Abstract
Objectives
Previously published studies showed that the standard tumor-to-blood standardized uptake value (SUV) ratio (SUR) was a more accurate prognostic method than tumor maximum standardized uptake value (SUVmax). This study evaluated and compared prognostic value of positron emission tomography (PET) parameters and normalized value of PET parameters by blood pool SUV in non-small-cell lung cancer (NSCLC) patients who received curative surgery.
Methods
Seventy-seven patients who underwent curative resection for NSCLC between January 2010 to December 2013 were enrolled in this study. 18Fluorine-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) was performed before surgery. The mean standardized uptake value (SUVmean), SUVmax, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of each lesion was measured, on the workstation. SURmean, SURmax, and TLGSUR were calculated by dividing each of them by descending aorta SUVmean. Cox proportional hazards regression was used to analyze the effect of age, sex, pathological parameters, and PET parameters on recurrence and death.
Results
In Cox regression analysis, N stage predicted for both recurrence (p < 0.0001) and death (p < 0.0001). SURmax predicted recurrence (p = 0.0014), not death. Area under the receiver operating characteristic curve of SURmax was 0.759 with cutoff value 4.004. However, SUVmax, SUVmean, MTV, TLG, SURmean, and TLGSUR predicted neither recurrence nor death.
Conclusions
Among PET parameters, SURmax was the independent predictor of recurrence in NSCLC patients who received curative surgery. N stage was the independent prognostic factor for both recurrence and death. Both parameters could be used to stratify the risk of NSCLC patients.
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References
Jung K-W, Park S, Kong H-J, Won Y-J, Lee JY, Seo HG, et al. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2009. Cancer Res Treat. 2012;44:11–24.
Bareschino MA, Schettino C, Rossi A, Maione P, Sacco PC, Zeppa R, et al. Treatment of advanced non small cell lung cancer. J Thorac Dis. 2011;3:122–33.
Crino L, Weder W, van Meerbeeck J, Felip E, Group EGW. Early stage and locally advanced (non-metastatic) non-small-cell lung cancer: esmo clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol: Off J Eur Soc Med Oncol / ESMO. 2010;21 Suppl 5:v103–15.
Bunyaviroch T, Coleman RE. Pet evaluation of lung cancer. J Nucl Med. 2006;47:451–69.
Adams MC, Turkington TG, Wilson JM, Wong TZ. A systematic review of the factors affecting accuracy of suv measurements. AJR Am J Roentgenol. 2010;195:310–20.
Zhu D, Ma T, Niu Z, Zheng J, Han A, Zhao S, et al. Prognostic significance of metabolic parameters measured by (18)f-fluorodeoxyglucose positron emission tomography/computed tomography in patients with small cell lung cancer. Lung Cancer. 2011;73:332–7.
Kim K, Kim SJ, Kim IJ, Kim YS, Pak K, Kim H. Prognostic value of volumetric parameters measured by f-18 fdg pet/ct in surgically resected non-small-cell lung cancer. Nucl Med Commun. 2012;33:613–20.
Im HJ, Pak K, Cheon GJ, Kang KW, Kim SJ, Kim IJ, et al. Prognostic value of volumetric parameters of (18)f-fdg pet in non-small-cell lung cancer: a meta-analysis. Eur J Nucl Med Mol Imaging. 2015;42:241–51.
Kim DH, Son SH, Kim CY, Hong CM, Oh JR, Song BI, et al. Prediction for recurrence using f-18 fdg pet/ct in pathologic n0 lung adenocarcinoma after curative surgery. Ann Surg Oncol. 2014;21:589–96.
van den Hoff J, Oehme L, Schramm G, Maus J, Lougovski A, Petr J, et al. The pet-derived tumor-to-blood standard uptake ratio (sur) is superior to tumor suv as a surrogate parameter of the metabolic rate of fdg. EJNMMI Res. 2013;3:77.
Butof R, Hofheinz F, Zophel K, Stadelmann T, Schmollack J, Jentsch C, et al. Prognostic value of pretherapeutic tumor-to-blood standardized uptake ratio in patients with esophageal carcinoma. J Nucl Med. 2015;56:1150–6.
Tas F, Ciftci R, Kilic L, Karabulut S. Age is a prognostic factor affecting survival in lung cancer patients. Oncol Lett. 2013;6:1507–13.
Asmis TR, Ding K, Seymour L, Shepherd FA, Leighl NB, Winton TL, et al. National Cancer Institute of Canada Clinical Trials G: age and comorbidity as independent prognostic factors in the treatment of non small-cell lung cancer: a review of national cancer institute of Canada clinical trials group trials. J Clin Oncol: Off J Am Soc Clin Oncol. 2008;26:54–9.
