Abstract
BACKGROUND: Microsatellite instability (MSI) is one of the important factors that determine the effectiveness of immunotherapy in colorectal cancer (CRC) and serves as a prognostic biomarker for its clinical outcomes. PURPOSE: To investigate whether the metabolic parameters derived from(18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) can predict MSI status in patients with CRC. MATERIALS AND METHODS: A retrospective analysis was performed on CRC patients who underwent (18)F-FDG PET/CT examination before surgery between January 2015 and April 2021. The metabolic (18)F-FDG PET/CT parameters of the primary CRC lesion were calculated and recorded with different thresholds, including the maximum, peak, and mean standardized uptake value (SUV(max), SUV(peak), and SUV(mean)), as well as the metabolic tumor volume (MTV) and the total lesion glycolysis (TLG). The status of MSI was determined by immunohistochemical assessment. The difference of quantitative parameters between MSI and microsatellite stability (MSS) groups was assessed, and the receiver operating characteristic (ROC) analyses with area under ROC curves (AUC) was used to evaluate the predictive performance of metabolic parameters. RESULTS: A total of 44 patients (24 men and 20 women; mean ± standard deviation age: 71.1 ± 14.2 years) were included. There were 14 patients in the MSI group while there were 30 in the MSS group. MTV(30%), MTV(40%), MTV(50%), and MTV(60%), as well as TLG(50%) and TLG(60%) showed significant difference between two groups (all p-values <0.05), among which MTV(50%) demonstrated the highest performance in the prediction of MSI, with an AUC of 0.805 [95% confidence interval (CI): 0.657-0.909], a sensitivity of 92.9% (95% CI: 0.661-0.998), and a specificity of 66.7% (95% CI: 0.472-0.827). Patients' age and MTV(50%) were significant predictive indicators of MSI in multivariate logistic regression. CONCLUSION: The metabolic parameters derived from(18)F-FDG PET/CT were able to preoperatively predict the MSI status in CRC, with MTV(50%) demonstrating the highest predictive performance. PET/CT imaging could serve as a noninvasive tool in the guidance of immunotherapy and individualized treatment in CRC patients.