Fructose 1,6-Bisphosphatase 1 Expression Reduces (18)F-FDG Uptake in Clear Cell Renal Cell Carcinoma

PURPOSE: To determine the relationship between fructose 1,6-bisphosphatase 1 (FBP1) expression and fluorine 18 ((18)F) fluorodeoxyglucose (FDG) uptake in patients with clear cell renal cell carcinoma (ccRCC), and to investigate how (18)F-FDG uptake and FBP1 expression are related to tumor metabolism and tumor differentiation grade. MATERIALS AND METHODS: A total of 54 patients with ccRCC underwent (18)F-FDG combined positron emission tomography and computed tomography (PET/CT) before tumor resection. The maximum standardized uptake value (SUVmax) for the primary tumor was calculated from the (18)F-FDG uptake. The relationship between SUVmax of primary tumor and the expression of FBP1, hexokinase 2 (HK2), and glucose transporter 1 (GLUT1) was analyzed via immunohistochemical analysis. RESULTS: We identified an inverse relationship between FBP1 expression and SUVmax (P=0.031). SUVmax was higher in patients with high-grade ccRCC (mean, 11.6 ± 5.0) than in those with low-grade ccRCC (mean, 3.8 ± 1.6, P < 0.001). FBP1 expression was significantly lower in patients with high-grade ccRCC (mean, 0.23 ± 0.1) than in those with low-grade ccRCC (mean, 0.57 ± 0.08; P=0.018). FBP1 status could be predicted with an accuracy of 66.7% when a SUVmax cutoff value of 3.55 was used. GLUT1 expression in ccRCC was positively correlated with (18)F-FDG uptake and FBP1 status, whereas HK2 expression was not. CONCLUSION: SUVmax in patients with ccRCC is inversely associated with the expression of FBP1, and FBP1 may inhibit (18)F-FDG uptake via regulating GLUT1. SUVmax is higher in patients with high-grade ccRCC than in those with low-grade ccRCC, which could be the result of lower FBP1 expression in patients with high-grade ccRCC.