those with distant metastasis. Univariate analysis identified PT SULmax, PT SUVmean, PT TLG, lymph node and distant metastasis, SAT SUVmax, and sarcopenia as poor prognostic factors, while multivariate analysis confirmed BMI, distant metastasis, PT SUVmean, PT TLG as independent predictors of OS. CONCLUSION This study demonstrated that sarcopenia, linked to reduced survival, correlates with primary tumor SULmax, distant metastasis, and subcutaneous tissue PET parameters, exerting a notable impact on survival, particularly in locally advanced stages. Attenuation-corrected CT can be used instead of diagnostic CT, and sarcopenia can be diagnosed using not only L3 but also C3 slices.
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Affiliation(s)
- Merve Nur Acar Tayyar
- Department of Nuclear Medicine, University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey.
| | - Müge Öner Tamam
- Department of Nuclear Medicine, University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Gündüzalp Buğrahan Babacan
- Department of Nuclear Medicine, University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Mehmet Can Şahin
- Department of Nuclear Medicine, University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Halim Özçevik
- Department of Nuclear Medicine, University of Health Sciences, Başaksehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Necla Gürdal
- Department of Radiation Oncology, University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Kadir Atakır
- Department of Radiology, University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
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Yu J, Spielvogel C, Haberl D, Jiang Z, Özer Ö, Pusitz S, Geist B, Beyerlein M, Tibu I, Yildiz E, Kandathil SA, Buschhorn T, Schnöll J, Kumpf K, Chen YT, Wu T, Zhang Z, Grünert S, Hacker M, Vraka C. Systemic Metabolic and Volumetric Assessment via Whole-Body [ 18F]FDG-PET/CT: Pancreas Size Predicts Cachexia in Head and Neck Squamous Cell Carcinoma. Cancers (Basel) 2024; 16:3352. [PMID: 39409971 PMCID: PMC11475137 DOI: 10.3390/cancers16193352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2024] [Revised: 09/27/2024] [Accepted: 09/28/2024] [Indexed: 10/20/2024] Open
Abstract
Background/Objectives: Cancer-associated cachexia in head and neck squamous cell carcinoma (HNSCC) is challenging to diagnose due to its complex pathophysiology. This study aimed to identify metabolic biomarkers linked to cachexia and survival in HNSCC patients using [18F]FDG-PET/CT imaging and machine learning (ML) techniques. Methods: We retrospectively analyzed 253 HNSCC patients from Vienna General Hospital and the MD Anderson Cancer Center. Automated organ segmentation was employed to quantify metabolic and volumetric data from [18F]FDG-PET/CT scans across 29 tissues and organs. Patients were categorized into low weight loss (LoWL; grades 0-2) and high weight loss (HiWL; grades 3-4) groups, according to the weight loss grading system (WLGS). Machine learning models, combined with Cox regression, were used to identify survival predictors. Shapley additive explanation (SHAP) analysis was conducted to determine the significance of individual features. Results: The HiWL group exhibited increased glucose metabolism in skeletal muscle and adipose tissue (p = 0.01), while the LoWL group showed higher lung metabolism. The one-year survival rate was 84.1% in the LoWL group compared to 69.2% in the HiWL group (p < 0.01). Pancreatic volume emerged as a key biomarker associated with cachexia, with the ML model achieving an AUC of 0.79 (95% CI: 0.77-0.80) and an accuracy of 0.82 (95% CI: 0.81-0.83). Multivariate Cox regression confirmed pancreatic volume as an independent prognostic factor (HR: 0.66, 95% CI: 0.46-0.95; p < 0.05). Conclusions: The integration of metabolic and volumetric data provided a strong predictive model, highlighting pancreatic volume as a key imaging biomarker in the metabolic assessment of cachexia in HNSCC. This finding enhances our understanding and may improve prognostic evaluations and therapeutic strategies.
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Affiliation(s)
- Josef Yu
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria; (J.Y.); (C.S.); (D.H.); (Z.J.); (Ö.Ö.); (S.P.); (B.G.); (S.G.); (M.H.)
| | - Clemens Spielvogel
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria; (J.Y.); (C.S.); (D.H.); (Z.J.); (Ö.Ö.); (S.P.); (B.G.); (S.G.); (M.H.)
| | - David Haberl
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria; (J.Y.); (C.S.); (D.H.); (Z.J.); (Ö.Ö.); (S.P.); (B.G.); (S.G.); (M.H.)
