The Relationship between the SUVmax Value Obtained in Ga-68 PSMA PET/CT and Lactate Dehydrogenase and Alkaline Phosphatase in Prostate Cancer

Objectives: ALP and LDH are serum markers of prognostic importance in prostate cancer patients. PET/CT imaging with Ga-68 PSMA has played an important role in prostate cancer imaging in recent years. Our aim in this study was to evaluate the relationship and prognostic significance between SUVmax values obtained with Ga-68 PSMA PET/CT and LDH and ALP levels in prostate cancer patients. Methods: We retrospectively evaluated 61 prostate cancer patients who had Ga-68 PSMA PET/CT imaging and who did not have a prostatectomy between 2019 and 2020. PSA, ALP and LDH levels were measured in all patients before or after imaging within a maximum of 28 days. Results: The median age of the patients included in this study was 73 (range: 57–89) and all 61 patients were prostatic adenocarcinoma. 50 (82%) of the patients had distant metastasis in Ga-68 PSMA PET/CT. There was a significant positive correlation between serum LDH and PSA levels. There was a positive correlation between serum ALP and PSA levels. A negative correlation was found between ALP levels and prostate SUVmax. Conclusions: While negative correlation was found between SUVmax and ALP levels, no correlation was found between LDH levels and SUVmax. High ALP levels were found to be related to metastasis rates and severity and high serum PSA levels (AU)

Objetivos: ALP y LDH son marcadores séricos deimportancia pronóstica en pacientes con cáncer de próstata.Las imágenes de PET/CT con Ga-68 PSMA han jugado unpapel importante en las imágenes de cáncer de próstata enlos últimos años. Nuestro objetivo en este estudio fue evaluar la relación y la importancia pronóstica entre los valores de SUVmax obtenidos con Ga-68 PSMA PET/CT ylos niveles de LDH y ALP en pacientes con cáncer de próstata.Métodos: Evaluamos retrospectivamente a 61 pacientes con cáncer de próstata que se sometieron a imágenes de PET/CT con Ga-68 PSMA y que no se sometierona prostatectomía entre 2019 y 2020. Los niveles de PSA,ALP y LDH se midieron en todos los pacientes antes o después de la obtención de imágenes en un plazo máximo de28 días.Resultados: La mediana de edad de los pacientes incluidos en este estudio fue de 73 (rango: 57–89) y los 61pacientes eran adenocarcinoma de próstata. 50 (82%) delos pacientes tenían metástasis a distancia en Ga-68 PSMAPET/CT. Hubo una correlación positiva significativa entrelos niveles séricos de LDH y PSA. Hubo una correlaciónpositiva entre los niveles séricos de ALP y PSA. Se encontró una correlación negativa entre los niveles de ALP y elSUVmáx prostático.Conclusiones: Si bien se encontró una correlaciónnegativa entre los niveles de SUVmáx y ALP, no se encontró correlación entre los niveles de LDH y el SUVmáx. Seencontró que los niveles altos de ALP estaban relacionadoscon las tasas de metástasis y la gravedad y los niveles altosde PSA en suero. (AU)

Relaciones entre el factor-1alfa inducido por hipoxia y los parámetros de la PET/TC con 18F-FDG en el cáncer colorrectal / Relationships between hypoxia induced factor-1alfa and 18F-FDG PET/CT parameters in colorectal cancer

