Primary tumor heterogeneity on pretreatment18F-FDG PET/CT to predict outcome in patients with rectal cancer who underwent surgery after neoadjuvant therapy

Purpose: This retrospective study aimed to investigate the value of texture features of primary tumors in pretreatment18F-FDG PET/CT in the prediction of response to treatment, progression, and overall survival in patients with rectal cancer who underwent surgery after neoadjuvant therapy (NAT).Methods: Patients with rectal cancer who had pretreatment18F-FDG PET/CT, and underwent surgery after NAT were included in this study. Clinicopathologic features, date of last follow-up, progression, and death were recorded. Textural and conventional PET parameters (maximum standardized uptake value-SUVmax, metabolic tumor volume-MTV, total lesion glycolysis-TLG) were obtained from PET/CT images using LifeX program. Parameters were grouped using Youden index in ROC analysis. Factors predicting the pathological response to treatment, progression, and overall survival were determined using logistic regression and Cox regression analyses.Results: Forty-four patients (26(59%) male, 18 (41%) female; 60.1 & PLUSMN; 11.4 years) with rectal cancer were included in this study. The numbers of patients with responders and non-responders to NAT were15(34.9%) and 28(65.1%), respectively. One patient' pathology report did not contain the response status to NAT. The median of follow-up duration was 29.9 months. 9(20.5%) showed disease progression, and 8(18.2%) died during the follow-up period. Difference entropy GLCM and correlation GLCM parameters were found as independent predictors for response to NAT. The positivity of surgical margin, intensity interquartile range CONV and AUC-CSHDISC texture parameters were independent predictors of progression, while normalized inverse difference GLCM and LZLGEGLZLM parameters were independent predictors of mortality. Conclusion: The texture parameters obtained from pretreatment18F-FDG PET/CT have presented a more robust predictive value than conventional parameters in patients with rectal cancer who underwent surgery after NAT.& COPY; 2023 Sociedad Espanola de Medicina Nuclear e Imagen Molecular. Published by Elsevier Espana, S.L.U. All rights reserved.