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Ventura L, Scarlattei M, Gnetti L, Silini EM, Rossi M, Tiseo M, Sverzellati N, Bocchialini G, Musini L, Balestra V, Ampollini L, Rusca M, Carbognani P, Ruffini L. Prognostic value of [ 18F]FDG PET/CT parameters in surgically resected primary lung adenocarcinoma: a single-center experience. TUMORI JOURNAL 2020; 106:300891620904404. [PMID: 32056506 DOI: 10.1177/0300891620904404] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the prognostic role of maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) measured by FDG-positron emission tomography (PET)/computed tomography (CT) in patients with primary lung adenocarcinoma undergoing surgical resection. METHODS All consecutive patients undergoing curative surgery for primary lung adenocarcinoma at the Thoracic Surgery Unit of the University Hospital of Parma between January 2009 and December 2014 were retrospectively analyzed. The cutoff point of each continuous PET parameter was determined through receiver operating characteristic curve and Youden index, using overall survival (OS) as the classification status. Univariate and multivariate Cox proportional hazards models were applied to evaluate the association between OS and potential prognostic variables, including SUVmax, MTV, and TLG. RESULTS A total of 193 patients were considered eligible for this study. The mean 5-year OS rate was 70.5 ± 3.5%. Acinar and lepidic patterns were more frequently associated with absent or low (<2.5) SUVmax values [18F]FDG uptake. At univariate analysis, male sex, advanced stage, micropapillary and solid pattern, lymphatic, blood vessels and pleural invasion, high SUVmax, MTV, and TLG were significantly associated with poorer OS. Multivariate analyses revealed that only sex, stage, and TLG were independent factors for OS, with male sex, stage 3+4, and high TLG value (p = 0.041) significantly associated with poorer OS. CONCLUSIONS In this study, [18F]FDG PET/CT parameters SUVmax, MTV, and TLG were prognostic factors in patients with surgically resected lung adenocarcinoma, able to predict OS and helping to further stratify these patients into prognostic subsets. Elevated TLG was also an independent predictor for shorter OS.
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Affiliation(s)
- Luigi Ventura
- Thoracic Surgery, Department of Vascular, Cardiac and Thoracic Surgery, University Hospital of Parma, Parma, Italy
| | - Maura Scarlattei
- Nuclear Medicine Unit, University Hospital of Parma, Parma, Italy
| | - Letizia Gnetti
- Pathology Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Enrico Maria Silini
- Pathology Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Maurizio Rossi
- Department of Clinical and Experimental Medicine, University Hospital of Parma, Parma, Italy
| | - Marcello Tiseo
- Medical Oncology, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Nicola Sverzellati
- Section of Radiology, Diagnostic Department, University Hospital of Parma, Parma, Italy
| | - Giovanni Bocchialini
- Thoracic Surgery, Department of Vascular, Cardiac and Thoracic Surgery, University Hospital of Parma, Parma, Italy
| | - Luca Musini
- Thoracic Surgery, Department of Vascular, Cardiac and Thoracic Surgery, University Hospital of Parma, Parma, Italy
| | - Valeria Balestra
- Thoracic Surgery, Department of Vascular, Cardiac and Thoracic Surgery, University Hospital of Parma, Parma, Italy
| | - Luca Ampollini
- Thoracic Surgery, Department of Vascular, Cardiac and Thoracic Surgery, University Hospital of Parma, Parma, Italy
| | - Michele Rusca
- Thoracic Surgery, Department of Vascular, Cardiac and Thoracic Surgery, University Hospital of Parma, Parma, Italy
| | - Paolo Carbognani
- Thoracic Surgery, Department of Vascular, Cardiac and Thoracic Surgery, University Hospital of Parma, Parma, Italy
| | - Livia Ruffini
- Nuclear Medicine Unit, University Hospital of Parma, Parma, Italy
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Prognostic Value of the Volumetric Parameters of Dual–Time-Point18F-FDG PET/CT in Non–Small Cell Lung Cancer Treated With Definitive Radiation Therapy. AJR Am J Roentgenol 2019; 213:1366-1373. [DOI: 10.2214/ajr.19.21376] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Shrestha S, Higuchi T, Shirai K, Tokue A, Shrestha S, Saitoh JI, Hirasawa H, Ohno T, Nakano T, Tsushima Y. Prognostic significance of semi-quantitative FDG-PET parameters in stage I non-small cell lung cancer treated with carbon-ion radiotherapy. Eur J Nucl Med Mol Imaging 2019; 47:1220-1227. [PMID: 31758225 PMCID: PMC7101295 DOI: 10.1007/s00259-019-04585-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/16/2019] [Indexed: 12/24/2022]
