18F-FDG PET/CT and Urothelial Carcinoma: Impact on Management and Prognosis-A Multicenter Retrospective Study.

Objectives: To evaluate the ability of 18F-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.

Cancers. 2019 May 20*** epublish ***

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

Department of Surgery, Oncology and Gastroenterology, University of Padua, 35128 Padua, Italy. ., Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy. ., Department of Surgery, Oncology and Gastroenterology, University of Padua, 35128 Padua, Italy. ., Department of Urology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy. ., Department of Nuclear Medicine, Sant'Orsola-Malpighi Hospital, 40138 Bologna, Italy. ., Nuclear Medicine Unit, Diagnostic Imaging e Laboratory Medicine Department, University Hospital of Ferrara, 44121 Ferrara, Italy. ., Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy. ., Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy. ., Department of Urology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy. ., Department of Urology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy. ., Department of Nuclear Medicine, Sant'Orsola-Malpighi Hospital, 40138 Bologna, Italy. ., Department of Urology, Sant'Orsola-Malpighi Hospital, 40138 Bologna, Italy. ., Department of Urology, Sant'Orsola-Malpighi Hospital, 40138 Bologna, Italy. ., Nuclear Medicine Unit, Diagnostic Imaging e Laboratory Medicine Department, University Hospital of Ferrara, 44121 Ferrara, Italy. ., Division of Nuclear Medicine, Mayo Clinic, Rochester, MN 55905, USA. ., Department of Urology, Mayo Clinic, Rochester, MN 55905, USA. ., Nuclear Medicine and Molecular Imaging Unit, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy. .