PET/CT imaging features and lipid metabolism related mechanisms of low adhesion gastric cancer

doi:10.3877/cma.j.issn.1674-3946.2024.03.007

Abstract

Abstract:

Objective

By comparing the differences of 18F FDG-PET/CT uptake rate, biochemical indexes and expression of genes related to glucose and lipid metabolism between non-low adhesion and low adhesion gastric cancer, the possibility of low adhesion gastric cancer obtaining energy through fatty acid metabolism was explored.

Methods

The clinical data of 94 patients with gastric cancer WHO received PET/CT examination from January 2013 to December 2021 were retrospectively analyzed. According to WHO classification, they were divided into low adhesion cancer (n=28 cases) and non-low adhesion cancer (n=66 cases). SPSS 25.0 statistical software was used for data analysis, and the measurement data between the two groups were measured by t test or Mann-WhitneyU test. The statistical data were measured by χ² test. Kaplan-Meier survival curve was used to analyze the difference in overall survival (OS) between the two groups. P<0.05 indicated that the difference was statistically significant.

Results

The standardized mean uptake (SUVmean) of low-adhesion carcinoma group was significantly lower than that of non-low-adhesion carcinoma group (P = 0.049), and apolipoprotein AI and high-density lipoprotein were significantly higher than those of non-low-adhesion carcinoma group (P<0.05). Kaplan-Meier curve showed that OS in the low adhesion group was significantly lower than that in the non-low adhesion group (P=0.016). The expression of leukocyte differentiation antigen 36 (CD36) and fatty acid binding protein 4 (FABP4) in low-adhesion carcinoma was significantly higher than that in non-low-adhesion carcinoma (P<0.05), and glucose transporter 1 (GLUT1) was significantly lower than that in non-low-adhesion carcinoma (P=0.033). Univariate and multivariate COX regression analysis showed low SUVmean value (<3.25 vs. ≥3.25, HR=4.7, P=0.004), low adhesion cancer (HR=5.1, P=0.031), late stage (stage IV, HR=10.7, P=0.010) and tumor size (≥5 cm vs. <5 cm, HR=5.6, P=0.041) were independent risk factors for OS.

Conclusion

The expression of genes related to glucose metabolism in patients with low adhesion gastric cancer was significantly lower than that of non-low adhesion gastric cancer, and the expression of genes related to lipid metabolism was significantly higher than that of non-low adhesion gastric cancer, and the serum apolipoprotein AI and high-density lipoprotein were significantly increased in patients with low adhesion gastric cancer. Because SUVmean is significantly lower than non-low-adhesion cancers, it often results in non-development during PET/CT examination.

Key words: Stomach Neoplasms, Positron-Emission Tomography, Carbohydrate Metabolism, Lipid Metabolism, Leukocyte Differentiation Antigen 36, Fatty Acid Binding Protein 4, Glucose Transporter 1

Lingxiao Pu, Junhao Zhu, Liang Tao, Feng Wang, Meng Wang, Wenxian Guan. PET/CT imaging features and lipid metabolism related mechanisms of low adhesion gastric cancer[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(03): 255-260.

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Figures/Tables 6

References 32

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组别	例数	性别（例）	年龄（岁，）	体重指数（kg/m², ）	空腹血糖[mmol/L, M(Q1, Q3)]
组别	例数	男/女	年龄（岁，）	体重指数（kg/m², ）	空腹血糖[mmol/L, M(Q1, Q3)]
低黏附癌组	28	12/16	56.7±18.0	23.4±4.1	4.7(4.5, 4.9)
非低黏附癌组	66	52/14	61.8±15.6	23.6±3.9	4.9(4.4, 5.3)
t/χ²/U值		0.125	0.073	0.275	0.166
P值		0.450	0.166	0.691	0.347
组别	例数	合并疾病（例）	肿瘤位置（例）	T分期（例）	手术方式（例）
组别	例数	有/无	A/B/C	T₂/T₃/T₄	D/E
低黏附癌组	28	12/16	5/9/14	8/15/5	14/14
非低黏附癌组	66	40/26	15/20/31	21/35/10	31/35
t/χ²/U值		0.130	0.914	0.298	0.124
P值		0.925	0.633	0.585	0.725

