Original Article

European Journal of Nuclear Medicine and Molecular Imaging

, Volume 41, Issue 2, pp 276-282

The association of 18F-FDG PET/CT parameters with survival in malignant pleural mesothelioma

  • Astero KlabatsaAffiliated withDepartment of Thoracic Oncology, Guys and St Thomas’ NHS Foundation Trust
  • , Sugama ChickloreAffiliated withDivision of Imaging Sciences and Biomedical Engineering, Kings College London
  • , Sally F. BarringtonAffiliated withDivision of Imaging Sciences and Biomedical Engineering, Kings College London
  • , Vicky GohAffiliated withDivision of Imaging Sciences and Biomedical Engineering, Kings College London
  • , Loic Lang-LazdunskiAffiliated withDepartment of Thoracic Oncology, Guys and St Thomas’ NHS Foundation Trust
  • , Gary J. R. CookAffiliated withDivision of Imaging Sciences and Biomedical Engineering, Kings College LondonClinical PET Centre, Division of Imaging Sciences and Biomedical Engineering, St Thomas’ Hospital, Kings College London Email author 

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Abstract

Purpose

Malignant pleural mesothelioma (MPM) is a disease with poor prognosis despite multimodal therapy but there is variation in survival between patients. Prognostic information is therefore potentially valuable in managing patients, particularly in the context of clinical trials where patients could be stratified according to risk. Therefore we have evaluated the prognostic ability of parameters derived from baseline 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT).

Methods

In order to determine the relationships between metabolic activity and prognosis we reviewed all 18F-FDG PET/CT scans used for pretreatment staging of MPM patients in our institution between January 2005 and December 2011 (n = 60) and measured standardised uptake values (SUV) including mean, maximum and peak values, metabolic tumour volume (MTV) and total lesion glycolysis (TLG). Overall survival (OS) or time to last censor was recorded, as well as histological subtypes.

Results

Median follow-up was 12.7 months (1.9–60.9) and median OS was 14.1 months (1.9–54.9). By univariable analysis histological subtype (p = 0.013), TLG (p = 0.024) and MTV (p = 0.038) were significantly associated with OS and SUVmax was borderline (p = 0.051). On multivariable analysis histological subtype and TLG were associated with OS but at borderline statistical significance (p = 0.060 and 0.058, respectively). No statistically significant differences in any PET parameters were found between the epithelioid and non-epithelioid histological subtypes.

Conclusion

18F-FDG PET/CT parameters that take into account functional volume (MTV, TLG) show significant associations with survival in patients with MPM before adjusting for histological subtype and are worthy of further evaluation to determine their ability to stratify patients in clinical trials.

Keywords

Mesothelioma 18F-FDG PET/CT Prognosis Standardised uptake value Total lesion glycolysis Metabolic tumour volume