Nuclear Medicine and Molecular Imaging

, Volume 52, Issue 5, pp 334–341 | Cite as

Inverse Prognostic Relationships of 18F-FDG PET/CT Metabolic Parameters in Patients with Distal Bile Duct Cancer Undergoing Curative Surgery

  • Hyun Kyung Yi
  • Yong-Jin Park
  • Ji Hoon Bae
  • Jong Kyun Lee
  • Kwang Hyuk Lee
  • Seong Ho Choi
  • Kyung-Han Lee
  • Byung-Tae Kim
  • Joon Young ChoiEmail author
Original Article



As there were few previous studies with a small number of subjects, the purpose of this was to evaluate the prognostic significance of 18F-FDG PET/CT in patients with distal bile duct cancer undergoing curative surgery.


The study included 40 patients (M/F = 24:16; age 68.0 ± 8.0 years) who underwent preoperative 18F-FDG PET/CT followed by curative surgical resection. The participant’s age, sex, Eastern Cooperative Oncology Group performance-status score, baseline serum CA 19-9 level, stage, pathologic T and N stages, tumor size, tumor grade, tumor growth pattern, R0 resection, and adjuvant therapy were included as clinicopathological variables for predicting overall survival. The PET variables were maximum standardized uptake value (SUVmax), average SUV (SUVavg), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the tumor. The Kaplan-Meyer method and Cox proportional hazards model were used for the survival analysis.


A total of 15 of 40 patients (37.5%) died during the follow-up period. In univariate analysis, low SUVmax (≤ 2.7, p = 0.0005) and low SUVavg (≤ 2.6, p = 0.0034) were significant predictors of poor overall survival. In multivariate analyses, only low SUVmax (HR = 6.7016, 95% CI 1.9961–22.4993, p = 0.0047) was an independent prognostic factor associated with poor overall survival.


The SUVmax of the primary tumor measured by 18F-FDG PET/CT was an independent significant prognostic factor for overall survival in patients with distal bile duct cancer. However, different results from a previous study warrant further large sample-sized study.


Cholangiocarcinoma Distal bile duct cancer 18F-FDG PET Prognosis 


Compliance with Ethical Standards

Conflict of Interest

Hyun Kyung Yi, Yong-Jin Park, Ji Hoon Bae, Jong Kyun Lee, Kwang Hyuk Lee, Seong Ho Choi, Kyung-Han Lee, Byung-Tae Kim, and Joon Young Choi declare that they have no conflicts of interest.

Ethics Statement

All procedures performed in studies that involved human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

For this type of study, formal consent was not required.

Informed Consent

The institutional review board of our institute approved this retrospective study, and the requirement to obtain informed consent was waived.