Abstract
Purpose Prognostic significance of volumetric 18F-fluorodeoxyglucose (FDG) positron emission tomography/computer tomography (PET/CT) parameters in carbon-ion radiotherapy (C-ion RT) treated stage I non-small cell lung cancer, and need of histology-wise separate cut-off values for risk stratification were assessed. Methods Thirty-nine patients (29 men and 10 women, 71.9 ± 8.3 years) who underwent FDG PET/CT examinations before C-ion RT were retrospectively evaluated. FDG-PET parameters: standardized uptake values (SUVmax, SUVpeak, and SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG), and clinicopathological variables were assessed for prognosis using Cox proportional hazards regression analysis. Mann-Whitney test compared medians of significant parameters between adenocarcinoma (AC) and squamous cell carcinoma (SCC), and Kaplan-Meier curves were plotted for median-based low- and high-risk groups. Results Median follow-up period was 44.8 months. 1/2/3-year overall survival (OS), progression-free survival (PFS) and local control (LC) rates were 94.9/84.3/70.8, 82.1/69.2/58.4 and 97.3/85.7/82.3%. Multivariate analysis revealed age (hazard ratio, HR: 1.09; 95% confidence interval, CI: 1.0–1.19, p < 0.05) and MTV (HR 4.83, 95% CI 1.21–19.27, p < 0.03) predicted OS, and only MTV predicted PFS (HR 5.3, CI 1.32–21.35, p < 0.02) independently. Compared with AC, SCC had higher MTV (median, 6.625cm3 vs 0.2 cm3, p < 0.01). Single MTV cut-off based on overall cohort was insignificant in SCC for PFS (p > 0.02); separate cut-offs of MTV, 0.2 cm3 for AC (p < 0.03) and 6.625 cm3 for SCC (p < 0.05) were relevant. Conclusion Among all FDG PET/CT parameters, only MTV beared prognostic ability for stage I NSCLC treated with C-ion RT, and its histological variation may need consideration for risk-adapted therapeutic management.
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Affiliation(s)
- Suman Shrestha
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511 Japan
- Department of Diagnostic Radiology and Nuclear Medicine, Nepal Cancer Hospital and Research Center, Harisiddhi, Lalitpur, Nepal
| | - Tetsuya Higuchi
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511 Japan
| | - Katsuyuki Shirai
- Gunma University Heavy Ion Medical Center, Gunma University, Maebashi, Japan
| | - Azusa Tokue
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511 Japan
| | - Shreya Shrestha
- Department of Nephrology and Rheumatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Jun-ichi Saitoh
- Gunma University Heavy Ion Medical Center, Gunma University, Maebashi, Japan
| | - Hiromi Hirasawa
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511 Japan
| | - Tatsuya Ohno
- Gunma University Heavy Ion Medical Center, Gunma University, Maebashi, Japan
| | - Takashi Nakano
- Gunma University Heavy Ion Medical Center, Gunma University, Maebashi, Japan
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511 Japan
- Research Program for Diagnostic and Molecular Imaging, Division of Integrated Oncology Research, Gunma University Initiative for Advanced Research (GIAR), Maebashi, Japan
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Volume-based parameters on FDG PET may predict the proliferative potential of soft-tissue sarcomas. Ann Nucl Med 2018; 33:22-31. [PMID: 30196378 DOI: 10.1007/s12149-018-1298-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/03/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Soft-tissue sarcomas (STS) are rare types of tumors that have variable levels of tumor differentiation. F-18 fluorodeoxyglucose positron emission tomography (FDG PET) has been established as an useful tool for STS patients, and the metabolic tumor volume (MTV) and total lesion glycolysis (TLG) are reported to be useful in various cancers. We compared the diagnostic value of four PET parameters (maximum standardized uptake value [SUVmax], SUVmean, MTV, and TLG) from two acquisition timings for predicting the expression of the pathological marker of cell proliferation Ki-67, based on pathological investigation. MATERIALS