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Agüloğlu N, Aksu A, Unat DS, Selim Unat Ö. The value of PET/CT radiomic texture analysis of primary mass and mediastinal lymph node on survival in patients with non-small cell lung cancer. Rev Esp Med Nucl Imagen Mol 2024; 43:500027. [PMID: 39029620 DOI: 10.1016/j.remnie.2024.500027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 07/21/2024]
Abstract
OBJECTIVE This study was designed to determine the potential prognostic value of radiomic texture analysis and metabolic-volumetric parameters obtained from positron emission tomography (PET) in primary mass and metastatic hilar/mediastinal lymph nodes in stage 2-3 non-small cell lung cancer (NSCLC). METHODS Images of patients diagnosed with stage 2-3 NSCLC who underwent 18F-FDG PET/CT imaging for staging up to 4 weeks before the start of treatment were evaluated using LIFEx software. Volume of interest (VOI) was generated from the primary tumor and metastatic lymph node separately, and volumetric and textural features were obtained from these VOIs. The relationship between the parameters obtained from PET of primary mass and the metastatic hilar/mediastinal lymph nodes with overall survival (OS) and progression-free survival (PFS) was analyzed. RESULTS When radiomic features, gender and stage obtained from lymph nodes were evaluated by Cox regression analysis; GLCM_correlation (p: 0.033, HR: 4,559, 1.660-12.521, 95% CI), gender and stage were determined as prognostic factors predicting OS. In predicting PFS; stage, smoking and lymph node MTV (p: 0.033, HR: 1.008, 1.001-1.016, 95% CI) were determined as prognostic factors. However, the radiomic feature of the primary tumor could not show a significant relationship with either OS or PFS. CONCLUSIONS In a retrospective cohort of NSCLC patients with Stage 2 and 3 disease, volumetric and radiomic texture characteristics obtained from metastatic lymph nodes were associated with PFS and OS. Tumor heterogeneity, defined by radiomic texture features of 18 F-FDG PET/CT images, may provide complementary prognostic value in NSCLC.
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Affiliation(s)
- N Agüloğlu
- Department of Nuclear Medicine, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, İzmir, Turkey.
| | - A Aksu
- Department of Nuclear Medicine, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey.
| | - D S Unat
- Giresun Dr. Ali Menekşe Chest Diseases Hospital, Giresun, Turkey.
| | - Ö Selim Unat
- Giresun Dr. Ali Menekşe Chest Diseases Hospital, Giresun, Turkey.
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Yoo J, Lee J, Cheon M, Kim H, Choi YS, Pyo H, Ahn MJ, Choi JY. Radiomics Analysis of 18F-FDG PET/CT for Prognosis Prediction in Patients with Stage III Non-Small Cell Lung Cancer Undergoing Neoadjuvant Chemoradiation Therapy Followed by Surgery. Cancers (Basel) 2023; 15:cancers15072012. [PMID: 37046673 PMCID: PMC10093358 DOI: 10.3390/cancers15072012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/27/2023] [Accepted: 03/27/2023] [Indexed: 03/30/2023] Open
Abstract
We investigated the prognostic significance of radiomic features from 18F-FDG PET/CT to predict overall survival (OS) in patients with stage III NSCLC undergoing neoadjuvant chemoradiation therapy followed by surgery. We enrolled 300 patients with stage III NSCLC who underwent PET/CT at the initial work-up (PET1) and after neoadjuvant concurrent chemoradiotherapy (PET2). Radiomic primary tumor features were subjected to LASSO regression to select the most useful prognostic features of OS. The prognostic significance of the LASSO score and conventional PET parameters was assessed by Cox proportional hazards regression analysis. In conventional PET parameters, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of each PET1 and PET2 were significantly associated with OS. In addition, both the PET1-LASSO score and the PET2-LASSO score were significantly associated with OS. In multivariate Cox regression analysis, only the PET2-LASSO score was an independently significant factor for OS. The LASSO score showed better predictive performance for OS regarding the time-dependent receiver operating characteristic curve and decision curve analysis than conventional PET parameters. Radiomic features from PET/CT were an independent prognostic factor for the estimation of OS in stage III NSCLC. The newly developed LASSO score using radiomic features showed better prognostic results for individualized OS estimation than conventional PET parameters.
