FDG PET correlates weakly with HIF-1α expression in solid tumors: a meta-analysis

Background Hypoxia-inducible factor (HIF)-1 alpha plays a key role in hypoxic adaptation of tumor cells. Overexpression of HIF-1 alpha is associated with tumor aggressiveness and worse prognosis in several malignancies. Presumably, expression of HIF-1a may be reflected by positron emission tomography with 2-deoxy-2 [fluorine-18] fluoro-D-glucose (18F-FDG PET). There are inconsistent data about relationships between FDG PET and HIF-1 alpha. Purpose To provide evident data about associations between maximum standardized uptake value (SUVmax) and HIF-1 alpha expression in solid tumors. Material and Methods MEDLINE, SCOPUS, and EMBASE databases were screened for relationships between SUV and HIF-1 alpha up to August 2019. Overall, 21 studies with 1154 patients were identified. The following data were extracted from the literature: authors; year of publication; number of patients; and correlation coefficients. Results Correlation coefficients between SUV(max)and HIF-1 alpha were in the range of -0.51-0.71. The pooled correlation coefficient was 0.27 (95% confidence interval [CI] = 0.14-0.41). Furthermore, correlation coefficients for some tumor entities were calculated. For this sub-analysis, data for primary tumors with >2 reports were included. The calculated correlation coefficients in the analyzed subgroups were as follows: head and neck squamous cell carcinoma: rho = 0.25 (95% CI = 0.07-0.42); non-small lung cell cancer: rho = 0.27 (95% CI = -0.14-0.67); uterine cervical cancer: rho = -0.09 (95% CI = -0.89-0.71); thymic tumors: rho = 0.39 (95% CI = 0.04-0.58). Conclusion SUV(max)of FDG PET correlated weakly with expression of HIF-1 alpha both in overall sample and tumor subgroups. Therefore, FDG PET cannot be used for prediction of hypoxia in clinical practice.

Automated summary

The study aimed to provide clear data about the associations between maximum standardized uptake value (SUVmax) and HIF-1 alpha expression in solid tumors. The results showed a weak correlation between SUVmax of FDG PET and HIF-1 alpha in both overall sample and tumor subgroups.