Evidence map›Paper›PMID 41410873›Full record

ArticleEuropean journal of nuclear medicine and molecular imaging2026

[18 F]FDG PET unveils a cachexia-specific multiorgan metabolic phenotype and identifies patients with poor prognosis in locally advanced rectal cancer.

Zhixing Kuang, Xiaoqiang Lin, Jiannan Tu, Qizhen Huang, Siqin Liao, Zhongyou Ji, Benhua Xu

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Article in European journal of nuclear medicine and molecular imaging, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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1 citing paper in PubMed.

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5 · Who and what money

Authors and funding

7 authors.

Zhixing Kuang *Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, People's Republic of China.
Xiaoqiang Lin *Department of PET Center, Fujian Medical University Union Hospital, Fuzhou, People's Republic of China.
Jiannan Tu *Department of Medical Oncology, Fudan University Shanghai Cancer Center Xiamen Hospital, Xiamen, People's Republic of China.
Qizhen HuangDepartment of Radiation Oncology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China.
Siqin LiaoDepartment of PET Center, Fujian Medical University Union Hospital, Fuzhou, People's Republic of China.
Zhongyou JiDepartment of PET Center, Fujian Medical University Union Hospital, Fuzhou, People's Republic of China. jizhongyou@yahoo.com.
Benhua XuDepartment of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, People's Republic of China. benhuaxu@163.com.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeCancer cachexia is a debilitating syndrome that profoundly impacts survival, yet its systemic metabolic characteristics and prognostic drivers in locally advanced rectal cancer (LARC) remain poorly defined. This study aimed to comprehensively profile the host’s metabolic response in LARC-associated cachexia using [18 F]FDG PET-CT and to evaluate its prognostic implications.

methodsIn this retrospective analysis, 131 LARC patients were stratified by cachexia status. Receiver operating characteristic (ROC) analysis was used to identify the most discriminative metabolic parameters. Structural equation modeling was applied to assess the mediating role of systemic metabolism between primary tumor metabolic tumor volume (MTV) and cachexia. Survival analysis was conducted using Kaplan–Meier curves and Cox proportional hazards models, with overall survival (OS) as the primary endpoint.

resultsCachectic patients displayed a distinct systemic metabolic profile. First, a coordinated reduction in aortic, hepatic, and pancreatic FDG uptake emerged as a hallmark of systemic metabolic suppression. Conversely, adipose tissue exhibited a paradoxical hypermetabolism that was not only preserved but markedly accentuated across all depots after normalization to aortic uptake, revealing a consistent and systemic shift in metabolic partitioning. Path analysis within our model revealed significant direct paths from hypometabolism in the aorta and pancreas to cachexia. The effect of primary tumor MTV was channeled through both direct and indirect routes, with subcutaneous fat metabolism exhibiting the most substantial mediating effect. Critically, survival analysis pinpointed subcutaneous fat glucose uptake (SubFat SUVmax) from this metabolic network, validating it in multivariate analysis as a powerful independent prognostic factor that surpassed the clinical diagnosis of cachexia.

conclusionThis study delineates a comprehensive metabolic landscape of cachexia in LARC, revealing a systemic energy imbalance in which adipose tissue hypermetabolism acts as both a key pathophysiological mediator and a superior prognostic biomarker compared to clinical cachexia diagnosis. These findings support a shift from phenotypic to metabolic stratification in the management of cancer cachexia.

Indexed as

CachexiaFluorodeoxyglucose F18Positron Emission Tomography Computed TomographyRectal NeoplasmsAgedFemaleHumansMaleMiddle AgedOrgan SpecificityPhenotypePrognosisRadiopharmaceuticalsRetrospective StudiesFluorodeoxyglucose F18Radiopharmaceuticals[18F]FDG PET-CTCachexiaLocally advanced rectal cancer (LARC)Metabolic tumor volume (MTV)Prognosis

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.