AND METHODS In this retrospective study, we investigated 20 patients (59 ± 19 years old, 18-87 years old) with pathologically confirmed STS who underwent FDG PET before surgical intervention. The patients fasted ≥ 6 h before the intravenous injection of FDG. The whole body was scanned twice; at an early phase (61.5 ± 2.6 min) and at a delayed phase (118.0 ± 2.1 min) post-injection. The SUVmax, SUVmean, MTV, and TLG of the primary lesion were measured with a tumor boundary determined by SUV ≥ 2.0. Ki-67 was measured using MIB-1 immunohistochemistry. We used Pearson's correlation coefficient to analyze the relationships between the PET parameters and Ki-67 expressions. The Kaplan-Meier analysis with the log-rank test was performed to compare overall survival between high-group and low-group at each of the four PET parameters and Ki-67 expression. RESULTS All four PET parameters at each phase showed significant correlations with Ki-67. Among them, the Pearson's correlation coefficient (r) was largest for TLG (r = 0.76 and 0.77 at the early and delayed phases, respectively), followed by MTV (0.70 and 0.72), SUVmax (r = 0.65 and 0.66), and SUVmean (r = 0.62 and r = 0.64). From early to delayed phases, the SUVmax and SUVmean both increased in all 20 patients, whereas the MTV and TLG increased in 13/20 (65%) and 16/20 (80%) patients, respectively. None of the %increases of the PET parameters were significantly correlated with Ki-67. The overall survival was shorter for high-SUVmax, high-SUVmean, high-TLG, and high-Ki-67 groups than the other groups, although the difference did not reach statistical significance. CONCLUSION The SUVmax, SUVmean, MTV, and TLG acquired at both 1 and 2 h after injection showed significant correlations with Ki-67. Among them, correlation coefficient with Ki-67 expression was highest for TLG, although the best parameter should be determined in a larger population. The delayed-phase FDG PET was equally useful as that of early-phase to predict tumor aggressiveness in STS.
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Pu Y, Zhang JX, Liu H, Appelbaum D, Meng J, Penney BC. Developing and validating a novel metabolic tumor volume risk stratification system for supplementing non-small cell lung cancer staging. Eur J Nucl Med Mol Imaging 2018; 45:2079-2092. [PMID: 29882161 DOI: 10.1007/s00259-018-4059-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/23/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE We hypothesized that whole-body metabolic tumor volume (MTVwb) could be used to supplement non-small cell lung cancer (NSCLC) staging due to its independent prognostic value. The goal of this study was to develop and validate a novel MTVwb risk stratification system to supplement NSCLC staging. METHODS We performed an IRB-approved retrospective review of 935 patients with NSCLC and FDG-avid tumor divided into modeling and validation cohorts based on the type of PET/CT scanner used for imaging. In addition, sensitivity analysis was conducted by dividing the patient population into two randomized cohorts. Cox regression and Kaplan-Meier survival analyses were performed to determine the prognostic value of the MTVwb risk stratification system. RESULTS The cut-off values (10.0, 53.4 and 155.0 mL) between the MTVwb quartiles of the modeling cohort were applied to both the modeling and validation cohorts to determine each patient's MTVwb risk stratum. The survival analyses showed that a lower MTVwb risk stratum was associated with better overall survival (all p < 0.01), independent of TNM stage together with other clinical prognostic factors, and the discriminatory power of the MTVwb risk stratification system, as measured by Gönen and Heller's concordance index, was not significantly different from that of TNM stage in both cohorts. Also, the prognostic value of the MTVwb risk stratum was robust in the two randomized cohorts. The discordance rate between the MTVwb risk stratum and TNM stage or substage was 45.1% in the modeling cohort and 50.3% in the validation cohort. CONCLUSION This study developed and validated a novel MTVwb risk stratification system, which has prognostic value independent of the TNM stage and other clinical prognostic factors in NSCLC, suggesting that it could be used for further NSCLC pretreatment assessment and for refining treatment decisions in individual patients.