OBJETIVO: El factor inducible para hipoxia (HIF-1) tiene un papel crítico en la homeostasis del oxígeno y es un activador transcripcional de angiogénesis, eritropoyesis, hierro y metabolismo de glucosa. La tasa de metabolismo de glucosa aumenta en algunos tumores a través de HIF-1alfa. Nuestro objetivo es evaluar la relación entre hipoxia en el cáncer colorrectal, los parámetros de PET, el tamaño del tejido necrótico y los factores pronósticos patológicos mediante el uso de HIF-1alfa. MATERIALES/MÉTODOS: 70 pacientes (28 mujeres/42 hombres; promedio de edad: 63 años) diagnosticados con cáncer colorrectal mediante biopsia, se estadificaron con PET/TC preoperatoria y se operaron posteriormente. La puntuación de evaluación inmunohistoquímica se realizó de acuerdo con la expresión de HIF-1alfa nuclear, la intensidad y la densidad de tinción. El volumen metabólico tumoral (MTV), la glucólisis de lesión total (TLG) y el volumen tumoral (TV) se calculó utilizando el volumen de una fórmula elipsoide mediante las imágenes de TC y el porcentaje de necrosis tumoral (%TmNcr) se calculó por diferencia entre TV y MTV. RESULTADOS: Hubo una correlación positiva moderadamente significativa entre el SUVmáx del tumor y TV y el %TmNcr (r=0,403, p = 0,001 y r=0,5, p = 0,0001, respectivamente). No hubo una relación estadísticamente significativa entre niveles de expresión de HIF-1alfa y SUVmáx tumoral, TLG, MTV, TV, %TmNcr, estadio tumoral, invasión linfovascular, invasión perineural y afectación ganglionar extracapsular/capsular. Por otro lado, se observó una fuerte tinción inmunohistoquímica nuclear en las células tumorales adyacentes al borde invasivo, las células inflamatorias. Aunque no fue estadísticamente significativa, se observó una tinción nuclear moderada o fuerte en el 64,9% de los pacientes metastásicos. CONCLUSIÓN: Aunque la presencia de una correlación positiva entre SUVmáx tumoral y el % de TmNcr muestra que hay células hipóxicas en tejido canceroso con una alta captación de FDG, no se demostró ninguna relación entre la presencia de HIF-1alfa y el incremento metabólico de glucosa y los factores patológicos del tumor. La fuerte tinción inmunohistoquímica nuclear en células tumorales adyacentes a las células inflamatorias y de borde invasivas nos hace pensar que HIF-1alfa desempeña un papel en el área de invasión del microambiente tumoral

AIM: The hypoxia-inducible factor 1 (HIF-1) has a critical role in oxygen homeostasis and it is a transcriptional activator of angiogenesis, erythropoiesis, iron and glucose metabolism. Glucose metabolism rate is increased in some tumours via HIF-1alfa. Our aim is to evaluate the relationship between hypoxia in colorectal cancer, PET parameters, necrotic tissue size and pathologic prognostic factors via using HIF-1alfa. MATERIALS/METHODS: 70 patients (28 female/42 male; median age: 63 years) who were diagnosed with colorectal cancer via biopsy were staged with preoperative PET/CT and operated subsequently. Immunohistochemical evaluation scoring was done according to nuclear HIF-1alfa expression, staining density and intensity. Metabolic tumour volume (MTV), total lesion glycolysis (TLG) and tumour volume (TV) were calculated by using volume of an ellipsoid formula via CT images, and percentage of tumour necrosis (%TmNcr) that was calculated by the difference between TV and recorded MTV. RESULTS: There was a moderately meaningful positive correlation between tumour SUVmax and TV and %TmNcr (r=0.403, p = 0.001 and r=0.500, p = 0.0001, respectively). There were no statistically significant relationships between HIF-1alfa expression levels and tumour SUVmax, TLG, MTV, TV, %TmNcr, tumour stage, lymphovascular invasion, perineural invasion and extracapsular/capsular lymph node involvement. On the other hand, strong nuclear immunohistochemical staining was seen in tumour cells adjacent to invasive border, inflammatory cells. Although not statistically significant, moderate or strong nuclear staining were seen in 64.9% of metastatic patients. CONCLUSION: Although the presence of a positive correlation between tumour SUVmax and %TmNcr shows that there are hypoxic cells in cancer tissue with high FDG uptake, the relationship between the presence of HIF-1alfa and enhanced glucose metabolism and pathological prognostic factors of tumour was not shown. Strong nuclear immunohistochemical staining in tumour cells adjacent to invasive border and inflammatory cells leads us to believe that HIF-1alfa plays a role in the invasion area of tumour microenvironment

Relationships between hypoxia induced factor-1α and 18F-FDG PET/CT parameters in colorectal cancer. / Relaciones entre el factor-1α inducido por hipoxia y los parámetros de la PET/TC con 18F-FDG en el cáncer colorrectal.

