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Background  Surgical resection remains the mainstay of curative treatment for intrahepatic cholangiocarcinoma (ICC). Prognosis after surgery is unsatisfactory despite improvements in treatment and post-operative clinical management. Despite developments in the molecular profiling of ICC, the preoperative prediction of prognosis remains a challenge. This study aimed to identify clinical prognostic indicators by investigating the molecular profiles of ICC and evaluating the preoperative imaging data of  18 F-fluorodeoxyglucose positron emission tomography ( 18 F-FDG-PET).    Methods  A retrospective analysis was performed on 50 consecutive patients with ICC who underwent curative hepatectomy after  18 F-FDG-PET examination. To evaluate the molecular profiles of ICC,  KRAS  mutation status was assessed in resected specimens. For the assessment of glucose uptake, we observed the expression of glucose transporter-1 (GLUT-1) by immunohistochemistry. The data of  18 F-FDG-PET were re-evaluated as follows: maximum standardized uptake value, metabolic tumor volume (MTV), and total lesion glycolysis (TLG). Cut-off values were determined using receiver operating characteristic (ROC) curve analysis. Cumulative overall survival (OS) was analyzed using the Kaplan–Meier analysis.    Results  Overall, 16 (32.0%) patients had mutations in  KRAS . Patients with mutated  KRAS  exhibited shorter OS than those with wild-type  KRAS  (5-year OS, 0% vs. 35.1%,  P  < 0.001). GLUT-1 expression was significantly higher in tumors with mutated  KRAS  than in tumors with wild-type  KRAS  (median, 4.0 vs. 1.0,  P  < 0.001). Survival was significantly different when stratified by expression of GLUT-1 (5-year OS, 0% vs. 46.5%,  P  <0.001). Among the  18 F-FDG-PET parameters, the MTV and TLG were significantly higher in the mutated  KRAS  group than in the wild-type  KRAS  group ( P  = 0.013 and  P  = 0.026, respectively). ROC curve analysis revealed a cut-off value of 38 for the MTV, with the highest accuracy (area under the curve = 0.789; 95% confidence interval, 0.581–0.902) for predicting  KRAS  mutation. This cut-off value permitted stratification of OS (high vs. low: 5-year OS, 13.1% vs. 36.7%,  P  = 0.008).    Conclusions  High MTV is associated with  KRAS  mutation and poor postoperative outcomes in patients with ICC, suggesting that the MTV of ICC measured by  18 F-FDG-PET may provide useful information for tumor molecular profiles and prognosis.    Electronic supplementary material  The online version of this article (10.1186/s12967-018-1475-x) contains supplementary material, which is available to authorized users.

journal of translational medicine

Preoperative metabolic tumor volume of intrahepatic cholangiocarcinoma measured by 18F-FDG-PET is associated with the KRAS mutation status and prognosis