组别	例数	性别（例）	年龄（岁，）	体重指数（kg/m², ）	空腹血糖[mmol/L, M(Q1, Q3)]
组别	例数	男/女	年龄（岁，）	体重指数（kg/m², ）	空腹血糖[mmol/L, M(Q1, Q3)]
低黏附癌组	28	12/16	56.7±18.0	23.4±4.1	4.7(4.5, 4.9)
非低黏附癌组	66	52/14	61.8±15.6	23.6±3.9	4.9(4.4, 5.3)
t/χ²/U值		0.125	0.073	0.275	0.166
P值		0.450	0.166	0.691	0.347
组别	例数	合并疾病（例）	肿瘤位置（例）	T分期（例）	手术方式（例）
组别	例数	有/无	A/B/C	T₂/T₃/T₄	D/E
低黏附癌组	28	12/16	5/9/14	8/15/5	14/14
非低黏附癌组	66	40/26	15/20/31	21/35/10	31/35
t/χ²/U值		0.130	0.914	0.298	0.124
P值		0.925	0.633	0.585	0.725

项目	低黏附癌组(n=28)	非低黏附癌组(n=66)	P值
SUVmax值[M(Q1, Q3)]	4.8(3.5, 7.4)	6.9(3.9, 12.8)	0.073
SUVmean值[M(Q1, Q3)]	3(2.3, 4.3)	4.1(2.5, 7.4)	0.049
载脂蛋白AI[g/L, M(Q1, Q3)]	1.0(0.8, 1.2)	0.9(0.7, 1.0)	0.020
载脂蛋白B（g/L, ）	0.8±0.2	0.8±0.3	0.383
胆固醇（mmol/L, ）	4.0±0.8	4.0±1.0	0.762
HDL-C（mmol/L, ）	1.2±0.3	0.9±0.3	0.002
LDL-C（mmol/L, ）	2.2±0.6	2.3±0.8	0.875
GLUT1评分（分，）	2.0±1.4	3.4±1.5	0.033
CD36评分（分，）	3.9±1.8	2.1±1.0	0.021
FABP4评分（分，）	3.1±1.5	1.9±0.9	0.048

项目	低黏附癌组(n=28)	非低黏附癌组(n=66)	P值
SUVmax值[M(Q1, Q3)]	4.8(3.5, 7.4)	6.9(3.9, 12.8)	0.073
SUVmean值[M(Q1, Q3)]	3(2.3, 4.3)	4.1(2.5, 7.4)	0.049
载脂蛋白AI[g/L, M(Q1, Q3)]	1.0(0.8, 1.2)	0.9(0.7, 1.0)	0.020
载脂蛋白B（g/L, ）	0.8±0.2	0.8±0.3	0.383
胆固醇（mmol/L, ）	4.0±0.8	4.0±1.0	0.762
HDL-C（mmol/L, ）	1.2±0.3	0.9±0.3	0.002
LDL-C（mmol/L, ）	2.2±0.6	2.3±0.8	0.875
GLUT1评分（分，）	2.0±1.4	3.4±1.5	0.033
CD36评分（分，）	3.9±1.8	2.1±1.0	0.021
FABP4评分（分，）	3.1±1.5	1.9±0.9	0.048

影响因素	单因素分析			多因素分析
影响因素	HR值	可信区间（95%）	P值	HR值	可信区间（95%）	P值
性别
女	1
男	1.4	0.3-6.1	0.690
年龄
<65岁	1
≥65岁	1.7	0.6-4.9	0.305
术前并发症（高血压、糖尿病等）
否	1
是	1.9	0.6-5.2	0.278
SUV mean值
≥3.25	1
<3.25	2.8	1.0-7.2	0.021	4.7	1.4-11.8	0.004
WHO分型
非低黏附性	1
低黏附性	3.2	0.4-25.9	0.018	5.1	1.7-12.1	0.031
肿瘤位置
胃底	1
胃体	0.6	0.1-5.0	0.636
胃窦	1.1	0.4-3.2	0.910
手术方式
部分胃切除	1
全胃切除	1.9	0.5-6.8	0.326
T分期
T₂	1
T₃	0.9	0.1-7.5	0.960
T₄	1.9	0.2-17.6	0.545
TNM分期
Ⅱ期	1
Ⅲ期	8.3	1.1-64.9	0.044
Ⅳ期	76.2	6.8-850.3	<0.001	10.7	2.1-112.3	0.010
肿瘤最长径
<5 cm	1
≥5 cm	7.8	2.4-25.1	0.001	5.6	1.9-20.7	0.041

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