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Prognostic impact of combining whole-body PET/CT and brain PET/MR in patients with lung adenocarcinoma and brain metastases

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The role of brain FDG-PET in patients with lung cancer and brain metastases remains unclear. Here, we sought to determine the prognostic significance of whole-body PET/CT plus brain PET/MR in predicting the time to neurological progression (nTTP) and overall survival (OS) in this patient group.

Methods

Of 802 patients with non-small cell lung cancer who underwent primary staging by a single-day protocol of whole-body PET/CT plus brain PET/MR, 72 cases with adenocarcinoma and brain metastases were enrolled for a prognostic analysis of OS. On the basis of the available follow-up brain status, only 52 patients were eligible for prognostic analysis of nTTP. Metastatic brain tumors were identified on post-contrast MR imaging, and the tumor-to-brain ratio (TBR) was measured on PET images.

Results

Multivariate analysis revealed that FDG-PET findings and eligibility for initial treatment with targeted therapy were significant independent predictors of nTTP and OS. A new index, termed the molecular imaging prognostic (MIP) score, was proposed to define three disease classes. MIP scores were significant predictors of both nTTP and OS (P < 0.001). Pre-existing prognostic indices such as Lung-molGPA scores were significant predictors of OS but did not predict nTTP.

Conclusions

When staging is performed with whole-body PET/CT plus brain PET/MR, our new prognostic index may be helpful to stratify the outcomes of patients with lung adenocarcinoma and brain metastases. The superior prognostic power of this index for nTTP might be used to select appropriate patients for intracranial control and thereby achieve better quality of life.

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Acknowledgements

This study was financially supported by a grant from the Chang Gung Memorial Hospital (CMRPG3B0343), Taiwan. The authors acknowledge the statistical assistance provided by the Clinical Trial Center (MOHW107-TDU-B-212-123005), Linkou, Taiwan.

Funding

This study was financially supported by a grant from the Chang Gung Memorial Hospital (CMRPG3B0343), Taiwan.

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Keelung, Taiwan

    Kung-Chu Ho & Tzu-Pei Su

  2. Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan

    Cheng-Hong Toh

  3. Department of Thoracic Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan

    Shih-Hong Li, Chien-Ying Liu & Cheng-Ta Yang

  4. Department of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan

    Yu-Jen Lu

  5. Department of Anatomic Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan

    Chih-Wei Wang

  6. Department of Nuclear Medicine and Center for Advanced Molecular Imaging and Translation, Chang Gung Memorial Hospital and Chang Gung University, 5 Fu-Shin Street, Kueishan, Taoyuan, 333, Taiwan

    Tzu-Chen Yen

  7. Department of Nuclear Medicine, Xiamen Chang Gung Hospital, Xiamen, Fujian, China

    Tzu-Chen Yen

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  1. Kung-Chu Ho
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Correspondence to Tzu-Chen Yen.

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The authors declare no conflicts of interest.

Ethical approval

All procedures performed in the study were in accordance with the ethical standards of the institutional and/or national research committee and the 1964 Helsinki Declaration (and its later amendments).

Informed consent

Waiver of consent for this retrospective study was approved by the Institutional Review Board.

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Ho, KC., Toh, CH., Li, SH. et al. Prognostic impact of combining whole-body PET/CT and brain PET/MR in patients with lung adenocarcinoma and brain metastases. Eur J Nucl Med Mol Imaging 46, 467–477 (2019). https://doi.org/10.1007/s00259-018-4210-1

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  • DOI: https://doi.org/10.1007/s00259-018-4210-1

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