Association of mismatch repair deficiency in endometrial cancer with 18F-FDG PET/CT and clinicopathological features and their prognostic value.

PURPOSE: Identification of the mismatch repair (MMR) deficiency in endometrial cancer (EC) may aid in the screening of patients who may benefit from immunotherapy. Our goal was to investigate the relationship between MMR status and 18F-FDG PET/CT metabolic parameters and clinicopathological features in patients with EC, as well as to explore their prognostic value. METHODS: This retrospective study included 106 EC patients who were classified as MMR deficient (dMMR) or MMR proficient (pMMR) group based on MMR protein expression status evaluated by immunohistochemistry. Clinicopathological characteristics and PET metabolic parameters were compared between the dMMR and pMMR groups, and their relationships with MMR status and prognosis were evaluated. RESULTS: Of 106 EC patients, 30 patients (28.1%) had dMMR, while 76 (71.7%) had pMMR. Compared with the pMMR group, the dMMR group showed a lower prevalence of overweight (BMI ≥ 25) (17.2% vs. 43.9%, P = 0.019) and more lymph vascular space invasion (43.3% vs. 21.1%, P = 0.029). Although no relationship between glucometabolism parameters and MMR status was observed in all enrolled patients, higher SUVmax was observed in the endometrioid type of EC with MMR deficiency (P = 0.047). Additionally, SUVmax related to MMR status was found in EC patients with advanced FIGO stage (P = 0.026) or deep myometrial invasion (P = 0.026). Multivariate Cox regression analysis revealed that lymph node metastasis was independently predictive of PFS, while advanced FIGO stage was an independent predictor of OS. No significant association between MMR status and prognosis was found in EC. CONCLUSION: Higher SUVmax was associated with MMR deficiency in EC patients with endometrioid type, advanced stage, or deep myometrial invasion, which may be useful for predicting the MMR status and thus aiding in determination of immunotherapy for patients with EC.

Usefulness of 18 F-FDG PET/computed tomography metabolic parameters in predicting sarcopenia and prognosis of treatment-naive patients with non-small cell lung cancer.

PURPOSE: Sarcopenia tremendously impacts the quality of life but remains debatable in prognostication in treatment-naive patients with non-small cell lung cancer (NSCLC). Hence, this study aimed to find a clinically feasible approach using 18 F-FDG PET/computed tomography (CT) imaging parameters and clinical characteristics to predict sarcopenia and determine independent prognostic factors. METHODS: Clinical characteristics and 18 F-FDG PET/CT metabolic parameters, including maximum standard uptake value, metabolic tumor volume, and total lesion glycolysis of primary tumor (SUVmax_P, MTV_P, and TLG_P) and combination of whole-body lesions (MTV_C and TLG_C) were collected in 344 treatment-naive patients with NSCLC. Skeletal muscle index at the third lumbar vertebra was calculated to determine sarcopenia. SUVmax of the psoas major muscle (SUVmax_M) was measured at the third lumbar vertebra as well. The diagnostic endpoint is the probability of sarcopenia, and the survival endpoints include progression-free survival (PFS) and overall survival (OS). RESULTS: Among 344 patients with NSCLC there were 271 patients with adenocarcinoma and 73 with squamous cell carcinoma (SCC). One hundred forty-seven patients (42.7%) were diagnosed with sarcopenia. Higher age, male, lower BMI, SCC, and lower SUVmax_M were correlated with a higher incidence of sarcopenia ( P < 0.05), while age, sex and SUVmax_M were independently predictive of sarcopenia. Multivariate Cox-regression analysis revealed that BMI, advanced stage and TLG_C were independent predictors of PFS and OS, while sex was independently predictive of OS. CONCLUSIONS: The incidence of sarcopenia increased with declining SUVmax of muscle. BMI, tumor stage, and TLG_C, but not sarcopenia, were found independently predictive of both PFS and OS.

Relationship between 18F-fluorodeoxyglucose PET/computed tomography metabolic parameters and clinicopathology in endometrial cancer.

OBJECTIVE: Endometrial cancer (EC) is the most common invasive gynecological malignancy. This study aimed to retrospectively analyze the relationship between 18F-fluorodeoxyglucose (18F-FDG) PET/computed tomography (CT) parameters and clinicopathological factors in EC patients, and assess whether 18F-FDG PET/CT can be applied for predicting the expressed status of histologic molecular markers. METHODS: Pretreatment clinicopathological characteristics and 18F-FDG PET/CT parameters of maximum standard uptake value (SUVmax), metabolic tumor volume and total lesion glycolysis of primary lesion (MTV-P and TLG-P), and combination of primary lesion and metastases (MTV-C and TLG-C) were retrospectively reviewed in 101 patients with EC. RESULTS: The median age of these 101 patients was 55 years (range, 35-85 years), and 95 patients (94.1%) presented with abnormal vaginal bleeding, 26 patients (25.7%) with elevated serum cancer antigen 125 (CA-125) and 46 patients (45.5%) with increased human epididymis protein 4 (HE4). Sixty-nine cases were at International Federation of Gynecology and Obstetrics (FIGO) stage I, eight at stage II, 20 at stage III, and four at stage IV. FDG uptake was avid in all cases, and the median SUVmax, MTV-P, TLG-P, MTV-C, and TLG-C were 12.9 (range, 2.8-34.2), 8.1 (range, 0.9-547.8), 52.2 (range, 2.5-4420.6), 8.2 (range, 0.9-790.3), and 58.4 (range, 2.5-6972.2), respectively. Estrogen receptor (ER) and progesterone receptor (PR) positive expressions were in 93.1% (94/101) and 90.1% (91/101) patients, respectively. The median Ki-67 index of 101 cases was 40% (range, 0-95%). P53 pattern was tested in 89 patients and 24 cases were mutant type (27.0%). Mesenchymal-epithelial transition factor (c-Met) expression was investigated in 86 patients, and the positivity was in 36 patients (41.9%). Higher PET/CT metabolic parameters were observed in patients with elevated CA-125 and HE4, advanced FIGO stage and higher Ki-67 index (P < 0.05), but had no association with ER/PR expression, P53 pattern, and c-Met expression (P > 0.05). CONCLUSION: FDG uptake in EC was associated with serum CA-125 and HE4, FIGO stage, and Ki-67 index, but no correlations were found between glucose metabolism and ER/PR, P53, and c-Met.