Metabolic active tumour volume quantified on [18F]FDG PET/CT further stratifies TNM stage IV non-small cell lung cancer patients

Rocha, Ana Luísa Gomes; da Conceição, Mauro Alessandro Monteiro; da Cunha Sequeira Mano, Francisco Xavier Proença; Martins, Helder Carvalho; Costa, Gracinda Maria Lopes Magalhães; Dos Santos Oliveiros Paiva, Bárbara Cecília Bessa; Lapa, Paula Alexandra Amado

doi:10.1007/s00432-021-03799-w

Metabolic active tumour volume quantified on [¹⁸F]FDG PET/CT further stratifies TNM stage IV non-small cell lung cancer patients

Original Article – Cancer Research
Published: 27 September 2021

Volume 147, pages 3601–3611, (2021)
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Abstract

Purpose

This study aimed to assess whether the whole body metabolic active tumour volume (MTV_WB), quantified on staging [¹⁸F]FDG PET/CT, could further stratify stage IV non-small cell lung cancer (NSCLC) patients.

Methods

A group of 160 stage IV NSCLC patients, submitted to staging [¹⁸F]FDG PET/CT between July 2010 and May 2020, were retrospectively evaluated. MTV_WB was quantified. Univariate and multivariate Cox regressions were carried out to assess correlation with overall survival (OS). C-statistic was used to test predictive power. Kaplan–Meier survival curves with Log-Rank tests were performed to compute statistical differences between strata from dichotomized variables and to calculate the estimated mean survival times (EMST). Survival rates at 1 and 5 years were calculated.

Results

MTV_WB was a statistically significant predictor of OS on univariate (p < 0.0001) and multivariate analyses (p < 0.0001). The multivariate model with MTV_WB (Cindex ± SE = 0.657 ± 0.024) worked significantly better as an OS predictor than the cTNM model (Cindex ± SE = 0.544 ± 0.028) (p = 0.003). An EMST of 29.207 ± 3.627(95% CI 22.099–36.316) months and an EMST of 10.904 ± 1.171(95% CI 8.609–13.199) months (Log-Rank p < 0.0001) were determined for patients with MTV_WB < 104.3 and MTV_WB ≥ 104.3, respectively. In subsamples of stage IVA (cut-off point = 114.5) and IVB patients (cut-off point = 191.1), statistically significant differences between EMST were also reported, with p-values of 0.0001 and 0.0002, respectively. In both substages and in the entire cohort, patients with MTV_WB ≥ cut-off points had lower EMST and survival rates.

Conclusion

Baseline MTV_WB, measured on staging [¹⁸F]FDG PET/CT, further stratifies stage IV NSCLC patients. This parameter is an independent predictor of OS and provides valuable prognostic information over the 8th edition of cTNM staging.

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Availability of data and materials

The datasets generated and analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

[¹⁸F]FDG PET/CT:: 2-Deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography
3-D:: Three dimensional
AJCC:: American Joint Committee on Cancer
Ca.:: Carcinoma
CHUC:: Centro Hospitalar e Universitário de Coimbra
CI:: Confidence interval
C Index:: Harrell’s Concordance Index
cm³ :: Cubic centimetre
CT:: Computed tomography
cTNM staging:: Clinical tumour, node, metastasis staging
EMST:: Estimated mean survival time
FU:: Follow-up
GE:: General electric
HR:: Hazard ratio
IMB:: International Business Machines Corporation
IQR:: Interquartile range
kg:: Kilogram
kV:: Kilovolt
mA:: Milliampere
Max:: Maximum
MBq:: Megabecquerel
MBq.min.bed⁻¹ kg⁻¹ :: Megabecquerel.minute.bed⁻¹ kg⁻¹
Min:: Minimum
min.bed⁻ ¹ :: Minute.bed⁻¹
mm:: Millimetre
MTV:: Metabolic active tumour volume
MTV_WB :: Metabolic active tumour volume of the whole body
n:: Number of individuals
NSCLC:: Non-small cell lung carcinoma
NY:: New York
OS:: Overall survival
p :: p Value
PET:: Positron emission tomography
PET/CT:: Positron emission tomography/computed tomography
PET_VCAR:: Positron emission tomography with volume computer assisted reading
SD:: Standard deviation
SE:: Standard error
SPSS:: Statistical package for the social sciences
SUV:: Standardized uptake value
SUV_max :: Maximum standardized uptake value
SUV_mean :: Mean standardized uptake value
TLG:: Total lesion glycolysis
TLG_WB :: Total lesion glycolysis of the whole body
TNM staging:: Tumour, node, metastasis staging
USA:: United States of America
VUE:: Virtually unenhanced
vxtl:: Verxatile
WI:: Wisconsin

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Authors and Affiliations

Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, Celas, 3000-548, Coimbra, Portugal
Ana Luísa Gomes Rocha, Francisco Xavier Proença da Cunha Sequeira Mano, Gracinda Maria Lopes Magalhães Costa & Paula Alexandra Amado Lapa
Department of Nuclear Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
Mauro Alessandro Monteiro da Conceição, Gracinda Maria Lopes Magalhães Costa & Paula Alexandra Amado Lapa
Department of Nuclear Medicine, Centro Hospitalar e Universitário do Porto, Porto, Portugal
Helder Carvalho Martins
Laboratory of Biostatistics and Medical Informatics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
Bárbara Cecília Bessa Dos Santos Oliveiros Paiva
Coimbra Institute for Clinical and Biomedical Research, University of Coimbra, Coimbra, Portugal
Bárbara Cecília Bessa Dos Santos Oliveiros Paiva

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Ana Luísa Gomes Rocha
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Mauro Alessandro Monteiro da Conceição
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Francisco Xavier Proença da Cunha Sequeira Mano
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Helder Carvalho Martins
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Gracinda Maria Lopes Magalhães Costa
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Bárbara Cecília Bessa Dos Santos Oliveiros Paiva
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Paula Alexandra Amado Lapa
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Correspondence to Ana Luísa Gomes Rocha.

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Rocha, A.L.G., da Conceição, M.A.M., da Cunha Sequeira Mano, F.X.P. et al. Metabolic active tumour volume quantified on [¹⁸F]FDG PET/CT further stratifies TNM stage IV non-small cell lung cancer patients. J Cancer Res Clin Oncol 147, 3601–3611 (2021). https://doi.org/10.1007/s00432-021-03799-w

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