AIM: The hypoxia-inducible factor 1 (HIF-1) has a critical role in oxygen homeostasis and it is a transcriptional activator of angiogenesis, erythropoiesis, iron and glucose metabolism. Glucose metabolism rate is increased in some tumours via HIF-1α. Our aim is to evaluate the relationship between hypoxia in colorectal cancer, PET parameters, necrotic tissue size and pathologic prognostic factors via using HIF-1α. MATERIALS/METHODS: 70 patients (28 female/42 male; median age: 63 years) who were diagnosed with colorectal cancer via biopsy were staged with preoperative PET/CT and operated subsequently. Immunohistochemical evaluation scoring was done according to nuclear HIF-1α expression, staining density and intensity. Metabolic tumour volume (MTV), total lesion glycolysis (TLG) and tumour volume (TV) were calculated by using volume of an ellipsoid formula via CT images, and percentage of tumour necrosis (%TmNcr) that was calculated by the difference between TV and recorded MTV. RESULTS: There was a moderately meaningful positive correlation between tumour SUVmax and TV and %TmNcr (r=0.403, p=0.001 and r=0.500, p=0.0001, respectively). There were no statistically significant relationships between HIF-1α expression levels and tumour SUVmax, TLG, MTV, TV, %TmNcr, tumour stage, lymphovascular invasion, perineural invasion and extracapsular/capsular lymph node involvement. On the other hand, strong nuclear immunohistochemical staining was seen in tumour cells adjacent to invasive border, inflammatory cells. Although not statistically significant, moderate or strong nuclear staining were seen in 64.9% of metastatic patients. CONCLUSION: Although the presence of a positive correlation between tumour SUVmax and %TmNcr shows that there are hypoxic cells in cancer tissue with high FDG uptake, the relationship between the presence of HIF-1α and enhanced glucose metabolism and pathological prognostic factors of tumour was not shown. Strong nuclear immunohistochemical staining in tumour cells adjacent to invasive border and inflammatory cells leads us to believe that HIF-1α plays a role in the invasion area of tumour microenvironment.

Modification of Diet in Renal Disease equation in the risk stratification of contrast induced acute kidney injury in hospital inpatients.

BACKGROUND: Several organizations recommend using estimated glomerular filtration rate (eGFR) in kidney function monitoring, preferably calculated with Modification of Diet in Renal Disease (MDRD) formula. The role of this formula is not clear in the risk stratification of contrast induced acute kidney injury (CIAKI) in nonsteady state patients. AIM: Comparative evaluation of the MDRD eGFR in risk stratification of CIAKI. METHOD: GFR was measured twice (pre- and post-examination) by Tc-99m-DTPA, along with serum levels of urea nitrogen and creatinine in 32 patients (mean age+/-SD; 60.1+/-13.2 years) needing hospital care for various reasons and underwent to x-ray examination with contrast media (mean; 90.2+/-16.8 ml). eGFR was calculated by the dedicated formula. Agreement between measured GFR (mGFR) and MDRD eGFR was assessed and patients were scored and stratified for CIAKI by using first mGFR, then eGFR and results were compared. RESULTS: A moderate correlation was obtained between mGFR and eGFR (r=0.47, p < 0.001) and the difference was not significant. However, Bland & Altman analysis revealed large limits of agreement between mGFR and eGFR (-80.3 to 55.2) with a mean difference of -12.5 ml/min/1.73m2. In ROC analysis, when mGFR values were classified as normal (>60ml/min/1.73m2) and decreased (<60ml/min/1.73m2), AUC was 0.80 (95%CI; 0.62-0.92) for eGFR, with a sensitivity of 29% and specificity of 100%. Furthermore, the risk group categorization, using eGFR instead of mGFR was resulted in a group change for four patients (13%); from moderate to low risk group. CONCLUSION: It seems that MDRD eGFR differs from mGFR. In nonsteady state patients CIAKI classification using eGFR should be considered with caution.