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Affiliation(s)
- Jang Yoo
- Department of Nuclear Medicine, Veterans Health Service Medical Center, Seoul 05368, Republic of Korea
| | - Jaeho Lee
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Miju Cheon
- Department of Nuclear Medicine, Veterans Health Service Medical Center, Seoul 05368, Republic of Korea
| | - Hojoong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Yong Soo Choi
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Hongryull Pyo
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Myung-Ju Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
- Correspondence: ; Tel.: +82-2-3410-2648; Fax: +82-2-3410-2639
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Zoair M, Taber S, Bittner R, Foerster G, Griff S, Bauer TT, Pfannschmidt J. Value of 18F FDG-PET/CT parameters on long term follow-up for patients with non-small cell lung cancer. Innov Surg Sci 2022; 7:35-43. [PMID: 36317010 PMCID: PMC9574653 DOI: 10.1515/iss-2022-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 07/19/2022] [Indexed: 11/05/2022] Open
Abstract
Objectives The purpose of this study was to investigate the value of PET/CT in the preoperative staging of non-small cell lung cancer in predicting long-term survival and diagnostic performance, validated by histopathology following surgical resection. Methods Between 02/2009 and 08/2011, 255 patients with non-small cell lung cancer were included in this single-center prospective study. All underwent 18F FDG-PET/CT for pre-operative staging, and in 243 patients complete surgical resection was possible. Regarding lymph node involvement and extrathoracic metastases, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using the histopathological staging as reference. Median follow-up for censored patients was 9.1 years. Results Overall 5-year survival rate of all patients was 55.6%, and of patients who had complete surgical resection it was 58.2%. In multivariate analysis of all surgically resected patients lymph node involvement (p=0.029) and age >61 years (p=<0.001) were significant independent prognostic factors. SUVmax and SUVmean cut-offs between SUV 2 and 11, however, were not associated with better or ;worse survival. The PET-CT sensitivity, specificity, positive predictive value and negative predictive value for predicting lymph node involvement were 57, 95, 88, and 76%, respectively. Furthermore, sensitivity, specificity, positive predictive value, and negative predictive value for detecting extrathoracic metastases were 100, 58, 98, and 100%, respectively. Conclusions In this study, tumor 18F FDG-uptake values did not provide additional prognostic information. Age>61 years and lymph node metastasis were associated with worse long-term survival in surgically resected patients. 18F FDG-PET/CT scans allow for improved patient selection. However, in staging mediastinal lymph nodes, there is a high rate of false positives and false negatives, suggesting that tissue biopsy is still indicated in many cases.
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Affiliation(s)
- Mohammed Zoair
- Department of Thoracic Surgery, Heckeshorn Lung Clinic, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Samantha Taber
- Department of Thoracic Surgery, Heckeshorn Lung Clinic, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Roland Bittner
- Department of Radiology and Nuclear Medicine, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Gregor Foerster
- Department of Radiology and Nuclear Medicine, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Sergej Griff
- Institute of Pathology, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Torsten T. Bauer
- Department of Pneumology, Heckeshorn Lung Clinic, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Joachim Pfannschmidt
- Department of Thoracic Surgery, Heckeshorn Lung Clinic, HELIOS Klinikum Emil von Behring, Berlin, Germany
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Sun X, Chen T, Xie C, Liu L, Lei B, Wang L, Ruan M, Yan H, Zhang Q, Chang C, Xie W. Relationships between SUVmax of lung adenocarcinoma and different T stages, histological grades and pathological subtypes: a retrospective cohort study in China. BMJ Open 2022; 12:e056804. [PMID: 35580966 PMCID: PMC9114855 DOI: 10.1136/bmjopen-2021-056804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Cancer cell has aberrant metabolism. The purpose of this study aimed to investigate relationships between maximum standard uptake value (SUVmax)of 18fluoro-2-deoxy-d-glucose and T stages, histological grades and pathological subtypes of lung adenocarcinoma. DESIGN Retrospective cohort study, employing the Kruskal-Wallis, Bonferroni-Dunn and Mann-Whitney tests to compare SUVmax of different T stages, histological grades and pathological subtypes of lung adenocarcinoma. SETTING The outpatients who had aberrant positron emission tomography/CT (PET/CT) images in chest were enrolled this study from August 2016 to November 2018 in Shanghai, China. PARTICIPANT Initial 11 270 patients with suspected lung cancer who underwent PET/CT examinations were surveyed. A total of 1454 patients who were diagnosed as lung adenocarcinoma by pathologist were included in this project. PRIMARY OUTCOME MEASURES SUVmax value at different tumour-node-metastasis stages of lung adenocarcinoma before surgery. RESULTS The mean SUVmax of patients with lung adenocarcinoma was significantly elevated with the increase in T stages. There were significant evident differences in SUVmax among T1a-T1c (p<0.05). However, after the staging of patients was more than T1 stage, SUVmax of T2a, T2b, T2 visceral pleural invasion, T3 and T4 had not dramatic changes. SUVmax value of lung adenocarcinoma in the same T stage group was the highest in patients with the high grade of malignancy and solid-predominant invasive adenocarcinoma. CONCLUSIONS SUVmax value was significantly associated with T stages, grades of malignancy and pathological subtypes of lung adenocarcinoma.
