18F-FDG PET/CT and urothelial carcinoma: Impact on management and prognosis—a multicenter retrospective study

Fabio Zattoni, Elena Incerti, Fabrizio Dal Moro, Marco Moschini, Paolo Castellucci, Stefano Panareo, Maria Picchio, Federico Fallanca, Alberto Briganti, Andrea Gallina, Stefano Fanti, Riccardo Schiavina, Eugenio Brunocilla, Ilaria Rambaldi, Val Lowe, Jeffrey R. Karnes, Laura Evangelista

Research output: Contribution to journalArticle

Abstract

Objectives: To evaluate the ability of18F-labeled fluoro-2-deoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) to predict survivorship of patients with bladder cancer (BC) and/or upper urinary tract carcinoma (UUTC). Materials: Data from patients who underwent FDG PET/CT for suspicion of recurrent urothelial carcinoma (UC) between 2007 and 2015 were retrospectively collected in a multicenter study. Disease management after the introduction of FDG PET/CT in the diagnostic algorithm was assessed in all patients. Kaplan-Meier and log-rank analysis were computed for survival assessment. A Cox regression analysis was used to identify predictors of recurrence and death, for BC, UUTC, and concomitant BC and UUTC. Results: Data from 286 patients were collected. Of these, 212 had a history of BC, 38 of UUTC and 36 of concomitant BC and UUTC. Patient management was changed in 114/286 (40%) UC patients with the inclusion of FDG PET/CT, particularly in those with BC, reaching 74% (n = 90/122). After a mean follow-up period of 21 months (Interquartile range: 4–28 mo.), 136 patients (47.4%) had recurrence/progression of disease. Moreover, 131 subjects (45.6%) died. At Kaplan-Meier analyses, patients with BC and positive PET/CT had a worse overall survival than those with a negative scan (log-rank < 0.001). Furthermore, a negative PET/CT scan was associated with a lower recurrence rate than a positive examination, independently from the primary tumor site. At multivariate analysis, in patients with BC and UUTC, a positive FDG PET/CT resulted an independent predictor of disease-free and overall survival (p < 0,01). Conclusions: FDG PET/CT has the potential to change patient management, particularly for patients with BC. Furthermore, it can be considered a valid survival prediction tool after primary treatment in patients with recurrent UC. However, a firm recommendation cannot be made yet. Further prospective studies are necessary to confirm our findings.

Original languageEnglish
Article number700
JournalCancers
Volume11
Issue number5
DOIs
Publication statusPublished - May 2019

Keywords

  • Bladder cancer
  • PET/CT
  • Survival
  • Upper tract urothelial carcinoma
  • Urothelial carcinoma

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    Zattoni, F., Incerti, E., Dal Moro, F., Moschini, M., Castellucci, P., Panareo, S., Picchio, M., Fallanca, F., Briganti, A., Gallina, A., Fanti, S., Schiavina, R., Brunocilla, E., Rambaldi, I., Lowe, V., Karnes, J. R., & Evangelista, L. (2019). 18F-FDG PET/CT and urothelial carcinoma: Impact on management and prognosis—a multicenter retrospective study. Cancers, 11(5), [700]. https://doi.org/10.3390/cancers11050700