Value of quantitative FDG PET/CT volumetric biomarkers in recurrent colorectal cancer patient survival

Charles Marcus, Rick Wray, Mehdi Taghipour, Wael Marashdeh, Se Jin Ahn, Esther Mena, Rathan M. Subramaniam

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


OBJECTIVE. The purpose of this study was to evaluate the impact of quantitative PET parameters in the overall survival of patients with recurrent colorectal cancer. MATERIALS AND METHODS. A total of 105 patients with a biopsy-proven recurrence of colorectal cancer who underwent PET/CT were included in the study. A gradient segmentation method was used to calculate maximum and peak standardized uptake values (SUVmax, SUVpeak), total lesion glycolysis (TLGtotal), and metabolic tumor volume (MTVt otal). These parameters were measured for each recurrent lesion at the primary, locoregional, and distant sites. The median follow-up time was 31.3 months. Overall survival (OS) was the primary outcome and was calculated using Kaplan-Meier survival plots and Cox regression analyses. RESULTS. The mean ± SD for SUVmax, SUVpeak, TLGtotal, and MTVtotal of the included patients was 7.3 ± 5.3, 5.3 ± 3.3, 280.8 ± 1181 g, and 79.8 ± 294 mL, respectively. The median OS for patients who were alive was 50 months in comparison with 23.4 months among patients who died. Age (p = 0.041), tumor grade (p = 0.010), median TLG (p = 0.031), and median MTV (p = 0.009) remained significantly associated with OS in the multivariate Cox regression analysis. Kaplan-Meier survival analysis performed on the basis of the median PET/CT parametric values showed that SUVmax (threshold, 5.63; hazard ratio [HR] = 1.7; 95% CI, 1-2.8; p = 0.02), MTVtotal (threshold, 13.85 mL; HR = 2.2; 95% CI, 1.3-3.9; p = 0.003), and TLGtotal (threshold, 36.14 g; HR = 1.9; 95% CI, 1.1-3.3; p = 0.01) were significant predictors of OS during follow-up. An integrated risk stratification model with SUVmax and MTVtotal into three subgroups predicted patient survival outcomes (HR = 1.8; 95% CI, 1.25-2.65; logrank p = 0.003). CONCLUSION. SUVmax, MTVtotal, TLGtotal, and integrated score with FDG avidity and total tumor burden provide survival information for patients with biopsy-proven recurrent colorectal cancer.

Original languageEnglish (US)
Pages (from-to)257-265
Number of pages9
JournalAmerican Journal of Roentgenology
Issue number2
StatePublished - Aug 2016


  • Colorectal cancer
  • Follow-up
  • Metabolic tumor volume
  • Overall survival
  • PET/CT
  • Recurrence
  • Standardized uptake value
  • Total lesion glycolysis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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