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Affiliation(s)
- Xiaoyan Sun
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Tianxiang Chen
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China, Shanghai, China
| | - Chun Xie
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Liu Liu
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Bei Lei
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Lihua Wang
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Maomei Ruan
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hui Yan
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Qi Zhang
- Department of Nuclear Medicine, Anhui Chest Hospital, Anhui, China
| | - Cheng Chang
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Wenhui Xie
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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Mertoğlu A, Üçvet A, Balci G, Aksel N, Batum Ö, Cireli E, Ceylan KC, Koparal H, Çirak AK, Gürsoy S, Yilmaz U, Kömürcüoğlu B. Correlation of preoperative PET/computer tomography 18F-fluorodeoxyglucose uptake (maximum standardized uptake value) with prognosis in patients with operated lung cancer. Nucl Med Commun 2022; 43:475-482. [PMID: 35165217 DOI: 10.1097/mnm.0000000000001542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to investigate the correlation of preoperative 18F-fluorodeoxyglucose PET/computed tomography maximum standardized uptake value (SUVmax) in operated non-small cell lung cancer (NSCLC) cases with other prognostic parameters and survival. PATIENTS AND METHODS NSCLC patients treated by surgical resection were imaged with PET within 60 days before surgery. RESULTS Overall, 525 cases consecutive patients were retrospectively reviewed. The median value of SUVmax in a total of 525 cases was 12.1, and the mean was 13.3 ± 7.13. Logistic regression analysis performed to identify the variables that have an impact on SUVmax revealed that histology [hazard ratio (HR: 1.893; 95% CI; P = 0.001) and T status (HR: 8.991; 95% CI; P = 0.000) are correlated with SUVmax. Kaplan-Meier analysis revealed a mean survival of 73.7 ± 1.95 months and a median survival of 85.6 ± 6.03 months. In the group with an SUVmax value of less than 10, the mean survival was 81.9 ± 3.02 months (76.0-87.8), and in the group with SUVmax greater than 10.1, the mean survival was 68.6 ± 2.4 months (63.9-73.3) (P = 0.000). In the multivariate analysis, SUVmax, age, tumor histology, lymph node metastasis, comorbid diseases and complete/incomplete status of the resection were identified as the factors predictive of prognosis. CONCLUSION It is seen that preoperative SUVmax is a parameter with prognostic significance at least as much as histopathology, age, complete/incomplete status of resection and lymph node involvement.
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Affiliation(s)
- Aydan Mertoğlu
- Chest Diseases, University of Health Sciences, Dr Suat Seren Chest Disease and Surgery Training and Research Hospital
| | - Ahmet Üçvet
- Chest Surgery, University of Health Sciences, Dr Suat Seren Chest Disease and Surgery Training and Research Hospital
| | - Günseli Balci
- Chest Diseases, University of Health Sciences, Dr Suat Seren Chest Disease and Surgery Training and Research Hospital
| | - Nimet Aksel
- Chest Diseases, University of Health Sciences, Dr Suat Seren Chest Disease and Surgery Training and Research Hospital
| | - Özgür Batum
- Chest Diseases, University of Health Sciences, Dr Suat Seren Chest Disease and Surgery Training and Research Hospital
| | - Emel Cireli
- Chest Diseases, University of Health Sciences, Dr Suat Seren Chest Disease and Surgery Training and Research Hospital
| | - Kenan Can Ceylan
- Chest Surgery, University of Health Sciences, Dr Suat Seren Chest Disease and Surgery Training and Research Hospital
| | - Hakan Koparal
- Nuclear Medicine, University of Health Sciences, Dr Suat Seren Chest Disease and Surgery Training and Research Hospital, İzmir, Turkey
| | - Ali Kadri Çirak
- Chest Diseases, University of Health Sciences, Dr Suat Seren Chest Disease and Surgery Training and Research Hospital
| | - Soner Gürsoy
- Chest Surgery, University of Health Sciences, Dr Suat Seren Chest Disease and Surgery Training and Research Hospital
| | - Ufuk Yilmaz
- Chest Diseases, University of Health Sciences, Dr Suat Seren Chest Disease and Surgery Training and Research Hospital
| | - Berna Kömürcüoğlu
- Chest Diseases, University of Health Sciences, Dr Suat Seren Chest Disease and Surgery Training and Research Hospital
