Prognostic Value Of Metabolic Parameters Measured By Pretreatment Dual-Time-Point F-18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography In Patients With Intrahepatic Or Perihilar Cholangiocarcinoma A Strobe Study

The purpose of this study was to determine the glucose metabolism at delay phase measured by pretreatment dual-time-point F-18-fluorodeoxyglucose (F-18-FDG) positron emission tomography (PET)/ computed tomography (CT) provides prognostic information independent of well-known prognostic factors in patients with intrahepatic or perihilar cholangiocarcinoma (ICC or PCC). From July 2012 to December 2017, 55 patients (men 27, women 28, mean age 68 +/- 11 years) with pathologically proven ICC or PCC were enrolled in this retrospective study. The dual-time-point F-18-FDG PET/CT as part of a staging workup was performed in all patients. The patient's data includes age, sex, serum CA19-9, presence of LN or distant metastasis, early SUVmax (early maximum standardized uptake value [eSUV]), delay SUVmax (delay maximum standardized uptake value [dSUV]), retention index of SUVmax (percent change of maximum standardized uptake values [Delta SUV]), neutrophil to lymphocyte ratio (NLR) and histopathology including pCEA, p53, Ki-67 index. The analysis of the relationship between metabolic parameters and survival was done using the Kaplan-Meier curve and Cox proportional hazards regression model. Median survival for all patients was 357 days. Median early and delay SUVmax was 5.2 (range: 2.0-21.4) and 6.5 (range 2.7-24.5), respectively. The overall survival was found to be significantly related to eSUV, dSUV, Delta SUV, age, serum CA19-9 and NLR in univariate analysis. In multivariate analysis, dSUV (P = .014, 95%CI; 1.30-10.7, HR 3.74) and Delta SUVmax (P = .037, 95%CI; 1.05-6.12, HR 2.5) were independent factors of overall survival. Kaplan-Meier curve analysis clearly showed the significant difference of overall survival between 2 groups (high eSUV, low eSUV + high Delta SUV vs low eSUV and Delta SUV, P < .001) among the comparisons of the SUV parameters on FDG PET. In the receiver operating characteristic analysis using combinations of the SUV parameters, the 2 groups [eSUV + Delta SUV (P = .0001, area under the curve [AUC] 0.68) and dSUV + Delta SUV (P = .0002, AUC 0.71)] showed significantly larger AUC than the other groups applying eSUV or dSUV alone (AUC 0.61 and AUC 0.68). dSUV and Delta SUV on pretreatment dual-time-point F-18-FDG PET/CT can be useful parameters in the prediction of survival in patients with ICC or PCC.