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Dani KA, Rich JM, Kumar SS, Cen H, Duddalwar VA, D’Souza A. Comprehensive Systematic Review of Biomarkers in Metastatic Renal Cell Carcinoma: Predictors, Prognostics, and Therapeutic Monitoring. Cancers (Basel) 2023; 15:4934. [PMID: 37894301 PMCID: PMC10605584 DOI: 10.3390/cancers15204934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 09/30/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Challenges remain in determining the most effective treatment strategies and identifying patients who would benefit from adjuvant or neoadjuvant therapy in renal cell carcinoma. The objective of this review is to provide a comprehensive overview of biomarkers in metastatic renal cell carcinoma (mRCC) and their utility in prediction of treatment response, prognosis, and therapeutic monitoring in patients receiving systemic therapy for metastatic disease. METHODS A systematic literature search was conducted using the PubMed database for relevant studies published between January 2017 and December 2022. The search focused on biomarkers associated with mRCC and their relationship to immune checkpoint inhibitors, targeted therapy, and VEGF inhibitors in the adjuvant, neoadjuvant, and metastatic settings. RESULTS The review identified various biomarkers with predictive, prognostic, and therapeutic monitoring potential in mRCC. The review also discussed the challenges associated with anti-angiogenic and immune-checkpoint monotherapy trials and highlighted the need for personalized therapy based on molecular signatures. CONCLUSION This comprehensive review provides valuable insights into the landscape of biomarkers in mRCC and their potential applications in prediction of treatment response, prognosis, and therapeutic monitoring. The findings underscore the importance of incorporating biomarker assessment into clinical practice to guide treatment decisions and improve patient outcomes in mRCC.
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Affiliation(s)
- Komal A. Dani
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA;
| | - Joseph M. Rich
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA;
| | - Sean S. Kumar
- Eastern Virginia Medical School, Norfolk, VA 23507, USA;
- Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033, USA
| | - Harmony Cen
- University of Southern California, Los Angeles, CA 90033, USA;
| | - Vinay A. Duddalwar
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA;
- Institute of Urology, University of Southern California, Los Angeles, CA 90033, USA
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA 90089, USA
| | - Anishka D’Souza
- Department of Medical Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033, USA
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Gasparro D, Scarlattei M, Silini EM, Migliari S, Baldari G, Cervati V, Graziani T, Campanini N, Maestroni U, Ruffini L. High Prognostic Value of 68Ga-PSMA PET/CT in Renal Cell Carcinoma and Association with PSMA Expression Assessed by Immunohistochemistry. Diagnostics (Basel) 2023; 13:3082. [PMID: 37835825 PMCID: PMC10572927 DOI: 10.3390/diagnostics13193082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/05/2023] [Accepted: 09/23/2023] [Indexed: 10/15/2023] Open
Abstract
In oligo-metastatic renal cell carcinoma (RCC), neither computed tomography (CT) nor bone scan is sensitive enough to detect small tumor deposits hampering early treatment and potential cure. Prostate-specific membrane antigen (PSMA) is a transmembrane glycoprotein expressed in the neo-vasculature of numerous malignant neoplasms, including RCC, that can be targeted by positron emission tomography (PET) using PSMA-targeting radioligands. Our aim was to investigate whether PSMA-expression patterns of renal cancer in the primary tumor or metastatic lesions on immunohistochemistry (IHC) are associated with PET/CT findings using [68Ga]-PSMA-HBED-CC (PSMA-PET/CT). We then analyzed the predictive and prognostic role of the PSMA-PET/CT signal. In this retrospective single-center study we included patients with renal cancer submitted to PSMA-PET/CT for staging or restaging, with tumor specimens available for PSMA-IHC. Clinical information (age, tumor type, and grade) and IHC results from the primary tumor or metastases were collected. The intensity of PSMA expression at IHC was scored into four categories: 0: none; 1: weak; 2: moderate; 3: strong. PSMA expression was also graded according to the proportion of vessels involved (PSMA%) into four categories: 0: none; 1: 1-25%; 2: 25-50%; 3: >50%. The intensity of PSMA expression and PSMA% were combined in a three-grade score: 0-2 absent or mildly positive, 3-4 moderately positive, and 5-6 strongly positive. PSMA scores were used for correlation with PSMA-PET/CT results. Results: IHC and PET scans were available for the analysis in 26 patients (22 ccRCC, 2 papillary RCC, 1 chromophobe, 1 "not otherwise specified" RCC). PSMA-PET/CT was positive in 17 (65%) and negative in 9 patients (35%). The mean and median SUVmax in the target lesion were 34.1 and 24.9, respectively. Reporter agreement was very high for both distant metastasis location and local recurrence (kappa 1, 100%). PSMA-PET detected more lesions than conventional imaging and revealed unknown metastases in 4 patients. Bone involvement, extension, and lesion number were greater than in the CT scan (median lesion number on PET/CT 3.5). The IHC PSMA score was concordant in primary tumors and metastases. All positive PSMA-PET/CT results (15/22 ccRCC, 1 papillary cancer type II, and 1 chromofobe type) were revealed in tumors with strong or moderate PSMA combined scores (3-4 and 5-6). In ccRCC tissue samples, PSMA expression was strong to moderate in 20/22 cases. The SUVmax values correlated to the intensity of PSMA expression which were assessed using IHC (p = 0.01), especially in the ccRCC subgroup (p = 0.009). Median survival was significantly higher in patients with negative PSMA-PET/CT (48 months) compared to patients with a positive scan (24 months, p= 0.001). SUVmax ≥ 7.4 provides discrimination of patients with a poor prognosis. Results of PSMA-PET/CT changed treatment planning. Conclusions: in renal cancer, positive PSMA-PET/CT is strongly correlated to the intensity of PSMA expression on immunohistochemistry in both ccRCC and chromophobe cancer. PSMA-PET/CT signal predicts a poor prognosis confirming its potential as an aggressiveness biomarker and providing paramount additional information influencing patient management.
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Affiliation(s)
- Donatello Gasparro
- Oncology Division, Azienda Ospedaliero-Universitaria di Parma, 43126 Parma, Italy;
| | - Maura Scarlattei
- Nuclear Medicine Division, Azienda Ospedaliero-Universitaria di Parma, 43126 Parma, Italy; (M.S.); (G.B.); (V.C.); (T.G.); (L.R.)
| | - Enrico Maria Silini
- Pathology Division, Azienda Ospedaliero-Universitaria di Parma, 43126 Parma, Italy; (E.M.S.); (N.C.)
- Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
| | - Silvia Migliari
- Nuclear Medicine Division, Azienda Ospedaliero-Universitaria di Parma, 43126 Parma, Italy; (M.S.); (G.B.); (V.C.); (T.G.); (L.R.)
| | - Giorgio Baldari
- Nuclear Medicine Division, Azienda Ospedaliero-Universitaria di Parma, 43126 Parma, Italy; (M.S.); (G.B.); (V.C.); (T.G.); (L.R.)
| | - Veronica Cervati
- Nuclear Medicine Division, Azienda Ospedaliero-Universitaria di Parma, 43126 Parma, Italy; (M.S.); (G.B.); (V.C.); (T.G.); (L.R.)
| | - Tiziano Graziani
- Nuclear Medicine Division, Azienda Ospedaliero-Universitaria di Parma, 43126 Parma, Italy; (M.S.); (G.B.); (V.C.); (T.G.); (L.R.)
| | - Nicoletta Campanini
- Pathology Division, Azienda Ospedaliero-Universitaria di Parma, 43126 Parma, Italy; (E.M.S.); (N.C.)
- Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
| | - Umberto Maestroni
- Urology Division, Azienda Ospedaliero-Universitaria di Parma, 43126 Parma, Italy;
| | - Livia Ruffini
- Nuclear Medicine Division, Azienda Ospedaliero-Universitaria di Parma, 43126 Parma, Italy; (M.S.); (G.B.); (V.C.); (T.G.); (L.R.)
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Toguchi M, Ishigami K, Goya M, Saito S, Murayama S, Nishie A. Efficacy of Pre-operative 18F-FDG PET/CT in Prognostic Prediction in Patients With Renal Cell Carcinoma. CANCER DIAGNOSIS & PROGNOSIS 2022; 2:216-222. [PMID: 35399179 PMCID: PMC8962815 DOI: 10.21873/cdp.10097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 01/31/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND/AIM This study analyzed the parameters provided by preoperative 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for prognostic prediction of renal cell carcinoma (RCC). PATIENTS AND METHODS FDG-PET/CT data from 66 clear cell RCC and 19 non-clear cell RCC cases between January 2015 and October 2018 were reviewed retrospectively. We compared the two groups according to recurrence/metastasis to determine prognosis-influencing factors. Multivariate Cox hazard regression models were constructed to evaluate factors potentially predicting disease-free survival (DFS) after adjustment for confounders. DFS was then compared between groups. RESULTS Standardized uptake values (SUV) of the PET/CT scan were independent predictors of prognosis after adjusting for confounders. RCC cases were divided into two groups by optimal cut-off values. Differences between DFS percentages in high and low SUV groups were significant. Similar results were obtained in clear cell RCC groups. CONCLUSION Increased SUV of the PET/CT scan are significant predictors of worse prognoses in patients with surgically resected RCC.
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Affiliation(s)
- Masafumi Toguchi
- Department of Radiology, Miyako Prefectural Hospital, Okinawa, Japan
| | - Kousei Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masato Goya
- Graduate School of Medical Science, University of the Ryukyus, Department of Urology, Okinawa, Japan
| | - Seiichi Saito
- Graduate School of Medical Science, University of the Ryukyus, Department of Urology, Okinawa, Japan
| | | | - Akihiro Nishie
- Graduate School of Medical Science, University of the Ryukyus, Department of Radiology, Okinawa, Japan
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Gasparro D, Scarlattei M, Manuguerra R, Guglielmo P, Migliari S, Sammartano A, Baldari G, Maestroni U, Silini EM, Ruffini L. 18F-FDG and 68GA-Prostate-Specific Membrane Antigen PET/CT Perform Better Than CT Alone in Restaging Papillary Renal Cell Carcinoma Recurrence. Clin Nucl Med 2021; 46:e458-e460. [PMID: 34374683 DOI: 10.1097/rlu.0000000000003660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ABSTRACT Renal cell carcinoma (RCC) shows variable FDG uptake; recently, PET/CT with prostate-specific membrane antigen (PSMA)-target radiotracers was demonstrated to be a promising tool in staging and restaging of RCC patients. We describe the case of a 77-year-old man with a lung metastasis of papillary RCC missed by CT scan who successfully underwent [18F]FDG PET/CT restaging. Targeted therapy with sunitinib was administered. A [68Ga]PSMA PET/CT performed during follow-up demonstrated, among the already known lesions, also a bone marrow metastasis, missed by previous CT scans. This case demonstrates that PET/CT molecular imaging with [18F]FDG and [68Ga]PSMA is superior to conventional imaging in RCC restaging and in assessing therapy response.