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Affiliation(s)
- Yonglin Pu
- Department of Radiology, The University of Chicago, 5841 S. Maryland Ave., MC 2026, Chicago, IL, 60637, USA.
| | - James X Zhang
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Haiyan Liu
- Department of Nuclear Medicine, First Hospital and Molecular Imaging Precision Medical Collaborative Innovation Center, Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Daniel Appelbaum
- Department of Radiology, The University of Chicago, 5841 S. Maryland Ave., MC 2026, Chicago, IL, 60637, USA
| | - Jianfeng Meng
- Department of Respiratory Medicine, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, 541002, Guangxi Zhuang Autonomous Region, China
| | - Bill C Penney
- Department of Radiology, The University of Chicago, 5841 S. Maryland Ave., MC 2026, Chicago, IL, 60637, USA
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Finkle JH, Jo SY, Ferguson MK, Liu HY, Zhang C, Zhu X, Yuan C, Pu Y. Risk-stratifying capacity of PET/CT metabolic tumor volume in stage IIIA non-small cell lung cancer. Eur J Nucl Med Mol Imaging 2017; 44:1275-1284. [PMID: 28265739 PMCID: PMC6048959 DOI: 10.1007/s00259-017-3659-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 02/14/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Stage IIIA non-small cell lung cancer (NSCLC) is heterogeneous in tumor burden, and its treatment is variable. Whole-body metabolic tumor volume (MTVWB) has been shown to be an independent prognostic index for overall survival (OS). However, the potential of MTVWB to risk-stratify stage IIIA NSCLC has previously been unknown. If we can identify subgroups within the stage exhibiting significant OS differences using MTVWB, MTVWB may lead to adjustments in patients' risk profile evaluations and may, therefore, influence clinical decision making regarding treatment. We estimated the risk-stratifying capacity of MTVWB in stage IIIA by comparing OS of stratified stage IIIA with stage IIB and IIIB NSCLC. METHODS We performed a retrospective review of 330 patients with clinical stage IIB, IIIA, and IIIB NSCLC diagnosed between 2004 and 2014. The patients' clinical TNM stage, initial MTVWB, and long-term survival data were collected. Patients with TNM stage IIIA disease were stratified by MTVWB. The optimal MTVWB cutoff value for stage IIIA patients was calculated using sequential log-rank tests. Univariate and multivariate cox regression analyses and Kaplan-Meier OS analysis with log-rank tests were performed. RESULTS The optimal MTVWB cut-point was 29.2 mL for the risk-stratification of stage IIIA. We identified statistically significant differences in OS between stage IIB and IIIA patients (p < 0.01), between IIIA and IIIB patients (p < 0.01), and between the stage IIIA patients with low MTVWB (below 29.2 mL) and the stage IIIA patients with high MTVWB (above 29.2 mL) (p < 0.01). There was no OS difference between the low MTVWB stage IIIA and the cohort of stage IIB patients (p = 0.485), or between the high MTVWB stage IIIA patients and the cohort of stage IIIB patients (p = 0.459). Similar risk-stratification capacity of MTVWB was observed in a large range of cutoff values from 15 to 55 mL in stage IIIA patients. CONCLUSIONS Using MTVWB cutoff points ranging from 15 to 55 mL with an optimal value of 29.2 mL, stage IIIA NSCLC may be effectively stratified into subgroups with no significant survival difference from stages IIB or IIIB NSCLC. This may result in more accurate survival estimation and more appropriate risk adapted treatment selection in stage IIIA NSCLC.
