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Prognostic Aspects of ¹⁸F-FDG PET Kinetics in Patients with Metastatic Colorectal Carcinoma Receiving FOLFOX Chemotherapy

¹ Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Heidelberg, Germany
² Department of Nuclear Medicine, University of Zürich, Zürich, Switzerland
³ Department of Human Biology, University of Munich, Munich, Germany
⁴ Department of Internal Medicine IV, University of Heidelberg, Heidelberg, Germany
⁵ Department of Internal Medicine, Theresien Krankenhaus and St. Hedwig Klinik GmbH, University of Heidelberg, Mannheim, Germany

We evaluated quantitative measurement series (MS) with ¹⁸F-FDG and PET and compared different quantification methods for prediction of individual survival in patients with metastatic colorectal cancer receiving chemotherapy with 5-fluorouracil, folinic acid, and oxaliplatin (FOLFOX). Methods: The study comprised 25 patients. All patients were examined before the onset of FOLFOX therapy and after completion of the first and fourth cycles. SUV, fractal dimension (FD), a 2-compartment model with computation of k1, k2, k3, and k4, and vascular fraction (VB) were used for data evaluation. Survival data served as a reference for the PET data. Discriminant analysis (DA), regression, and best-subset analysis were applied to the data. Results: Twenty of 25 patients died up to 801 d after the first PET study. A cutoff of 1 y (364 d) was used to classify the patients into 2 a priori groups, namely the short- and long-term survival groups. DA was used to predict the 2 categories using SUV and kinetic parameters of ¹⁸F-FDG metabolism as predictor variables. SUV provided a correct classification rate (CCR) ranging from 62% to 69%. SUV of the third MS resulted in a CCR of 69% as a single parameter. The best results were yielded by the use of kinetic parameters (k1, k3, VB, and FD) as predictor variables. CCR was 78% using kinetic ¹⁸F-FDG parameters of the first and third MS, in comparison with 69% for the corresponding SUVs. A multiple linear regression model was applied to the data to assess the relationship between individual survival and the PET data. The best-subset method revealed a correlation coefficient of 0.850 for the kinetic parameters of the first (k3, k4, VB, and FD) and third (k1, k2, k4, and VB) MS. Conclusion: The combination of kinetic parameters of the first and the third MS is acceptable for classification into a short or long survival class. Furthermore, even an individual prognosis of survival can be achieved using kinetic ¹⁸F-FDG parameters of the first and third MS.

Key Words: ¹⁸F-FDG • colorectal tumor • survival

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