- Christian Doppler Laboratory for Applied Metabolomics, Medical University of Vienna, 1090 Vienna, Austria
| | - Zewen Jiang
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria; (J.Y.); (C.S.); (D.H.); (Z.J.); (Ö.Ö.); (S.P.); (B.G.); (S.G.); (M.H.)
| | - Öykü Özer
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria; (J.Y.); (C.S.); (D.H.); (Z.J.); (Ö.Ö.); (S.P.); (B.G.); (S.G.); (M.H.)
| | - Smilla Pusitz
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria; (J.Y.); (C.S.); (D.H.); (Z.J.); (Ö.Ö.); (S.P.); (B.G.); (S.G.); (M.H.)
| | - Barbara Geist
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria; (J.Y.); (C.S.); (D.H.); (Z.J.); (Ö.Ö.); (S.P.); (B.G.); (S.G.); (M.H.)
| | - Michael Beyerlein
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria; (J.Y.); (C.S.); (D.H.); (Z.J.); (Ö.Ö.); (S.P.); (B.G.); (S.G.); (M.H.)
| | - Iustin Tibu
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria; (J.Y.); (C.S.); (D.H.); (Z.J.); (Ö.Ö.); (S.P.); (B.G.); (S.G.); (M.H.)
| | - Erdem Yildiz
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, 1090 Vienna, Austria; (E.Y.); (S.A.K.); (T.B.); (J.S.)
| | - Sam Augustine Kandathil
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, 1090 Vienna, Austria; (E.Y.); (S.A.K.); (T.B.); (J.S.)
| | - Till Buschhorn
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, 1090 Vienna, Austria; (E.Y.); (S.A.K.); (T.B.); (J.S.)
| | - Julia Schnöll
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, 1090 Vienna, Austria; (E.Y.); (S.A.K.); (T.B.); (J.S.)
| | - Katarina Kumpf
- IT4Science, Medical University of Vienna, 1090 Vienna, Austria;
| | - Ying-Ting Chen
- Teaching Center, Medical University of Vienna, 1090 Vienna, Austria;
| | - Tingting Wu
- Department of Cardiology, Xiangya Hospital Central South University, Changsha 410008, China;
| | - Zhaoqi Zhang
- Department of Nuclear Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050010, China;
| | - Stefan Grünert
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria; (J.Y.); (C.S.); (D.H.); (Z.J.); (Ö.Ö.); (S.P.); (B.G.); (S.G.); (M.H.)
| | - Marcus Hacker
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria; (J.Y.); (C.S.); (D.H.); (Z.J.); (Ö.Ö.); (S.P.); (B.G.); (S.G.); (M.H.)
| | - Chrysoula Vraka
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria; (J.Y.); (C.S.); (D.H.); (Z.J.); (Ö.Ö.); (S.P.); (B.G.); (S.G.); (M.H.)
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Lee JW, Yoo ID, Hong SP, Kang B, Kim JS, Kim YK, Bae SH, Jang SJ, Lee SM. Prognostic Impact of Visceral Adipose Tissue Imaging Parameters in Patients with Cholangiocarcinoma after Surgical Resection. Int J Mol Sci 2024; 25:3939. [PMID: 38612748 PMCID: PMC11011754 DOI: 10.3390/ijms25073939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/29/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
Visceral adiposity is known to be related to poor prognosis in patients with cholangiocarcinoma; however, the prognostic significance of the qualitative features of adipose tissue in cholangiocarcinoma has yet to be well defined. This study investigated the prognostic impact of adipose tissue imaging parameters reflecting the quantity and qualitative characteristics of subcutaneous (SAT) and visceral (VAT) adipose tissue on recurrence-free survival (RFS) and overall survival (OS) in 94 patients undergoing resection of cholangiocarcinoma. The area, mean computed tomography (CT) attenuation, and mean 2-deoxy-2-[18F]fluoro-D-glucose (FDG) uptake of SAT and VAT on positron emission tomography (PET)/CT for staging work-up were measured, and the relationship of these adipose tissue imaging parameters with clinicopathological factors and survival was assessed. TNM stage, histologic grade, lymphovascular invasion, and the size of cholangiocarcinoma showed positive correlations with adipose tissue imaging parameters. Multivariate survival analysis demonstrated that the visceral-to-subcutaneous adipose tissue area ratio (VSR) (p = 0.024; hazard ratio, 1.718) and mean FDG uptake of VAT (p = 0.033; hazard ratio, 9.781) were significant predictors for RFS, but all of the adipose tissue imaging parameters failed to show statistical significance for predicting OS. In addition to visceral adiposity, FDG uptake of VAT might be a promising prognostic parameter for predicting RFS in patients with cholangiocarcinoma.
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Affiliation(s)
- Jeong Won Lee
- Department of Nuclear Medicine, College of Medicine, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea; (J.W.L.); (I.D.Y.); (S.-p.H.)
| | - Ik Dong Yoo
- Department of Nuclear Medicine, College of Medicine, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea; (J.W.L.); (I.D.Y.); (S.-p.H.)
| | - Sun-pyo Hong
- Department of Nuclear Medicine, College of Medicine, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea; (J.W.L.); (I.D.Y.); (S.-p.H.)
| | - Beodeul Kang
- Division of Medical Oncology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam 13496, Republic of Korea (J.S.K.)
| | - Jung Sun Kim
- Division of Medical Oncology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam 13496, Republic of Korea (J.S.K.)
| | - Yung Kil Kim
- Department of Surgery, College of Medicine, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea; (Y.K.K.); (S.H.B.)
| | - Sang Ho Bae
- Department of Surgery, College of Medicine, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea; (Y.K.K.); (S.H.B.)
| | - Su Jin Jang
- Department of Nuclear Medicine, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam 13496, Republic of Korea
| | - Sang Mi Lee
- Department of Nuclear Medicine, College of Medicine, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea; (J.W.L.); (I.D.Y.); (S.-p.H.)
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