# Predictive Value of Preoperative Maximum Standardized Uptake Value (SUVmax) in Patients with Advanced Gastric Cancer

## TL;DR

This study shows that a pre-surgery PET scan measurement called SUVmax can predict outcomes for advanced gastric cancer patients, with lower values linked to better survival.

## Contribution

The study identifies SUVmax as an independent prognostic factor for recurrence and mortality in untreated advanced gastric cancer.

## Key findings

- Patients with low SUVmax had better progression-free and overall survival compared to those with high SUVmax.
- Lower SUVmax was associated with reduced risk of recurrence and mortality (HR = 0.565).
- Later tumor stage (stage III) was independently correlated with higher recurrence risk (HR = 3.049).

## Abstract

Background: This study aimed to investigate the clinical and prognostic significance of preoperative maximum standardized uptake value (SUVmax) and GLUT-1 expression in patients with advanced gastric cancer (AGC). Methods: Medical records of patients who were diagnosed with AGC between 2018 and 2020 at Zhongshan Hospital of Fudan University (Shanghai, China) were retrospectively analyzed. Finally, 182 patients were enrolled, and for each patient, SUVmax was calculated for the primary lesion on PET/CT prior to curative surgery. A total of 165 clinical tissue specimens were collected for immunohistochemical analysis of GLUT-1 expression. Results: A total of 182 patients were divided into two groups based on their SUVmax values. The low SUVmax group comprised 92 patients. Patients with low SUVmax tended to be younger and included a higher proportion of women, with their primary tumors typically smaller or in earlier TNM stages. The median follow-up time was 52 months. The 1-, 3-, and 5-year progression-free survival (PFS) rates were 90.7%, 71.4%, and 67.0%, respectively. Among them, 33 patients experienced recurrence and metastasis, and 40 ultimately died. Log-rank analysis revealed that the low SUVmax group exhibited superior progression-free survival (PFS) and overall survival (OS). Multivariate analysis indicated that, for AGC without preoperative treatment, later stage (stage III) was independently correlated with a higher risk of recurrence (HR = 3.049; 95%CI = 1.076–8.639; p = 0.036), while the low SUVmax group exhibited a reduced risk of recurrence and mortality compared with the high SUVmax group (HR = 0.565; 95%CI = 0.326–0.979; p = 0.042). Conclusions: The clinicopathological characteristics of patients with AGC with different SUVmax values appeared significantly different. Tumor stage and SUVmax were found as independent factors affecting postoperative recurrence and death of patients with AGC.