Prognostic value of the quantitative metabolic volumetric measurement on 18F-FDG PET/CT in Stage IV nonsurgical small-cell lung cancer.

Stage IV non-small-cell lung cancer (NSCLC) consists of a heterogeneous group of patients with different prognoses. We assessed the prognostic value of baseline whole body tumor burden as measured by metabolic tumor volume (MTV), total lesion glycolysis (TLG), and standardized uptake values (SUV(max) and SUV(mean)) of all tumors in nonsurgical patients with Stage IV NSCLC. Ninety-two consecutive patients with newly diagnosed Stage IV NSCLC who had a pretreatment F-18 fludeoxyglucose positron emission tomography/computed tomography scan were retrospectively reviewed. The MTV, TLG, SUV(mean), and SUV(max) of whole-body (WB) tumors were measured with the MIMvista workstation with manual adjustment. There was a statistically significant association between overall survival (OS) and ln(MTV)/ln(TLG) at the level of WB tumor burden (MTV(WB)) and of primary tumor (MTV(T)). The hazard ratio (HR) for a 1-unit increase of ln(MTV(WB)) and ln(MTV(T)) before and after adjusting for age and gender was 1.48/1.48 (both P < .001) and 1.25/1.25 (P = .006, .007), respectively. The HR for a 1-unit increase of ln(TLG(WB)) and ln(TLG(T)) before and after adjusting for age and gender was 1.37/1.37 (both P = .001) and 1.19/1.19 (P = .001, .017), respectively. There was no statistically significant association between OS and ln(SUV(max)) and ln(SUV(mean)) at WB tumor burden, primary tumor, nodal metastasis, or distant metastasis (P > .05). There was low interobserver variability between two radiologists with concordance correlation coefficients of 0.90 for ln(MTV(WB)) and greater than 0.90 for SUV(maxWB), SUV(meanWB), and ln(TLG(WB)). Baseline WB metabolic tumor burden, as measured with MTV and TLG, is a prognostic measurement in patients within Stage IV NSCLC with low interobserver variability. This study also suggests pretreatment MTV and TLG measurements may be used to further stratify patients with Stage IV NSCLC and are better prognostic measures than SUV(max) and SUV(mean) measurements.

Liao S ，Penney BC ，Zhang H ，Suzuki K ，Pu Y ... -  《-》

Prognostic value of metabolic tumor burden from (18)F-FDG PET in surgical patients with non-small-cell lung cancer.

To assess the prognostic value of metabolic tumor burden as measured with metabolic tumor volume (MTV) and total lesion glycolysis (TLG) on 2-deoxy-2-((18)F)fluoro-D-glucose ((18)F-FDG) positron emission tomography (PET)/computed tomography (CT), independent of current Union Internacional Contra la Cancrum/American Joint Committee on Cancer tumor, node, and metastasis (TNM) stage; in comparison with that of standardized uptake value (SUV) in surgical patients with non-small-cell lung cancer (NSCLC). This study retrospectively reviewed 104 consecutive surgical patients (47 males, 57 females, median age at PET/CT scan of 67.92 years) with diagnosed stage I to IV NSCLC who had baseline (18)F-FDG PET/CT scans. The (18)F-FDG PET/CT scans were performed in accordance with National Cancer Institute guidelines. The MTV of tumors in the whole body (MTV(WB)), TLG of tumors in the whole body (TLG(WB)), the maximum standardized uptake value of tumors in the whole body (SUV(maxWB)) as well as the mean standardized uptake value of tumor in the whole body (SUV(meanWB)) were measured. The median follow-up among 67 survivors was 42.07 months from the PET/CT (range 2.82-80.95 months). Statistical methods included Kaplan-Meier curves, Cox regression, and C-statistics. The interobserver variability of SUV(maxWB), SUV(meanWB), MTV(WB), and TLG(WB) between two observers was analyzed using concordance correlation coefficients (CCCs). The interobserver variability of SUV(maxWB), SUV(meanWB), MTV(WB) and TLG(WB) was very low with CCCs greater than 0.882. There was a statistically significant association of stage with overall survival (OS). The hazard ratio (HR) of stage III and stage IV as compared with stage I was 3.60 (P = .001) and 4.00 (P = .013), respectively. The MTV(WB) was significantly associated with OS with a HR for 1-unit increase of ln(MTV(WB)) of 1.40/1.32 (P = .004/.039), before/after adjusting for stage and other prognostic factors including chemoradiation therapy, and surgical procedure, respectively. TLG(WB) had a statistically significant association with OS before and after adjusting for stage and the other prognostic factors. The HR for 1-unit increase in ln(TLG(WB)) was 1.26 (P = .011) and 1.25 (P = .031), before and after the adjustment, respectively. Subjects with conditions that led to pneumonectomy (HR = 2.82, P = .035) or segmental resection (HR = 3.44, P = .044) had significantly worse survival than those needing lobectomy. There was no statistically significant association between OS and age, gender, tumor histology, ln(SUV(maxWB)), and ln(SUV(meanWB)) (all P > .05). There were 37 deaths during follow-up. Baseline whole-body metabolic tumor burden as measured with MTV(WB) and TLG(WB) on FDG PET is a prognostic measure independent of clinical stage and other prognostic factors including chemoradiation therapy and surgical procedure with low interobserver variability and may be used to further risk stratify surgical patients with NSCLC. This study also suggests that MTV and TLG are better prognostic measures than SUV(max) and SUV(mean). These results will need to be validated in larger cohorts in a prospective study.

