Prognostic Value of Intratumor Metabolic Heterogeneity Parameters on (18)F-FDG PET/CT for Patients with Colorectal Cancer

PURPOSE: Intratumor metabolic heterogeneity parameters on (18)F-2-fluoro-2-deoxy-D-glucose ((18)F-FDG) positron emission tomography-computed tomography (PET-CT) have been proven to be predictors of the clinical prognosis of cancer patients. The study aimed to examine the correlation between (18)F-FDG PET-CT-defined heterogeneity parameters and the prognostic significance in patients with colorectal cancer. METHODS: The study included 188 patients with colorectal cancer who received surgery and (18)F-FDG PET/CT examinations. Preoperative (18)F-FDG PET/CT conventional and metabolic heterogeneity parameters were collected, including maximum, peak, and mean standardized uptake value (SUVmax, SUVpeak, and SUVmean), metabolic tumor volume (MTV), total lesion glycolysis (TLG), heterogeneity index-1 (HI-1) and heterogeneity index-2 (HI-2), and clinicopathological information. Correlations between these parameters and patient survival outcomes were inferred. RESULTS: The associations between (18)F-FDG PET/CT parameters and clinical outcomes were analyzed. Tumor thrombus (P < 0.001), tumor stage (P=0.001), MTV (P=0.003), HI-1 (P=0.032), and HI-2 (P=0.001) differed between the two groups with and without recurrence. Multivariate analysis showed that, in the radical surgery group, HI-2 (HR = 1.10, 95% CI: 1.04–1.17, P=0.001), tumor stage (HR = 20.65, 95% CI: 4.81–88.62, P < 0.001), and regional lymph nodes status (HR = 0.16, 95% CI: 0.04–0.57, P=0.005) were independent variables significantly correlated with progression-free survival (PFS) and HI-2 (HR = 1.16, 95% CI: 1.07–1.26, P < 0.001) was an independent variable affecting overall survival (OS). In the palliative surgery group, HI-2 (HR = 1.03, 95% CI: 1.01–1.06, P=0.020) was an independent variable affecting PFS, and all the parameters were not statistically significant for OS. CONCLUSION: HI-2, tumor stage, and regional lymph nodes status might predict the outcomes of colorectal cancer more effectively than other (18)F-FDG PET/CT defined parameters.