Quantitative 18F-FDG PET analysis in survival rate prediction of patients with non-small cell lung cancer

Wenchao Ma, Minshu Wang, Xiaofeng Li, Hui Huang, Yanjia Zhu, Xiuyu Song, Dong Dai, Wengui Xu, Wenchao Ma, Minshu Wang, Xiaofeng Li, Hui Huang, Yanjia Zhu, Xiuyu Song, Dong Dai, Wengui Xu

Abstract

The aim of the present study was to investigate the prognostic value of quantitative [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) parameters for patients with non-small cell lung cancer (NSCLC). The present study conducted a retrospective review of the medical records of 203 patients with NSCLC, of which 193 patients underwent baseline 18F-FDG PET/CT prior to initial therapy. Multivariate analyses using Cox's proportional hazards regression were performed for the assessment of the association between initial PET/CT measurements and overall survival (OS). The multivariate models were adjusted for sex, age, smoking status, disease stage, standardized uptake value (SUV), standardized uptake value corrected for lean body mass (SUL), metabolic tumor volume (MTV), total lesion glycolysis (TLG) and standard deviation of SUV (SD). Kaplan-Meier (K-M) estimator curves were constructed following the formation of three approximately equal-sized groups using tertiles for each PET/CT measurement (n=65, 64 and 64). OS curves were plotted using K-M estimator curves. Results demonstrated significant associations between OS and MTVPET volume computerized assisted reporting (PETVCAR), MTV2.5, MTV25%, MTV42% and TLGPETVCAR; however, no significant associations were identified between OS and MTV50%, MTV75%, TLG2.5, all SUV and SUL. Subgroup analyses according to pathology demonstrated that there were statistically significant associations between OS and stage (P<0.001), MTV50% (P=0.002) and MTV42% (P=0.004) in the adenocarcinoma group, and SULmean (P=0.010), MTV25% (P=0.005) and MTV42% (P=0.001) in the squamous cell carcinoma group; however, no significant differences were identified between any other group. Furthermore, there was a significant association between OS and MTV42% (P=0.02) and MTV50% (P=0.04) in the early-stage group; however, no significant differences were identified in the advanced-stage group. K-M estimator curve analyses demonstrated that the pathology (P=0.01), stage (P<0.001) and all PET metabolic parameters with the exception of SD were significantly associated with OS (P<0.05). No significant associations were demonstrated between SD and OS. In conclusion, 18F-FDG PET/CT MTVPETVCAR, MTV2.5, MTV25%, MTV42% and TLGPETVCAR exhibit prognostic values with regard to OS. Overall, selection of appropriate metabolic parameters may predict NSCLC prognosis.

Keywords: [18F]fluorodeoxyglucose; lung cancer; positron emission tomography/computed tomography; quantitative analysis; survival analysis.

Figures

Figure 1.
Figure 1.
Survival rate curves for patients with SCC, AD and others. SCC, squamous cell carcinoma; AD, adenocarcinoma; Cum, cumulative.
Figure 2.
Figure 2.
Survival rate curves for patients with NSCLC. (A) Stage IA, IB, IIA, IIB, IIIA, IIIB and IV. (B) Stages I–IV. (C) Early and late stage. Cum, cumulative.
Figure 3.
Figure 3.
Survival rate curves following the formation of three approximately equal-sized groups using tertiles from each PET/CT index. Results demonstrate statistically significant associations between OS and (A) MTV2.5, (B) TLG2.5 or (C) SUVmax, but (D) no significant association between OS and SD. PET, positron emission tomography; CT, computerized tomography; MTV2.5, metabolic tumor volume >2.5; TLG2.5, total lesion glycolysis >2.5; SUVmax, maximum standardized uptake volume; SD, standard deviation of standardized uptake volume; Cum, cumulative.

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