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

Objectives The aim of this study was to investigate the predictive value of the numbers of metabolically positive lymph nodes (MPLN) detected by F-18-fluorodeoxyglucose (F-18-FDG) positron emission tomography (PET)/computed tomography (CT) in patients with locally advanced gastric cancer (LAGC). Methods 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 semiquantitative measurements of the maximized standardized uptake value (SUVmax). Performance was investigated in terms of predicting post-surgical overall survival (OS). Results 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 vs. >= 3), PET/CT LN (positivity vs. negativity), SUVmax of LN (< 2.8 vs. >= 2.8), TNM stage (I, II vs. III, IV), and surgery type (R0 vs. 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. Conclusions 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.