Prediction of survival and cancer recurrence using F-18 FDG PET/CT in patients with surgically resected early stage (Stage I and II) non-small cell lung cancer

Abstract

The aim of the current study was to investigate the prognostic value of SUV max in patients with completely resected early stage (stage I & II) NSCLC.A retrospective review identified 76 patients with surgically resected early (stage I and II) NSCLC who received F-18 FDG PET/CT at diagnosis of cancer. Survival analysis was conducted using Kaplan-Meier analysis, and survival curves stratified by age, sex, mediastinal lymph node involvement, SUV max , and TNM staging were generated for estimation of overall survival and disease free survival (DFS). Independent predictive factors for survival were determined using Cox proportional hazard model.For overall survival, the median survival of the patients with tumor SUV max ≤6.7 was 48.9 months and was significantly longer than the patients with tumor SUV max >6.7 (Log rank test, Χ 2 =18.01, p<0.0001). The overall DFS was better in patients with tumor SUV max ≤5.9 than the patients with tumor SUV max >5.9. The median survival of the patients with tumor SUV max ≤5.9 was 31.7 months (Log rank test, Χ 2 =16, p=0.0001). In conclusion, high FDG uptake measured by F-18 FDG PET/CT might have a prognostic value for overall survival and DFS in surgically resected early stage (stage I & II) NSCLC even after stratified by pathologic stages. Traditionally, early stage non-small cell lung cancer (NSCLC) is managed with surgical resection. In contrast to locally advanced and metastatic NSCLC, the prognosis following resection for early stage disease is favorable. In a number of reports, 5 year survival rates for patients with stage I disease range 60~75 %, while for stage II disease five-year survival rates vary from 36~60 % [2-6]. However, the recurrence rate after curative resection still remains high and approximately half of the patients may relapse and die within 5 years, and majority of these relapses are due to distant metastasis and occur within 2 years after complete resection [7,8].Fluorine-18 fluorodeoxyglucose positron emission tomography (F-18 FDG PET) has been established as a standard imaging technique in staging, treatment monitoring, prediction of survival after treatment, and follow-up of NSCLC patients [9][10][11][12][13][14][15]. Maximal standardized uptake value (SUV max ) measured by F-18 FDG PET is a semiquantitative index reflecting tumor metabolism and activities.Several previous studies suggested the prognostic role of F-18 FDG PET in patients with early stage NSCLC after complete resection [16][17][18][19][20]. Although different threshold SUV max values were proposed, high FDG uptake is associated with reduced overall survival and disease-free survival of patients with completely resected early stage NSCLC.In the current study, we investigated the prognostic value of SUV max measured by preoperative F-18 FDG PET in patients with completely resected early stage (stage I & II) NSCLC.

Prognostic Value of 18F-FDG PET/CT in Surgical Non-Small Cell Lung Cancer: A Meta-Analysis

“…Univariate analysis of 19 studies (3178 patients) explored the prognostic role of SUV max for OS and demonstrated a combined HR of 2.54 (95%CI: 1.86–3.49, P <0.00001, I 2 = 86%) ( Fig 4A ). I 2 was not statistically significant (17 studies, 2698 patients, P = 0.19, I 2 = 23%) after the exclusion of two studies [ 34 , 39 ] with an HR of 2.26 (95%CI: 1.94–2.64). Begg’s test revealed no significant publication bias ( z = 1.47, P = 0.141).…”

“…Sensitively analysis was further conducted with significant heterogeneity ( I 2 = 72%, P <0.00001, HR 2.43, 95%CI: 1.76–3.36) for multivariate analysis of SUV max and DFS (2279 patients) ( Fig 2B ) to estimate the effect of each study on the pooled HR by omitting one study at a time. Three studies [ 34 , 44 , 55 ] were omitted, and an HR of 3.24 (2.43–4.33) using a fixed-model was obtained with a decreased I 2 of 38% and a P value of 0.07 in the Q test. The Begg’s test was statistically significant ( z = 2.23, P = 0.026).…”

Standardized uptake value by positron emission tomography/computed tomography as a prognostic variable in metastatic breast cancer

“…Because cancers typically demonstrate greater than physiologic metabolic activity with high glucose uptake, higher FDG uptake on a PET/CT image may be indicative of a more aggressive phenotype. In a variety of malignancies, a higher SUVmax at diagnosis has been associated with inferior survival 8‐18. In breast cancer, there are significant challenges to the use of PET/CT imaging as a prognostic tool, including extensive tumor heterogeneity, variable uptake of FDG, and differential response to subsequent treatment.…”

A PET/CT-based Morphometric Study of Spinal Canal in Korean Young Adults: Anteroposterior Diameter from Cervical Vertebra to Sacrum

“…However, the data analyzed in this study were of patients who underwent PET/CT for internal organ cancer, not for the spine or nervous system, to rule out metastasis. For these patients, PET/CT is essential 1 , 3 , 9 , 11 , 12) .…”