Ye T, Pan Y, Wang R, Hu H, Zhang Y, Li H, et al. Analysis of the molecular and clinicopathologic features of surgically resected lung adenocarcinoma in patients under 40 years old. J Thorac Dis. 2014;6:1396–402.
Hsu CL, Chen JH, Chen KY, Shih JY, Yang JC, Yu CJ, et al. Advanced non-small cell lung cancer in the elderly: the impact of age and comorbidities on treatment modalities and patient prognosis. J Geriatr Oncol. 2015;6:38–45.
Goldstraw P, Crowley J, Chansky K, Giroux DJ, Groome PA, Rami-Porta R, et al. The iaslc lung cancer staging project: proposals for the revision of the tnm stage groupings in the forthcoming (seventh) edition of the tnm classification of malignant tumours. J Thorac Oncol: Off Publ Int Assoc Study of Lung Cancer. 2007;2:706–14.
Berghmans T, Dusart M, Paesmans M, Hossein-Foucher C, Buvat I, Castaigne C, et al. Primary tumor standardized uptake value (suvmax) measured on fluorodeoxyglucose positron emission tomography (fdg-pet) is of prognostic value for survival in non-small cell lung cancer (nsclc): a systematic review and meta-analysis (ma) by the European lung cancer working party for the iaslc lung cancer staging project. J Thorac Oncol. 2008;3:6–12.
Chen HH, Chiu N-T, Su W-C, Guo H-R, Lee B-F. Prognostic value of whole-body total lesion glycolysis at pretreatment fdg pet/ct in non–small cell lung cancer. Radiology. 2012;264:559–66.
Wahl RL, Jacene H, Kasamon Y, Lodge MA. From recist to percist: evolving considerations for pet response criteria in solid tumors. J Nucl Med. 2009;50 Suppl 1:122S–50S.
Chu KP, Murphy JD, La TH, Krakow TE, Iagaru A, Graves EE, et al. Prognostic value of metabolic tumor volume and velocity in predicting head-and-neck cancer outcomes. Int J Radiat Oncol Biol Phys. 2012;83:1521–7.
Takahashi Y, Oriuchi N, Otake H, Endo K, Murase K. Variability of lesion detectability and standardized uptake value according to the acquisition procedure and reconstruction among five pet scanners. Ann Nucl Med. 2008;22:543–8.
Laffon E, Adhoute X, de Clermont H, Marthan R. Is liver suv stable over time in (1)(8)f-fdg pet imaging? J Nucl Med Technol. 2011;39:258–63.
Park J, Chang KJ, Seo YS, Byun BH, Choi JH, Moon H, et al. Tumor suvmax normalized to liver uptake on (18)f-fdg pet/ct predicts the pathologic complete response after neoadjuvant chemoradiotherapy in locally advanced rectal cancer. Nucl Med Mol Imaging. 2014;48:295–302.
Song MJ, Bae SH, Lee SW, Song do S, Kim HY, Yoo Ie R, et al. 18f-fluorodeoxyglucose pet/ct predicts tumour progression after transarterial chemoembolization in hepatocellular carcinoma. Eur J Nucl Med Mol Imaging. 2013;40:865–73.
Shiono S, Abiko M, Okazaki T, Chiba M, Yabuki H, Sato T. Positron emission tomography for predicting recurrence in stage i lung adenocarcinoma: Standardized uptake value corrected by mean liver standardized uptake value. Eur J Cardiothorac Surg: Off J Eur Assoc Cardiothorac Surg. 2011;40:1165–9.
Besson FL, de Boysson H, Parienti JJ, Bouvard G, Bienvenu B, Agostini D. Towards an optimal semiquantitative approach in giant cell arteritis: An (18)f-fdg pet/ct case–control study. Eur J Nucl Med Mol Imaging. 2014;41:155–66.
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Seunghyeon Shin, Seong-Jang Kim, In Joo Kim, Kyoungjune Pak and Bum Soo Kim declare that they have no conflict of interest.
Ethical Statement
The study was approved by an institutional review board or equivalent and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All subjects in the study gave written informed consent or the institutional review board waived the need to obtain informed consent.
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Shin, S., Pak, K., Kim, I.J. et al. Prognostic Value of Tumor-to-Blood Standardized Uptake Ratio in Patients with Resectable Non-Small-Cell Lung Cancer. Nucl Med Mol Imaging 51, 233–239 (2017). https://doi.org/10.1007/s13139-016-0456-3
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DOI: https://doi.org/10.1007/s13139-016-0456-3