Modification of Diet in Renal Disease equation in the risk stratification of contrast induced acute kidney injury in hospital in patients

Antecedentes: Varios organismos recomiendan el uso de la tasa de filtrado glomerular estimada (TFGe) en la monitorización de la función renal, calculada preferentemente con la fórmula de Modificación de la Dieta en la Enfermedad Renal (MDRD). El papel de esta fórmula no está claro en la estratificación del riesgo de la lesión renal aguda inducida por contraste en pacientes no estables. Objetivo: Evaluación comparativa de la TFGe de la MDRD en la estratificación del riesgo de lesión renal aguda inducida por contraste. Método: La tasa de filtrado glomerular (TFG) se midió dos veces (pre- y posexamen) mediante Tc-99m-DTPA, junto con los niveles de nitrógeno ureico en suero y creatinina en 32 pacientes (edad media ± DE; 60,1 ± 13,2 años) que precisaban de cuidados hospitalarios por diversas razones y que se sometieron a rayos-x mediante contraste (mediana; 90,2 ± 16,8 ml). La TFGe se calculó mediante la fórmula correspondiente. Se evaluó la concordancia entre la TFG medida (TFGm) y la TFGe de la MDRD, asignando a los pacientes un baremo de estratificación para la lesión renal aguda inducida por contraste, usando primero la TFGm y posteriormente TFGe, comparando los resultados. Resultados: Se obtuvo una correlación moderada entre la TFGm y la TFGe (r =0,47, p <0,001), con una diferencia no significativa. Sin embargo, el análisis de Bland& Altman reveló grandes límites de concordancia entre la TFGm y la TFGe (-80,3 a 55,2), con una diferencia media de -12,5 ml/min/1,73 m2. En el análisis por método ROC, cuando los valores de la TFGm se catalogaron como normales(>60 ml/min/1,73 m2) y disminuidos (< 60 ml/min/1,73 m2), el área bajo la curva fue 0.80 (CI 95%; 0,62-0,92) para TFGe, con una sensibilidad del (..) (AU)

Background: Several organizations recommend using estimated glomerular filtration rate (eGFR) in kidney function monitoring, preferably calculated with Modification of Diet in Renal Disease (MDRD) formula. The role of this formula is not clear in the risk stratification of contrast induced acute kidney injury (CIAKI) in non steady state patients. Aim Comparative evaluation of the MDRD eGFR in risk stratification of CIAKI. Method: GFR was measured twice (pre and post-examination) by Tc-99m-DTPA, along with serum levels of urea nitrogen and creatinine in 32 patients (mean age ± SD; 60.1 ± 13.2 years) needing hospital care for various reasons and underwent to x-ray examination with contrast media (mean; 90.2 ± 16.8 ml). eGFR was calculated by the dedicated formula. Agreement between measured GFR(mGFR) and MDRD eGFR was assessed and patients were scored and stratified for CIAKI by using first mGFR, then eGFR and results were compared. Results: A moderate correlation was obtained between mGFR and eGFR (r = 0.47, p <0.001)and the difference was not significant. However, Bland&Altman analysis revealed large limits of agreement between mGFR and eGFR (-80.3 to 55.2) with a mean difference of -12.5 ml/min/1.73m2. In ROC analysis, when mGFR values were classified as normal (>60 ml/min/1.73m2)and decreased (<60ml/min/1.73m2), AUC was 0.80 (95%CI;0.62-0.92) for eGFR, with a sensitivity of 29% and specificity of 100%. Furthermore, the risk group categorization, using eGFR instead of mGFR was resulted in a group change for four patients (13%); from moderate to low risk group. Conclusion: It seems that MDRD eGFR differs from mGFR. In non steadystate patients CIAKI classification using eGFR should be considered with caution (AU)