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Abstract

OBJECTIVE:

Gastric neuroendocrine carcinomas (NEC) and mixed adenoneuroendocrine carcinoma (MANEC) are very rare, aggressive tumors of the stomach. We aimed to examine predictive role of pretreatment (18)F-FDG PET/CT-assessed metabolic parameter of primary tumors and metastases in patients with gastric NEC and MANEC.

METHODS:

We conducted a review of the 27 patients with histopathologically confirmed NECs (n = 10) and MANEC (n = 17) of the stomach at our institution between January 2005 and December 2012. All patients underwent (18)F-FDG-PET examination at diagnosis. Metabolic parameters [SUVmax, SUVmean, metabolic tumor volume (MTV) and total lesion glycolysis (TLG)] of the primary tumor and metastases on baseline PET/CT were analyzed.

RESULTS:

The median follow-up duration was 39.4 months (95 % CI 20.0-58.1 months) and the median overall survival (OS) was 25.7 months (95 % CI 14.1-37.2 months). All gastric lesions were well visualized (average SUVmax = 12.0, range 3.0-41.8). When subjects were divided into two groups by ROC cut-off value of 210.9 and 612, patients with high TLG in primary lesion and metastases showed poorer prognosis compared to low TLG patients (P = 0.09, P = 0.002, respectively). In the sub-analysis of patients with metastasis (n = 12), patients with high TLG in whole body tumor showed significantly shorter OS compared to those with low TLG (31.7 ± 11.4 vs. 7.2 ± 2.1 months, P = 0.006).

CONCLUSION:

(18)F-FDG PET/CT is useful in evaluating prognosis of advanced gastric cancer with neuroendocrine carcinoma components. Baseline MTV of primary gastric cancer with metastatic disease, and MTV, TLG of metastases may be prognostic markers in patients with gastric NEC and MANEC. 

Author information​

Lim SM1,2, Kim H3, Kang B4, Kim HS1, Rha SY1, Noh SH5, Hyung WJ5, Cheong JH5, Kim HI5, Chung HC1, Yun M6, Cho A7, Jung M8.

1Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea.

2Division of Medical Oncology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Seongnam, Gyeonggido, 13496, Republic of Korea.

3Department of Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea.

4Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.

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

6Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea.

7Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea. artycho@yuhs.ac.

8Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea. minkjung@yuhs.ac.