  1. 1.
    Everhart JE, Ruhl CE. Burden of digestive diseases in the United States part III: liver, biliary tract, and pancreas. Gastroenterology. 2009;136:1134–44.CrossRefPubMedGoogle Scholar
  2. 2.
    Nakeeb A, Pitt HA, Sohn TA, Coleman J, Abrams RA, Piantadosi S, et al. Cholangiocarcinoma. A spectrum of intrahepatic, perihilar, and distal tumors. Ann Surg. 1996;224:463–75.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Razumilava N, Gores GJ. Cholangiocarcinoma. Lancet. 2014;383:2168–79.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Moon CM, Bang S, Chung JB. The role of (18)F-fluorodeoxyglucose positron emission tomography in the diagnosis, staging, and follow-up of cholangiocarcinoma. Surg Oncol. 2011;20:e10–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Benson AB 3rd, Abrams TA, Ben-Josef E, Bloomston PM, Botha JF, Clary BM, et al. NCCN clinical practice guidelines in oncology: hepatobiliary cancers. J Natl Compr Cancer Netw. 2009;7:350–91.CrossRefGoogle Scholar
  6. 6.
    Chung YJ, Choi DW, Choi SH, Heo JS, Kim DH. Prognostic factors following surgical resection of distal bile duct cancer. J Korean Surg Soc. 2013;85:212–8.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Yoo J, Choi JY, Lee KT, Heo JS, Park SB, Moon SH, et al. Prognostic significance of volume-based metabolic parameters by (18)F-FDG PET/CT in gallbladder carcinoma. Nucl Med Mol Imaging. 2012;46:201–6.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Kim H, Yoo IR, Boo SH, Park HL, O JH, Kim SH. Prognostic value of pre- and post-treatment FDG PET/CT parameters in small cell lung cancer patients. Nucl Med Mol Imaging. 2018;52:31–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Lee Y, Yoo IR, Boo SH, Kim H, Park HL, Hyun OJ. The role of F-18 FDG PET/CT in intrahepatic cholangiocarcinoma. Nucl Med Mol Imaging. 2017;51:69–78.CrossRefGoogle Scholar
  10. 10.
    Hwang JP, Lim I, Na II, Cho EH, Kim BI, Choi CW, et al. Prognostic value of SUVmax measured by fluorine-18 fluorodeoxyglucose positron emission tomography with computed tomography in patients with gallbladder cancer. Nucl Med Mol Imaging. 2014;48:114–20.CrossRefPubMedGoogle Scholar
  11. 11.
    Choi MK, Choi JY, Lee J, Heo JS, Choi SH, Choi DW, et al. Prognostic and predictive value of metabolic tumor volume on 18F-FDG PET/CT in advanced biliary tract cancer treated with gemcitabine/oxaliplatin with or without erlotinib. Med Oncol. 2014;31:23.CrossRefPubMedGoogle Scholar
  12. 12.
    Lee JY, Kim HJ, Yim SH, Shin DS, Yu JH, Ju DY, et al. Primary tumor maximum standardized uptake value measured on 18F-fluorodeoxyglucose positron emission tomography-computed tomography is a prognostic value for survival in bile duct and gallbladder cancer. Korean J Gastroenterol. 2013;62:227–33.CrossRefGoogle Scholar
  13. 13.
    Park M-S, Lee S-M. Preoperative 18F-FDG PET-CT maximum standardized uptake value predicts recurrence of biliary tract cancer. Anticancer Res. 2014;34:2551–4.PubMedGoogle Scholar
  14. 14.
    Song JY, Lee YN, Kim YS, Kim SG, Jin SJ, Park JM, et al. Predictability of preoperative 18F-FDG PET for histopathological differentiation and early recurrence of primary malignant intrahepatic tumors. Nucl Med Commun. 2015;36:319–27.CrossRefGoogle Scholar
  15. 15.
    Lee SJ, Choi JY, Lee HJ, Baek CH, Son YI, Hyun SH, et al. Prognostic value of volume-based 18F-fluorodeoxyglucose PET/CT parameters in patients with clinically node-negative oral tongue squamous cell carcinoma. Korean J Radiol. 2012;13(6):752–9.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Cho KM, Oh DY, Kim TY, Lee KH, Han SW, Im SA, et al. Metabolic characteristics of advanced biliary tract cancer using 18F-fluorodeoxyglucose positron emission tomography and their clinical implications. Oncologist. 2015;20:926–33.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Lee EJ, Chang S-H, Lee TY, Yoon SY, Cheon YK, Shim CS, et al. Prognostic value of FDG-PET/CT total lesion glycolysis for patients with resectable distal bile duct adenocarcinoma. Anticancer Res. 2015;35:6985–91.PubMedGoogle Scholar
  18. 18.
    Hwang S, Lee YJ, Song GW, Park KM, Kim KH, Ahn CS, et al. Prognostic impact of tumor growth type on 7th AJCC staging system for intrahepatic cholangiocarcinoma: a single-center experience of 659 cases. J Gastrointest Surg. 2015;19:1291–304.CrossRefPubMedGoogle Scholar
  19. 19.
    Jarnagin WR, Bowne W, Klimstra DS, Ben-Porat L, Roggin K, Cymes K, et al. Papillary phenotype confers improved survival after resection of hilar cholangiocarcinoma. Ann Surg. 2005;241:703–14.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Cho JY, Han HS, Yoon YS, Hwang DW, Jung K, Kim JH, et al. Preoperative cholangitis and metastatic lymph node have a negative impact on survival after resection of extrahepatic bile duct cancer. World J Surg. 2012;36:1842–7.CrossRefPubMedGoogle Scholar
  21. 21.
    Akita M, Ajiki T, Matsumoto T, Shinozaki K, Goto T, Asari S, et al. Preoperative cholangitis affects survival outcome in patients with extrahepatic bile duct cancer. J Gastrointest Surg. 2017;21:983–9.CrossRefPubMedGoogle Scholar

Copyright information

© Korean Society of Nuclear Medicine 2018

Authors and Affiliations

  1. 1.Department of Nuclear Medicine, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
  2. 2.Department of MedicineSungkyunkwan University School of MedicineSeoulRepublic of Korea
  3. 3.Department of Surgery, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea

Personalised recommendations