Zhang H ，Wroblewski K ，Liao S ，Kampalath R ，Penney BC ，Zhang Y ，Pu Y ... -  《-》

Prognostic value of metabolic tumor burden on 18F-FDG PET in nonsurgical patients with non-small cell lung cancer.

Liao S ，Penney BC ，Wroblewski K ，Zhang H ，Simon CA ，Kampalath R ，Shih MC ，Shimada N ，Chen S ，Salgia R ，Appelbaum DE ，Suzuki K ，Chen CT ，Pu Y ... -  《-》

Prognostic significance of total lesion glycolysis in patients with advanced non-small cell lung cancer receiving chemotherapy.

[¹⁸F]fluorodeoxyglucose positron emission tomography (FDG-PET) imaging has been employed as a non-invasive diagnostic tool for malignant tumors. Total lesion glycolysis (TLG) on FDG-PET is calculated by multiplying the mean standardized uptake value (SUVmean) by the tumor volume. Unlike the maximum standardized uptake value (SUVmax), which represents the point of greatest metabolic activity within tumors, TLG has been suggested to reflect global metabolic activity in whole tumors. We retrospectively examined whether or not FDG-PET measurements, including SUVmean, SUVmax, and TLG, could predict progression-free survival (PFS) or overall survival (OS) in patients with non-small cell lung cancer (NSCLC) receiving chemotherapy. This study involved 81 consecutive patients with NSCLC who received chemotherapy. All of the patients underwent FDG-PET examination before treatment. SUVmean, SUVmax, and TLG on FDG-PET were significantly associated with gender, smoking status, and tumor histology. With adjustment for several other variables, Cox regression analysis showed that TLG was significantly prognostic for both PFS [hazard ratio=2.34; 95% confidence interval, 1.18-4.64; P=0.015] and OS (hazard ratio=2.80; 95% confidence interval, 1.12-6.96; P=0.003), whereas SUVmean and SUVmax had no significant association with PFS (P=0.693 and P=0.322, respectively) or OS (P=0.587 and P=0.214, respectively). Our findings suggest that TLG may be more useful than SUVmean and SUVmax for predicting PFS and OS in NSCLC patients receiving chemotherapy. The TLG measurement on FDG-PET imaging could be routinely recommended to advanced NSCLC patients.

Zaizen Y ，Azuma K ，Kurata S ，Sadashima E ，Hattori S ，Sasada T ，Imamura Y ，Kaida H ，Kawahara A ，Kinoshita T ，Ishibashi M ，Hoshino T ... -  《-》

Prognostic value of total lesion glycolysis by 18F-FDG PET/CT in surgically resected stage IA non-small cell lung cancer.

Despite the favorable prognosis of stage IA non-small cell lung cancer (NSCLC), the disease recurs after complete surgical resection in 20%-30% of patients. This study determined the prognostic value of various metabolic parameters of (18)F-FDG PET/CT in surgically resected stage IA NSCLC. We retrospectively reviewed 248 patients with stage IA NSCLC who underwent lobectomy and complete lymph node dissection after PET/CT. A region of interest was drawn on the primary lesion, and metabolic indices such as metabolic tumor volume, maximum standardized uptake value (SUV(max)), and total lesion glycolysis (TLG) were measured using an SUV cutoff of 2.5. The patients included 134 men and 114 women, and the mean age was 63.03 ± 10.01 y; 129 were stage T1a (≤ 2 cm) and 119 were T1b (>2 cm). The median follow-up period was 36.6 mo. Recurrence took place in 15 patients. The mean (± SD) SUV(max), metabolic tumor volume, and TLG were 4.55 ± 3.75, 5.92 ± 5.57, and 14.42 ± 17.35, respectively. The cutoffs of SUV(max) and TLG were 3.7 and 13.76, respectively. The 5-y overall survival (OS) was 95.1% in low-SUV(max) patients and 82.2% in high-SUV(max) patients (P = 0.02). The 5-y OS was 93.7% in low-TLG patients and 78.3% in high-TLG patients (P = 0.01). On multivariate analysis, TLG was a risk factor for OS (hazard ratio, 3.159; P = 0.040), but SUV(max) showed marginal significance (P = 0.064). The concordance index of the TLG model was 0.676 (95% CI, 0.541-0.812). TLG was a significant prognostic factor for OS in patients with stage IA NSCLC.

Park SY ，Cho A ，Yu WS ，Lee CY ，Lee JG ，Kim DJ ，Chung KY ... -  《-》