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Affiliation(s)
| | | | | | | | | | | | | | - Umberto Maestroni
- Urology Division, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
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Zhou Y, Yang X, Liu H, Luo W, Liu H, Lv T, Wang J, Qin J, Ou S, Chen Y. Value of [ 68Ga]Ga-FAPI-04 imaging in the diagnosis of renal fibrosis. Eur J Nucl Med Mol Imaging 2021; 48:3493-3501. [PMID: 33829416 DOI: 10.1007/s00259-021-05343-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/25/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE Renal fibrosis is a pathological state in the progression of chronic kidney disease. Early detection and treatment are vital to prolonging patient survival. Renal puncture examination is the gold standard for renal fibrosis, but it has several limitations. This study aims to evaluate the diagnostic performance of a novel PET radiotracer, [68Ga]Ga-fibroblast activation protein inhibitor (FAPI)-04, which specifically images fibroblast activation protein (FAP) expression for renal fibrosis. METHODS All patients underwent renal puncture before receiving [68Ga]Ga-FAPI-04 PET/CT imaging. They then underwent [68Ga]Ga-FAPI-04 PET/CT and immunochemistry examinations. The data obtained were analyzed. RESULTS The [68Ga]Ga-FAPI-04 PET/CT examination results demonstrated that almost all patients (12/13) exhibited increased radiotracer uptake. The maximum standardized uptake value (SUVmax) in patients with mild, moderate, and severe fibrosis was 3.92 ± 1.50, 5.98 ± 1.6, and 7.67 ± 2.23, respectively. CONCLUSION Compared with renal puncture examination, non-invasive imaging of FAP expression through [68Ga]Ga-FAPI-04 PET/CT quickly demonstrates bilateral kidney conditions with high sensitivity. [68Ga]Ga-FAPI-04 PET/CT can facilitate the evaluation of disease progression, diagnosis, and the development of a treatment plan.
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Affiliation(s)
- Yue Zhou
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District, Luzhou, Sichuan, 646000, People's Republic of China
- Academician (Expert) Workstation of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China, 646000
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China, 646000
| | - Xin Yang
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District. No 25 TaiPing St, Jiangyang District, Luzhou, Sichuan, 646000, People's Republic of China
- Sichuan Clinical Research Center for Nephropathy, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China, 646000
| | - Huipan Liu
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District, Luzhou, Sichuan, 646000, People's Republic of China
- Academician (Expert) Workstation of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China, 646000
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China, 646000
| | - Wenbin Luo
- Department of Cardiology, Daping Hospital of The Third Military Medical University, Chongqing, People's Republic of China, 400042
| | - Hanxiang Liu
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District, Luzhou, Sichuan, 646000, People's Republic of China
- Academician (Expert) Workstation of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China, 646000
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China, 646000
| | - Taiyong Lv
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District, Luzhou, Sichuan, 646000, People's Republic of China
- Academician (Expert) Workstation of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China, 646000
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China, 646000
| | - Junzheng Wang
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District, Luzhou, Sichuan, 646000, People's Republic of China
- Academician (Expert) Workstation of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China, 646000
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China, 646000
| | - Jianhua Qin
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District. No 25 TaiPing St, Jiangyang District, Luzhou, Sichuan, 646000, People's Republic of China
- Sichuan Clinical Research Center for Nephropathy, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China, 646000
| | - Santao Ou
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District. No 25 TaiPing St, Jiangyang District, Luzhou, Sichuan, 646000, People's Republic of China
- Sichuan Clinical Research Center for Nephropathy, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China, 646000
| | - Yue Chen
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District, Luzhou, Sichuan, 646000, People's Republic of China.
- Academician (Expert) Workstation of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China, 646000.
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China, 646000.
