Preoperatively Treated Diffuse-Type Gastric Adenocarcinoma: Glucose vs. Other Energy Sources Substantially Influence Prognosis and Therapy Response.
Ahmed A AbdelhakeemXuemei WangRebecca E WatersMadhavi PatnanaJeannelyn S EstrellaMariela Blum MurphyAllison M TrailYang LuCatherine E DevineNaruhiko IkomaPrajnan DasBrian D BadgwellJane E RogersJaffer A AjaniPublished in: Cancers (2021)
Diffuse type of gastric adenocarcinoma (dGAC) generally confers a poor prognosis compared to intestinal type. Some dGACs are not avid on fluorine-18 fluoro-2-deoxy-D-glucose PET (FDG-PET) while others seem to consume glucose avidly. We analyzed the outcomes based on the avidity (high with standardized uptake value (SUV) > 3.5 or low with SUV ≤ 3.5) of the primary on baseline FDG-PET. We retrospectively selected 111 localized dGAC patients who had baseline FDG-PET (all were treated with preoperative chemotherapy and chemoradiation). FDG-PET avidity was compared with overall survival (OS) and response to therapy. The mean age was 59.4 years and with many females (47.7%). The high-SUV group (58 (52.3%) patients) and the low-SUV group (53 (47.7%) patients) were equally divided. While the median OS for all patients was 49.5 months (95% CI: 38.5-98.8 months), it was 98.0 months (95% CI: 49.5-NE months) for the low-SUV group and 36.0 months for the high-SUV (p = 0.003). While the median DFS for all patients was 38.2 months (95%CI: 27.7-97.6 months), it was 98.0 (95% CI: 36.9-NE months) months for the low-SUV group was and only 27.0 months (95% CI: 15.2-63.2 months) for the high-SUV group (p = 0.005). Clinical responses before surgery were more common in the low-SUV group but overall we observed only 4 pathologic complete responses in 111 patients. Our unique data suggest that if dGACs used glucose as an energy source then the prognosis was very poor while non-glucose sources improved prognosis. Multi-platform (including metabolomics) profiling of dGACs would yield useful biologic understanding.
Keyphrases
- end stage renal disease
- positron emission tomography
- chronic kidney disease
- newly diagnosed
- ejection fraction
- pet ct
- pet imaging
- computed tomography
- squamous cell carcinoma
- stem cells
- blood glucose
- peritoneal dialysis
- machine learning
- type diabetes
- coronary artery disease
- locally advanced
- radiation therapy
- blood pressure
- skeletal muscle
- percutaneous coronary intervention
- acute coronary syndrome
- bone marrow
- low grade
- neoadjuvant chemotherapy
- big data
- glycemic control
- high grade
- insulin resistance
- coronary artery bypass