Abstract
Background
The prognosis of patients with non-small cell lung cancer (NSCLC) is important, as patients with resectable disease and poor prognostic variables might benefit from neoadjuvant therapy. The goal of this study is to evaluate SUVmax, SUVmax ratio, CT volume (CTvol), metabolic tumour volume (MTV) and total lesion glycolisis (TLG) as survival prognostic markers. In addition, we defined two variables; MTV x SUVmax (MTVmax) and CTvol x SUVmax (CTvolmax) and assessed whether they can be used as prognostic markers.
Methods
Patients with stage I-II NSCLC who underwent 18 F FDG PET/CT and surgery were evaluated. Cox proportional-hazard model was used to determine the association between variables and survival. Similar analysis was performed in cases with no lymph node (LN) involvement.
Results
One hundred and eighty-one patients were included (at the end of the study, 140 patients were alive). SUVmax with a cut-off value of 8.2 was significant survival prognostic factor regardless of LN involvement (P = 0.012). In cases with no LN involvement, SUVmax and CTvol (≥7.1 ml) were significant survival prognostic factors with P = 0.004 and 0.03, respectively.
Conclusions
SUVmax may be a useful prognostic variable in stage I-II NSCLC while morphologic tumour volume might be useful in cases with no lymph node involvement.
Key Points
• Identifying variables that predict the prognosis of patients with NSCLC is important.
• SUVmax in primary lung tumour is a useful independent prognostic variable.
• (CTvol) is an independent prognostic variable if no lymph nodes are involved.
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Abbreviations
- CTvol:
-
CT volume
- CTvolmax:
-
CT volume x SUVmax
- MTV:
-
Metabolic tumour volume
- MTVmax:
-
MTV x SUVmax
- NSCLC:
-
Non small cell lung cancer
- SUVmax:
-
SUVmaximum
- TLG:
-
Total lesion glycolisis
References
Lewis DR, Check DP, Caporaso NE, Travis WD, Devesa SS (2014) US lung cancer trends by histologic type. Cancer 120:2883–2892
Cancer Facts & Figures 2014 - acspc-042151.pdf.
Al-Sarraf N, Gately K, Lucey J et al (2008) Clinical implication and prognostic significance of standardised uptake value of primary non-small cell lung cancer on positron emission tomography: analysis of 176 cases. Eur J Cardiothorac Surg Off J Eur Assoc Cardiothorac Surg 34:892–897
Gallamini A, Zwarthoed C, Borra A (2014) Positron Emission Tomography (PET) in Oncology. Cancers 6:1821–1889
Zhang H, Wroblewski K, Appelbaum D, Pu Y (2013) Independent prognostic value of whole-body metabolic tumor burden from FDG-PET in non-small cell lung cancer. Int J Comput Assist Radiol Surg 8:181–191
Meisinger QC, Klein JS, Butnor KJ, Gentchos G, Leavitt BJ (2011) CT features of peripheral pulmonary carcinoid tumors. AJR Am J Roentgenol 197:1073–1080
Biehl KJ, Kong F-M, Dehdashti F et al (2006) 18F-FDG PET definition of gross tumor volume for radiotherapy of non-small cell lung cancer: is a single standardized uptake value threshold approach appropriate? J Nucl Med Off Publ Soc Nucl Med 47:1808–1812
Horne ZD, Clump DA, Vargo JA et al (2014) Pretreatment SUVmax predicts progression-free survival in early-stage non-small cell lung cancer treated with stereotactic body radiation therapy. Radiat Oncol Lond Engl 9:41
Yoo IR, Chung SK, Park HL et al (2014) Prognostic value of SUVmax and metabolic tumor volume on 18F-FDG PET/CT in early stage non-small cell lung cancer patients without LN metastasis. Biomed Mater Eng 24:3091–3103
Dhital K, Saunders CA, Seed PT, O’Doherty MJ, Dussek J (2000) [(18)F]Fluorodeoxyglucose positron emission tomography and its prognostic value in lung cancer. Eur J Cardiothorac Surg Off J Eur Assoc Cardiothorac Surg 18:425–428
Bradley JD, Ieumwananonthachai N, Purdy JA et al (2002) Gross tumor volume, critical prognostic factor in patients treated with three-dimensional conformal radiation therapy for non-small-cell lung carcinoma. Int J Radiat Oncol Biol Phys 52:49–57
Lee P, Weerasuriya DK, Lavori PW et al (2007) Metabolic tumor burden predicts for disease progression and death in lung cancer. Int J Radiat Oncol Biol Phys 69:328–333
Chung HW, Lee KY, Kim HJ, Kim WS, So Y (2014) FDG PET/CT metabolic tumor volume and total lesion glycolysis predict prognosis in patients with advanced lung adenocarcinoma. J Cancer Res Clin Oncol 140:89–98
Hyun SH, Choi JY, Kim K et al (2013) Volume-based parameters of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography improve outcome prediction in early-stage non-small cell lung cancer after surgical resection. Ann Surg 257:364–370
Melloni G, Gajate AMS, Sestini S et al (2013) New positron emission tomography derived parameters as predictive factors for recurrence in resected stage I non-small cell lung cancer. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol 39:1254–1261
Acknowledgments
The scientific guarantor of this publication is Dr Liran Domachevsky. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, observational, performed at one institution.
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Domachevsky, L., Groshar, D., Galili, R. et al. Survival Prognostic Value of Morphological and Metabolic variables in Patients with Stage I and II Non-Small Cell Lung Cancer. Eur Radiol 25, 3361–3367 (2015). https://doi.org/10.1007/s00330-015-3754-8
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DOI: https://doi.org/10.1007/s00330-015-3754-8