Editorial
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 14, 2017; 23(38): 6923-6926
Published online Oct 14, 2017. doi: 10.3748/wjg.v23.i38.6923
Evolving role of FDG-PET/CT in prognostic evaluation of resectable gastric cancer
Emilio De Raffele, Mariateresa Mirarchi, Dajana Cuicchi, Ferdinando Lecce, Bruno Cola
Emilio De Raffele, Dajana Cuicchi, Ferdinando Lecce, Bruno Cola, Unità Operativa di Chirurgia Generale, Dipartimento dell’Apparato Digerente, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, 40138 Bologna, Italy
Mariateresa Mirarchi, U.O. di Chirurgia Generale, Dipartimento Strutturale Chirurgico, Ospedale “SS Antonio e Margherita”, 15057 Tortona, Italy
Author contributions: De Raffele E conceived of and designed the study, and wrote the manuscript; De Raffele E, Mirarchi M, Cuicchi D and Lecce F contributed to acquisition, analysis and interpretation of data; Cola B made critical revisions on and provided final approval of the paper.
Conflict-of-interest statement: None of the authors have any conflict of interest related to this publication.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Emilio De Raffele, MD, PhD, Unità Operativa di Chirurgia Generale, Dipartimento dell’Apparato Digerente, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Via Massarenti 9, 40138 Bologna, Italy. e.deraffele@aosp.bo.it
Telephone: +39-51-6364235 Fax: +39-51-6363412
Received: July 4, 2017
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
Abstract

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.

Keywords: Gastric cancer, Prognosis, 18F-fluorodeoxyglucose, Positron emission tomography-computed tomography, Bone marrow

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.