Published online Oct 14, 2017. doi: 10.3748/wjg.v23.i38.6923
Peer-review started: July 5, 2017
First decision: July 28, 2017
Revised: August 28, 2017
Accepted: September 19, 2017
Article in press: September 19, 2017
Published online: October 14, 2017
Gastric cancer (GC) remains a leading cause of cancer death worldwide. Radical gastrectomy is the only potentially curative treatment, and perioperative adjuvant therapies may improve the prognosis after curative resection. Prognosis largely depends on the tumour stage and histology, but the host systemic inflammatory response (SIR) to GC may contribute as well, as has been determined for other malignancies. In GC patients, the potential utility of positron emission tomography/computed tomography (PET/CT) with the imaging radiopharmaceutical 18F-fluorodeoxyglucose (FDG) is still debated, due to its lower sensitivity in diagnosing and staging GC compared to other imaging modalities. There is, however, growing evidence that FDG uptake in the primary tumour and regional lymph nodes may be efficient for predicting prognosis of resected patients and for monitoring tumour response to perioperative treatments, having prognostic value in that it can change therapeutic strategies. Moreover, FDG uptake in bone marrow seems to be significantly associated with SIR to GC and to represent an efficient prognostic factor after curative surgery. In conclusion, PET/CT technology is efficient in GC patients, since it is useful to integrate other imaging modalities in staging tumours and may have prognostic value that can change therapeutic strategies. With ongoing improvements, PET/CT imaging may gain further importance in the management of GC patients.
Core tip: Gastric cancer (GC) is still a leading cause of cancer death worldwide. Prognosis depends on surgical curability, response to adjuvant therapies, tumour stage and histology, but also on the systemic inflammatory response to malignancy. While the diagnostic role of positron emission tomography with 18F-fluorodeoxyglucose (FDG) in GC is still debated, due to unsatisfactory sensitivity, there is growing evidence that FDG uptake, either at the tumour sites or in the bone marrow, may represent an efficient tool for predicting prognosis of resected patients and for monitoring tumour response to adjuvant treatments, and may have prognostic value in directing therapeutic strategies.