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Wu C, Cui Y, Zhao Y, Chen X, Liao X, Di L, Yin L, Liu M, Wang R. Elevated tumor-to-liver standardized uptake value ratio (TLR) from preoperative 18F-FDG PET/CT predicts poor prognosis of patients with clear cell renal cell carcinoma after nephrectomy. Eur J Radiol 2020; 131:109218. [PMID: 32882538 DOI: 10.1016/j.ejrad.2020.109218] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/20/2020] [Accepted: 08/05/2020] [Indexed: 01/22/2023]
Abstract
AIM To assess the potential of using preoperative 18F-FDG PET/CT to predict the prognosis of patients with clear cell renal cell carcinoma (ccRCC) after nephrectomy. METHODS Sixty-nine patients with newly diagnosed ccRCC who underwent 18F-FDG PET/CT prior to surgery were retrospectively reviewed. The metabolic parameters of maximum standardized uptake value (SUVmax) and tumor-to-liver ratio (TLR) from 18F-FDG PET/CT were obtained. Clinicopathological characteristics, including the World Health Organization/the International Society of Urological Pathology (WHO/ISUP) grade, pathological tumor node metastasis (pTNM) stage, venous tumor thrombus, and so on, were acquired. Univariate and multivariate Cox proportional hazards analyses were performed to identify the prognostic factors for disease-free survival (DFS). RESULTS Of the 69 patients, 25 patients (36.2%) experienced disease progression during the follow-up period. In univariate analysis, the primary tumor size (>4.85 cm), pTNM stage (Ⅲ/Ⅳ), WHO/ISUP grade (G3/4), venous tumor thrombus, adjuvant therapy, SUVmax (>3.55), and TLR (>1.66) were found to correlate with the incidence of decreased DFS (P < 0.05). In multivariate analysis, TLR (P = 0.007, HR: 5.489, 95%CI: 1.605-18.774) and pTNM stage (P = 0.024, HR: 10.385, 95%CI: 1.361-79.238) were revealed to serve as independent prognostic predictors for DFS after adjustment for other variables. Only 3 cases (8.3%) with normal TLR showed disease progression, while 22 cases (66.7%) with elevated TLR experienced disease progression. CONCLUSION ccRCC patients with preoperatively elevated TLR (>1.66) and high pTNM stages (Ⅲ/Ⅳ) had significantly unfavorable survival outcomes. These patients should be carefully monitored to detect the possibility of disease progression after nephrectomy as early as possible.
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Affiliation(s)
- Caixia Wu
- Department of Nuclear Medicine, Peking University First Hospital, No.8, Xishiku St., West District, Beijing, 100034, China
| | - Yonggang Cui
- Department of Nuclear Medicine, Peking University First Hospital, No.8, Xishiku St., West District, Beijing, 100034, China
| | - Yanyan Zhao
- Department of Nuclear Medicine, Peking University First Hospital, No.8, Xishiku St., West District, Beijing, 100034, China
| | - Xueqi Chen
- Department of Nuclear Medicine, Peking University First Hospital, No.8, Xishiku St., West District, Beijing, 100034, China
| | - Xuhe Liao
- Department of Nuclear Medicine, Peking University First Hospital, No.8, Xishiku St., West District, Beijing, 100034, China
| | - Lijuan Di
- Department of Nuclear Medicine, Peking University First Hospital, No.8, Xishiku St., West District, Beijing, 100034, China
| | - Lei Yin
- Department of Nuclear Medicine, Peking University First Hospital, No.8, Xishiku St., West District, Beijing, 100034, China
| | - Meng Liu
- Department of Nuclear Medicine, Peking University First Hospital, No.8, Xishiku St., West District, Beijing, 100034, China.
| | - Rongfu Wang
- Department of Nuclear Medicine, Peking University First Hospital, No.8, Xishiku St., West District, Beijing, 100034, China.
