Ott et al. found that a reduction in FDG uptake of more than 35% for metabolic responders predicted
a favorable response in gastric cancer patients PRN1371 chemical structure two weeks after initiation of chemotherapy [11], while metabolic non-responders or FDG non-avid tumors received an unfavorable prognosis. Cancer cells theoretically require a greater amount of glucose consumption than healthy tissue because of increased cell division [12, 13] or anaerobic respiration in tumors [14]. Many cancers increase glucose transport through glucose transporter 1 (GLUT1) and glucose phosphorylation by hexokinase (HK) [15–17]. A correlation between FDG uptake and GLUT1 expression has been found in gastric cancer patients [1, 3, 7, 8], but
these studies were conducted by non-quantitative immunohistochemistry analysis, such as negative or positive staining that can vary by evaluator. We therefore evaluated the expression of glucose metabolism-related proteins through quantitative reverse-transcription polymerase chain reaction (qRT-PCR) and compared the results to Selleckchem Stattic maximum SUV of FDG-PET. In addition, we also analyzed the expression of proliferating cell nuclear antigen (PCNA) as a valid marker of proliferation [18] and hypoxia-inducible factor 1 alpha (HIF1α) as a marker of hypoxia [19] to elucidate either of these mechanisms, i.e., tumor proliferation or tumor hypoxia, contribute to FDG uptake. We then discuss the significance and AZD1390 cost difficulties involved with the clinical application of FDG-PET in gastric cancer due to FDG uptake mechanisms. Materials and methods Patients This retrospective study involved 50 patients (29 male and 21 female; mean age ± standard error of measurement [SEM], 65.8 ± 1.4 years) with gastric cancer who underwent same FDG-PET system before gastrectomy in Kagawa University from July 2005 to March 2010. Tumor specimens were snap-frozen at the time of surgery, and stored at −80°C. Participants were divided into 25 cases of intestinal tumors and 25 cases of non-intestinal tumors based on histopathological diagnoses. When focal FDG
uptake was not found in the stomach, SUV was calculated from a lesion determined by histology results after gastrectomy. The International Union Against Cancer old staging system was used to determine clinicopathological parameters associated with FDG uptake. The protocol was approved by the institutional review board of our institution, and all patients provided written informed consent. FDG-PET imaging FDG-PET images were acquired with a PET scanner (ECAT EXACT HR+, Siemens/CTI, Knoxville, TN, USA). Patients fasted at least five hours before FDG injection. Images were reviewed on a Sun Microsystems workstation (Siemens/CTI) along transverse, coronal, and sagittal planes with maximum intensity projection images.