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Affiliation(s)
- Joshua H Finkle
- Department of Radiology, University of Chicago, 5841 S. Maryland Ave., Chicago, IL, 60637, USA
| | - Stephanie Y Jo
- Department of Radiology, University of Chicago, 5841 S. Maryland Ave., Chicago, IL, 60637, USA
| | - Mark K Ferguson
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Hai-Yan Liu
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Chenpeng Zhang
- Department of Nuclear Medicine, RenJi Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xuee Zhu
- Department of Radiology, BenQ Medical Center, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Cindy Yuan
- Department of Radiology, University of Chicago, 5841 S. Maryland Ave., Chicago, IL, 60637, USA
| | - Yonglin Pu
- Department of Radiology, University of Chicago, 5841 S. Maryland Ave., Chicago, IL, 60637, USA.
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Lim DH, Lee JH. Relationship Between Dual Time Point FDG PET/CT and Clinical Prognostic Indexes in Patients with High Grade Lymphoma: a Pilot Study. Nucl Med Mol Imaging 2017; 51:323-330. [PMID: 29242726 DOI: 10.1007/s13139-017-0480-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 02/20/2017] [Accepted: 03/21/2017] [Indexed: 11/25/2022] Open
Abstract
Purpose This study investigated the correlative relationship between metabolic parameters estimated from dual time point 2-deoxy-2-[18F] fluoro-D-glucose (18F-FDG) positron emission tomography/computerized tomography (PET/CT) and the clinical tools predicting the outcome of a lymphoma. We also measured metabolic and volumetric alterations between early and delayed 18F-FDG PET/CT in patients with high grade lymphoma (HGL). Methods The samples were 122 lymph nodes and extralymphatic lesions from 26 patients diagnosed with HGL. All patients were applied to the International Prognostic Index (IPI), Ann Arbor stage, and revised IPI as clinical prognostic parameters. 18F-FDG dual time point PET/CT (DTPFP) consisted of an early scan 1 h after 18F-FDG injection and a delayed scan 2 h after the early scan. Based on an analysis of DTPFP, we estimated the standardized uptake value (SUV) of tumors from the early and delayed scans, retention index (RI) representing the percentage change between early and delayed SUV, and metabolic volume different index (MVDI) calculated using metabolic tumor volumes (MTV). Results RImax showed a multiple positive correlative relationship with stage and IPI in lesion-by-lesion analysis (p < 0.01). In the case of IPI, the high risk group exhibited higher RImax than the low risk group (p = 0.004). In the case of revised IPI, the RImax of the low risk group were significantly lower than the intermediate and high risk groups, respectively (p < 0.01). The MVDIs of the best outcome group were decreased in comparison to the moderate outcome group (p = 0.029). There was a significant negative correlative relationship between RImax and MVDI, and the inclinations for decreased MVDIs were slightly associated with increased RIs. Conclusions RImax extracted from DTPFP had a significant relationship to extranodal involvement, staging, IPI, and revised IPI. MVDI showed significant negative correlation with RImax. Further large scale studies are warranted to support and extend these preliminary results.