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Xuan D, Wen W, Tian S, Piao M, Xu D, Liu L. Prognostic value of maximum standard uptake value, metabolic tumor volume, and total lesion glycolysis of 18F-FDG PET/CT in patients with renal carcinoma: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2020; 99:e19988. [PMID: 32443301 PMCID: PMC7254885 DOI: 10.1097/md.0000000000019988] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/18/2020] [Accepted: 03/23/2020] [Indexed: 01/20/2023] Open
Abstract
PURPOSE We present a comprehensive systematic review of the documented literature on parameters derived from F-fluorodeoxyglucose positron emission tomography (F-FDG PET) and meta-analysis of the prognostic value of maximal standard uptake value (SUVmax), metabolic tumor volume (MTV) and total lesional glycolysis (TLG) in patients with renal carcinoma (RCC). PATIENTS AND METHODS Relevant articles in English from PubMed, EMBASE, and the Cochrane Library were retrieved. Pooled hazard ratio (HR) values were used to assess the prognostic value of SUVmax, MTV, and TLG. RESULTS A total of 10 primary studies involving 780 patients with RCC were included. The combined HRs for event-free survival were 1.32 (95% CI 1.10-1.58) for SUVmax, 2.40 (95% CI 1.20-4.79) for MTV, and 3.31 (95% CI 1.68-6.50) for TLG. Pooled HRs for overall survival were 1.264 (95% CI 1.124-1.421) for SUVmax, 3.52 (95% CI 1.451-8.536) for MTV, and 6.33 (95% CI 1.32-30.30) for TLG. Subgroup analysis revealed SUVmax as an independent risk factor for patients with recurrence or metastasis. CONCLUSION The present meta-analysis confirmed that despite the clinical heterogeneity of RCC and adoption of various methods between studies, high SUVmax is a significant prognostic factor, especially in patients with recurrence or metastasis. MTV and TLG were associated with prediction of higher risk of adverse events or death in patients with RCC.
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Affiliation(s)
- Dongchun Xuan
- Center of Morphological Experiment, Medical College of Yanbian University
- Department of Nuclear Medicine
| | - Weibo Wen
- Center of Morphological Experiment, Medical College of Yanbian University
- Department of Nuclear Medicine
| | | | | | - Dongyuan Xu
- Center of Morphological Experiment, Medical College of Yanbian University
| | - Lan Liu
- Department of Pathology, Yanbian University hospital, Yanji, Jilin Province, China
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Abstract
PURPOSE OF REVIEW Worldwide, over 400 000 new cases of kidney cancer were diagnosed and over 175 000 deaths anticipated in 2018. It is ranked as the 14th most common cancer in women and 9th most common in men. Imaging is important for initial detection, staging, and monitoring to assist treatment planning, but conventional anatomic imaging is limited. Although functional PET/CT has proven helpful in the diagnosis and management of many cancers, its value in renal cell carcinoma (RCC) is still in evolution. RECENT FINDINGS FDG is probably the most useful radiotracer in RCC, although CAIX imaging can be helpful in clear cell RCC. Current research on PET imaging agents in RCC including 89Zr bevacizumab, 89Zr geruntuximab, 18F fluoro-L-thymidine (FLT), prostate-specific membrane antigen (PSMA), 11C choline, 18F sodium fluoride (NaF), and18F fluorodeoxyglucose (FDG) have shown some interesting results for detection and prognosis of the disease. SUMMARY Many innovative radiotracers have been tested in RCC, but robust differentiation of primary disease from normal parenchyma remains elusive for almost all of them. The metastatic setting and response to therapy for this cancer are more favorable PET applications. Continued research in promising molecular tracers will hopefully advance both diagnostic and therapeutic strategies to ultimately eradicate RCC.
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Abstract
PURPOSE OF REVIEW The clinical role of fluorine-18 fluoro-2-deoxyglucose (FDG)-positron emission tomography (PET) in renal cell carcinoma (RCC) is still evolving. Use of FDG PET in RCC is currently not a standard investigation in the diagnosis and staging of RCC due to its renal excretion. This review focuses on the clinical role and current status of FDG PET and PET/CT in RCC. RECENT FINDINGS Studies investigating the role of FDG PET in localized RCC were largely disappointing. Several studies have demonstrated that the use of hybrid imaging PET/CT is feasible in evaluating the extra-renal disease. A current review of the literature determines PET/CT to be a valuable tool both in treatment decision-making and monitoring and in predicting the survival in recurrent and metastatic RCC. PET/CT might be a viable option in the evaluation of RCC, especially recurrent and metastatic disease. PET/CT has also shown to play a role in predicting survival and monitoring therapy response.
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