Splenic FDG uptake predicts poor prognosis in patients with unresectable cholangiocarcinoma

Summary

Aim: Diffuse splenic ¹⁸F-Fluorodeoxyglucose (FDG) uptake has shown to be associated with concurrent inflammation. We evaluated the prognostic value of diffuse splenic FDG uptake for predicting prognosis in cholangiocarcinoma patients. Patients, methods: Sixty-four patients with unresectable cholangiocarcinoma performed Positron emission tomography/computed tomography (PET/CT) using FDG between July 2009 and April 2012. Patients were divided into two groups according to splenic FDG uptake relative to hepatic FDG uptake. Eleven patients showing splenic FDG uptake exceeding hepatic uptake were included in group A, while 53 patients with hepatic FDG uptake exceeding splenic uptake were included in group B. Prognostic factors for overall survival were evaluated using log-rank test. Variables with a probability of less than or equal to 0.1 on univariate analysis were considered as possible independent factors. Cox-proportional hazards Cholangiocarcinoma, a malignant neoplasm of biliary epithelium, is a rare disease with an increasing incidence worldwide (19). The chances of survival with cholan- giocarcinoma depend on its location and model was used to analyze univariate and multivariate analysis. Results: Mean standardized uptake value of the liver (Liver SUV_mean)/ Spleen SUV_mean (L/S) ratio <1 (p = 0.0034), WBC > 10 000 (p = 0.1155) and CEA >30 (p = 0.0946) were predictors of overall survival on univariate analysis. In a subsequent multivariate analysis, L/S ratio <1 remained a significant independent predictor of poor prognosis (HR 6.0153, 95% CI, 1.7193-21.0460, p = 0.0052). Conclusion: Our study has shown that splenic FDG uptake could be a predictor of overall survival of unresectable cholangiocarcinoma patients.

Zusammenfassung

Ziel: Diffuse ¹⁸F-Fluordesoxyglukose(FDG)-Auf- nahme der Milz ist mit einer Entzündung assoziiert. Wir untersuchten die prognostische Bedeutung einer diffusen FDG-Aufnahme in der Milz für den Verlauf bei Patienten mit Cholan-giokarzinom. Patienten, Methoden: Bei 64 Patienten mit inoperablem Cholangiokarzinom erfolgte zwischen Juli 2009 und April 2012 eine FDG-PET/CT. Sie wurden je nach FDG-Aufnahme der Milz im Verhältnis zur hepatischen FDG-Aufnahme zwei Gruppen zugeordnet: Gruppe A: 11 Patienten, bei denen die FDG-Aufnahme der Milz höher als die der Leber lag; Gruppe B: 54 Patienten, bei denen die hepatische FDG-Aufnahme die der Milz überstieg. Mittels Log-rank-Test wurden prognostische Faktoren für das Gesamtüberleben ausgewertet. Variablen mit der Wahrscheinlichkeit ≤ 0,1 bei der univariaten Analyse wurden als potenziell unabhängige Faktoren betrachtet. Uni- und multivariate Analysen wurden mit dem proportionalen Ha- zard-Modell nach Cox durchgeführt. Ergebnisse: Ein Verhältnis der mittleren standardisierten Aufnahmewerte der Leber (Leber SUVmean) / Milz SUVmean (L/S) <1 (p = 0,0034), Leukozytenzahl >10 000 (p = 0,1155) und ein CEA-Wert >30 (p = 0,0946) prognostizierten das Gesamtüberleben in der univariaten Analyse. In der anschließenden multivariaten Analyse blieb ein L/S < 1 als maßgeblicher unabhängiger Prädiktor für schlechte Prognose bestehen (HR 6,0153; 95% CI, 1,7193-21,0460, p = 0,0052). Schlussfolgerung: Die FDG-Aufnahme in der Milz könnte ein Prognosefaktor für das Gesamtüberleben bei inoperablem Cholangio- karzinom sein.

Keywords

PET - cholangiocarcinoma - spleen

Schlüsselwörter

PET - Cholangiokarzinom - Milz

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