Predictive Role of the Number of <sup>18</sup>F-FDG-Positive Lymph Nodes Detected by PET/CT for Pre-Treatment Evaluation of Locally Advanced Gastric Cancer

<div><p>Objectives</p><p>The aim of this study was to investigate the predictive value of the numbers of metabolically positive lymph nodes (MPLN) detected by <sup>18</sup>F-fluorodeoxyglucose (<sup>18</sup>F-FDG) positron emission tomography (PET)/computed tomography (CT) in patients with locally advanced gastric cancer (LAGC).</p><p>Methods</p><p>We retrospectively analyzed the records of 50 patients with LAGC (stage T2-T4) who had undergone pre-operative PET/CT examination and laparotomy (total gastrectomy, n = 11; subtotal gastrectomy, n = 13; distal gastrectomy, n = 22; and bypass with gastrojejunstomy, n = 4). The numbers of MPLN were determined by combining visual observations with semi-quantitative measurements of the maximized standardized uptake value (SUV<sub>max</sub>). Performance was investigated in terms of predicting post-surgical overall survival (OS).</p><p>Results</p><p>The median post-surgical OS was 32.57 months (range 3.0-94 months). The numbers of MPLN were moderately correlated with the numbers of histological positive LN (r = 0.694, p = 0.001). In univariate analyses, the numbers of MPLN (≤ 2 <i>vs</i>. ≥3), PET/CT LN (positivity <i>vs</i>. negativity), SUV<sub>max</sub> of LN (< 2.8 <i>vs</i>. ≥ 2.8), TNM stage (I, II <i>vs</i>. III, IV), and surgery type (R0 <i>vs</i>. non-R0) were significantly associated with OS. In multivariate analysis, surgery type (R0 vs. non-R0) and numbers of MPLN (≤ 2 vs. ≥ 3) were both independent factors for poor OS.</p><p>Conclusions</p><p>This explored study indicates that the number of MPLN could provide additional information for LAGC prognosis. Patients with MPLNs ≥ 3 may be at the risk of the more bad outcomes, and the further clinical trials are needed.</p></div>