The application value of preoperative F-FDG PET/CT in preoperative localized clear cell renal cell carcinoma

Abstract

Aim: In cancer tissues, glycolysis metabolism is often heightened, making 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) useful for assessing glucose metabolism. However, the kidneys' high glucose metabolism makes it difficult to distinguish between normal renal tissue and renal cancer. This study aims to evaluate the maximum standardized uptake value (SUVmax) in renal cancer using PET/CT and determine its relationship to prognosis.

Methods: We also aim to examine the correlation between SUVmax and clinical parameters and its potential link to prognosis. We enrolled 105 patients who underwent FDG-PET/CT between March 2012 and October 2017. These patients, diagnosed with localized renal cell carcinoma (RCC), underwent surgery and were pathologically confirmed to have clear cell RCC (ccRCC). We investigated the impact of SUVmax and other parameters on recurrence.

Results: SUVmax and C-reactive protein (CRP) were associated with tumor progression, alongside stage, nuclear grade, microvascular invasion [v(+)], and tumor-infiltrating lymphocytes (TILs). Multivariate analysis with recurrence-free survival (RFS) as the endpoint indicated significant results (SUVmax ≥ 3.7: relative risk 10.21, P < 0.01; CRP ≥ 0.11 mg/dL: relative risk 7.73, P < 0.01, n = 89). In survival curve analysis with RFS, high SUVmax or elevated CRP predicted poor prognosis, with further worsening when v(+) was added.

Conclusion: SUVmax is a strong prognostic factor for poor outcomes. CRP is also a prognostic factor, though it should be interpreted cautiously, as CRP reflects overall systemic conditions and may not exclusively represent renal cancer activity. Further research into pre-treatment RCC prognosis prediction is anticipated.

Keywords

Renal cell carcinoma / positron emission tomography/computed tomography / maximum standardized uptake value / CRP / microvascular invasion

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