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Cheung AHY, Wu VWC, Cheung ALY, Cai J. Respiratory 4D-Gating F-18 FDG PET/CT Scan for Liver Malignancies: Feasibility in Liver Cancer Patient and Tumor Quantitative Analysis. Front Oncol 2022; 12:789506. [PMID: 35223472 PMCID: PMC8864173 DOI: 10.3389/fonc.2022.789506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/12/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate the potential clinical role and effectiveness of respiratory 4D-gating F-18 FDG PET/CT scan for liver malignancies, relative to routine (3D) F-18 FDG PET/CT scan. Materials and Methods This study presented a prospective clinical study of 16 patients who received F-18 FDG PET/CT scan for known or suspected malignant liver lesions. Ethics approvals were obtained from the ethics committees of the Hong Kong Baptist Hospital and The Hong Kong Polytechnic University. Liver lesions were compared between the gated and ungated image sets, in terms of 1) volume measurement of PET image, 2) accuracy of maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), and 3) accuracy of total lesion glycoses (TLG). Statistical analysis was performed by using a two-tailed paired Student t-test and Pearson correlation test. Results The study population consisted of 16 patients (9 males and 7 females; mean age of 65) with a total number of 89 lesions. The SUVmax and SUVmean measurement of the gated PET images was more accurate than that of the ungated PET images, compared to the static reference images. An average of 21.48% (p < 0.001) reduction of the tumor volume was also observed. The SUVmax and SUVmean of the gated PET images were improved by 19.81% (p < 0.001) and 25.53% (p < 0.001), compared to the ungated PET images. Conclusions We have demonstrated the feasibility of implementing 4D PET/CT scan for liver malignancies in a prospective clinical study. The 4D PET/CT scan for liver malignancies could improve the quality of PET image by improving the SUV accuracy of the lesions and reducing image blurring. The improved accuracy in the classification and identification of liver tumors with 4D PET image would potentially lead to its increased utilization in target delineation of GTV, ITV, and PTV for liver radiotherapy treatment planning in the future.
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Affiliation(s)
- Anson H Y Cheung
- Department of Health Technology & Informatics, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China.,Radiotherapy and Oncology Department, Hong Kong Baptist Hospital, Hong Kong, Hong Kong SAR, China
| | - Vincent W C Wu
- Department of Health Technology & Informatics, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Andy L Y Cheung
- Department of Health Technology & Informatics, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China.,Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, Hong Kong SAR, China
| | - Jing Cai
- Department of Health Technology & Informatics, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
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Jiménez Londoño GA, García Vicente AM, Bosque JJ, Amo-Salas M, Pérez-Beteta J, Honguero-Martinez AF, Pérez-García VM, Soriano Castrejón ÁM. SUVmax to tumor perimeter distance: a robust radiomics prognostic biomarker in resectable non-small cell lung cancer patients. Eur Radiol 2022; 32:3889-3902. [PMID: 35133484 DOI: 10.1007/s00330-021-08523-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 10/18/2021] [Accepted: 11/30/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the prognostic value of novel geometric variables obtained from pre-treatment [18F]FDG PET/CT with respect to classical ones in patients with non-small cell lung cancer (NSCLC). METHODS Retrospective study including stage I-III NSCLC patients with baseline [18F]FDG PET/CT. Clinical, histopathologic, and metabolic parameters were obtained. After tumor segmentation, SUV and volume-based variables, global texture, sphericity, and two novel parameters, normalized SUVpeak to centroid distance (nSCD) and normalized SUVmax to perimeter distance (nSPD), were obtained. Early recurrence (ER) and short-term mortality (STM) were used as end points. Univariate logistic regression and multivariate logistic regression with respect to ER and STM were performed. RESULTS A cohort of 173 patients was selected. ER was detected in 49/104 of patients with recurrent disease. Additionally, 100 patients died and 53 had STM. Age, pathologic lymphovascular invasion, lymph nodal infiltration, TNM stage, nSCD, and nSPD were associated with ER, although only age (aOR = 1.06, p = 0.002), pathologic lymphovascular invasion (aOR = 3.40, p = 0.022), and nSPD (aOR = 0.02, p = 0.018) were significant independent predictors of ER in multivariate analysis. Age, lymph nodal infiltration, TNM stage, nSCD, and nSPD were predictors of STM. Age (aOR = 1.05, p = 0.006), lymph nodal infiltration (aOR = 2.72, p = 0.005), and nSPD (aOR = 0.03, p = 0.022) were significantly associated with STM in multivariate analysis. Coefficient of variation (COV) and SUVmean/SUVmax ratio did not show significant predictive value with respect to ER or STM. CONCLUSION The geometric variables, nSCD and nSPD, are robust biomarkers of the poorest outcome prediction of patients with NSCLC with respect to classical PET variables. KEY POINTS • In NSCLC patients, it is crucial to find prognostic parameters since TNM system alone cannot explain the variation in lung cancer survival. • Age, lymphovascular invasion, lymph nodal infiltration, and metabolic geometrical parameters were useful as prognostic parameters. • The displacement grade of the highest point of metabolic activity towards the periphery assessed by geometric variables obtained from [18F]FDG PET/CT was a robust biomarker of the poorest outcome prediction of patients with NSCLC.
