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 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 whole-body total lesion glycolysis at pretreatment FDG PET/CT in non-small cell lung cancer.

Chen HH ，Chiu NT ，Su WC ，Guo HR ，Lee BF ... -  《-》

Volume-based parameters measured by using FDG PET/CT in patients with stage I NSCLC treated with stereotactic body radiation therapy: prognostic value.

To evaluate the prognostic importance and predictive performance of volume-based parameters of fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) in patients with stage I non-small cell lung cancer (NSCLC) after stereotactic body radiation therapy (SBRT). This study had institutional review board approval. All patients gave written informed consent for SBRT as well as for future anonymous use of clinical data. Data in 88 patients with stage I NSCLC (68 patients with T1N0M0 disease and 20 with T2aN0M0 disease) who had undergone FDG PET/CT and then SBRT were retrospectively evaluated. Seventy-seven tumors were histopathologically proved (48 adenocarcinomas, 24 squamous cell carcinomas, and five unspecified non-small cell carcinomas), and the remaining 11 tumors were diagnosed clinically without histopathologic diagnosis. Maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were analyzed. The MTV of the primary tumor was calculated as all voxels with an SUV of 2.5 or greater within the isocontour line, while TLG was calculated as MTV multiplied by the average SUV, by using fixed thresholds of either 50% (TLG50) or 60% (TLG60) of the maximum intratumoral FDG activity. The prognostic importance of PET parameters and other clinicopathologic variables (age, sex, tumor size, tumor location [peripheral or central], and biologically effective dose) was assessed by using Cox proportional hazards regression analysis of overall survival (OS) and disease-free survival (DFS) for both univariate and multiple-variable analyses. The median follow-up period was 33 months. At 3 years, OS and DFS were 70.0% and 49.7%, respectively. In the univariate analyses, SUVmax (P = .001), MTV (P = .002), TLG50 (P = .001), and TLG60 (P < .001) were found to be significantly associated with DFS. In multiple variable analysis, these parameters were also significantly associated with DFS (P = .011 for SUVmax, P = .010 for MTV, P = .004 for TLG50, and P = .005 for TLG60). Only volumetric parameters (MTV, TLG50, and TLG60) were significant indicators of DFS in patients with tumors larger than 3 cm. SUVmax, MTV, and TLG at FDG PET/CT have a prognostic role for patients with NSCLC treated with SBRT. When tumors are larger than 3 cm, only MTV and TLG are predictive of DFS.

Satoh Y ，Onishi H ，Nambu A ，Araki T ... -  《-》