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Affiliation(s)
- Do Hyoung Lim
- Division of Hematology-Oncology, Department of Internal Medicine, Dankook University College of Medicine, Cheonan, South Korea
| | - Jai Hyuen Lee
- Department of Nuclear Medicine, Dankook University College of Medicine, Dongnam-ku, Anseo-dong Cheonan, 330-715 South Korea
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Prognostic value of quantitative PET/CT in patients with a nonsmall cell lung cancer and another primary cancer. Nucl Med Commun 2017; 38:185-192. [PMID: 27922540 DOI: 10.1097/mnm.0000000000000627] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The staging and management of patients with newly diagnosed nonsmall cell lung cancer (NSCLC) in the setting of recently diagnosed other (metachronous or synchronous) primary cancer are challenging. This retrospective cohort study was carried out to test our hypothesis that baseline 2-deoxy-2-[F]fluoro-D-glucose (F-FDG) PET/CT parameters, including whole-body metabolic tumor volume (MTVWB), total lesion glycolysis (TLGWB), and maximum standardized uptake value (SUVmaxWB), are associated with the overall survival (OS) of such patients. PATIENTS AND METHODS A total of 110 NSCLC patients (52 men and 58 women, aged 68.6±7.8 years) with other primary malignant cancers who had baseline F-FDG PET/CT scans were retrospectively reviewed. MTVWB, TLGWB, and SUVmaxWB were measured. Kaplan-Meier analysis with the log-rank test and Cox regression models were used to assess the association of OS with F-FDG PET/CT parameters and clinical risk factors. RESULTS Kaplan-Meier analysis and univariate Cox regression models showed significant associations of OS with ln(MTVWB), ln(TLGWB), ln(SUVmaxWB), TNM stage, and treatment type (surgery vs. no treatment). Multivariable Cox regression models showed a significant relationship of OS with ln(MTVWB) [hazard ratio (HR)=1.368, P=0.001], ln(TLGWB) (HR=1.313, P<0.001), and ln(SUVmaxWB) (HR=1.739, P=0.006), adjusted for age, treatment type, tumor histology, and TNM stage. The TNM stage was not associated significantly with OS when MTVWB, TLGWB, or SUVmaxWB were included in the multivariable models. CONCLUSION MTVWB, TLGWB, and SUVmaxWB from baseline F-FDG PET/CT are associated individually with OS of patients with both NSCLC and other primary malignant tumors independent of age, treatment type, tumor histology, and TNM stage.
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18F-FDG PET/CT Metabolic Tumor Volume and Intratumoral Heterogeneity in Pancreatic Adenocarcinomas: Impact of Dual-Time Point and Segmentation Methods. Clin Nucl Med 2017; 42:e16-e21. [PMID: 27819858 DOI: 10.1097/rlu.0000000000001446] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES We aimed to determine the consistency of quantitative PET measurements of metabolic tumor volume (MTV) and intratumoral heterogeneity index for primary untreated pancreatic adenocarcinomas, when using dual-time point F-FDG PET/CT imaging. METHODS This is an institutional review board-approved, retrospective study including 71 patients with pancreatic adenocarcinoma, who underwent dual-time point F-FDG PET/CT imaging, at approximately 1 hour (early) and 2 hours (delayed), after injection. Automated gradient-based and 50% SUVmax-threshold segmentation methods were used to assess the primary tumor MTV and metabolic intratumoral heterogeneity index, calculated as the area under cumulative SUV-volume histograms (AUC-CSH), with lower AUC-CHS indexes corresponding to higher degrees of tumor heterogeneity. We defined that more than a ±10% change in MTV or AUC-CSH, compared with baseline, as clinically significant. RESULTS Seventy-one FDG-avid pancreatic tumors were identified, with an average tumor diameter of 3.4 ± 0.9 cm (range, 1.5-6.4 cm). Metabolic tumor volume values remained consistent between early and delayed imaging when using the gradient PET segmentation method (P = 0.086), whereas statistically significant change was seen when using 50% SUVmax-threshold segmentation (P < 0.001). A decrease in more than 10% change in MTV (% ΔMTV) was observed in 70.4% (50/71) tumors, and 7.0% (5/71) of the tumors showed an increase more than 10 % ΔMTV, when using the 50% SUVmax-threshold segmentation. AUC-CSH indexes showed statistically significant differences between early and delayed time points (P < 0.001), when using the gradient segmentation. AUC-CSH index decreased by 10% or greater in 40.8% (29/71) of the tumors. AUC-CSH index remained stable between early and delayed when using the 50% SUVmax-threshold segmentation (P = 0.148) with percentage of change of less than 10% for all tumors. CONCLUSIONS Metabolic tumor volume was relatively stable between early and delayed time points when PET gradient segmentation was used but changed greater than 10% in 77.4% of the tumors at delayed time point when threshold segmentation was used. The tumor heterogeneity index (AUC-CSH) changed greater than 10% in 40.8% of tumors at delayed imaging, when gradient segmentation was used but remained stable when threshold segmentation was used. It is important to standardize uptake time and segmentation methods to use FDG PET MTV and heterogeneity index as imaging biomarkers.
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