Diagnostic Value of 18F-FDG PET/CT Parameters Combined with Serum FOXM1 for Lymph Node Metastasis in Colorectal Cancer

Yuanqing Zhu,1,* Lei Bo,2,* Lin Li,1 Yinggang Sun,1 Bo Wu1 1Department of Gastrointestinal Surgery, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, People’s Republic of China; 2Department of Clinical Laboratory, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Bo Wu, Email [email protected]: To evaluate the diagnostic value of maximum standardized uptake value (SUVmax), total lesion glycolysis (TLG), and metabolic tumor volume (MTV) in 18F-FDG PET/CT combined with serum forkhead box protein M1 (FOXM1) for detecting lymph node metastasis (LNM) in colorectal cancer (CRC).Methods: A retrospective study was conducted on 107 CRC patients who underwent 18F-FDG PET/CT and serum FOXM1 testing, with postoperative pathology as the reference standard. Patients were divided into LNM-positive (n=52) and LNM-negative (n=55) groups. PET/CT metabolic parameters (SUVmax, TLG, MTV) and serum FOXM1 levels were compared, correlations were analyzed by Spearman’s test, and receiver operating characteristic (ROC) curves were plotted to assess diagnostic efficacy.Results: SUVmax was significantly higher in LNM-negative patients, whereas TLG, MTV, and serum FOXM1 were higher in LNM-positive patients (all P< 0.05). Serum FOXM1 showed negative correlation with SUVmax (r=− 0.356) and positive correlation with TLG and MTV (r=0.564, 0.549). The combined model of SUVmax, TLG, MTV, and FOXM1 yielded the highest diagnostic performance (AUC=0.971, sensitivity=92.2%, specificity=94.3%).Conclusion: SUVmax, TLG, MTV, and FOXM1 are interrelated and, when combined, provide superior diagnostic value for CRC LNM, though validation in larger, multicenter cohorts is needed.Keywords: 18F-FDG PET/CT, SUVmax, TLG, MTV, serum FOXM1, colorectal cancer, lymph node metastasis