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Affiliation(s)
| | - Ana Maria García Vicente
- Department of Nuclear Medicine, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Jesús J Bosque
- Department of Mathematics, Mathematical Oncology Laboratory (MOLAB), Universidad de Castilla-La Mancha, Ciudad Real, Spain
| | - Mariano Amo-Salas
- Department of Mathematics, Universidad de Castilla-La Mancha, Ciudad Real, Spain
| | - Julián Pérez-Beteta
- Department of Mathematics, Mathematical Oncology Laboratory (MOLAB), Universidad de Castilla-La Mancha, Ciudad Real, Spain
| | | | - Víctor M Pérez-García
- Department of Mathematics, Mathematical Oncology Laboratory (MOLAB), Universidad de Castilla-La Mancha, Ciudad Real, Spain
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Zhang S, Lin D, Yu Y, Cao Q, Liu G, Jiang D, Wang H, Fang Y, Shen Y, Yin J, Hou Y, Shi H, Ge D, Wang Q, Tan L. Which will carry more weight when CTR > 0.5, solid component size, CTR, tumor size or SUVmax? Lung Cancer 2021; 164:14-22. [PMID: 34974221 DOI: 10.1016/j.lungcan.2021.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 12/01/2021] [Accepted: 12/09/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study was conducted to explore the clinical significance of the maximum standard uptake value (SUVmax) in the clinical stage IA lung adenocarcinoma with tumor size ≤ 2 cm and consolidation to tumor ratio (CTR) > 0.5. METHODS We retrospectively reviewed non-small cell lung cancer patients who underwent surgeries between January 2014 and March 2017. Clinical stage IA lung adenocarcinoma patients with tumor of size ≤ 2 cm and CTR > 0.5 were enrolled. The patients were divided into two groups: part-solid and pure-solid based on whether CTR = 1.0 or not. Nodules with any amount of solid or micropapillary components were regarded as the high-risk subtype. Time-dependent ROC curve was used to determine the best cut-off value. Finally, we analyzed the relationship between SUVmax, high-risk subtypes, node metastasis and 5-year relapse-free survival and overall survival. RESULTS Totally, 270 patients were included. The distribution of pathological subtypes (p < 0.001), SUVmax (p < 0.001), and pathological N stage (p < 0.001) were different between the two groups. Multivariable analysis indicated that SUVmax could predict high-risk subtypes in cases of part-solid nodules (p < 0.001) and both high-risk subtypes (p = 0.022) and node metastasis (p < 0.001) in cases of pure-solid ones. SUVmax ≥ 2.6 and SUVmax ≥ 5.1 were strongly associated with 5-year relapse-free survival (p < 0.001) and 5-year overall survival (p < 0.001) among all the patients, respectively. CONCLUSION Part-solid nodules with 0.5 < CTR < 1 and pure-solid nodules in lung adenocarcinoma show different clinicopathological characteristics, especially in SUVmax. SUVmax is significantly associated with high-risk subtypes, node metastasis, 5-year relapse-free survival and overall survival.
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Affiliation(s)
- Shaoyuan Zhang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Dong Lin
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200080, China
| | - Yangli Yu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Qiqi Cao
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Guobing Liu
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Dongxian Jiang
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Hao Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yong Fang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yaxing Shen
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jun Yin
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yingyong Hou
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Hongcheng Shi
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Di Ge
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Lijie Tan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
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Positron emission tomography/computed tomography findings of lung invasive adenocarcinoma subgroups and comparison of their short-term survivals. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 29:370-376. [PMID: 34589256 PMCID: PMC8462100 DOI: 10.5606/tgkdc.dergisi.2021.20143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/18/2020] [Indexed: 01/15/2023]
Abstract
Background
The aim of this study was to compare the maximum standardized uptake values on positron emission tomography/ computed tomography and survival of lung invasive adenocarcinoma subgroups.
Methods
Between January 2010 and January 2016, a total of 152 patients (112 males, 40 females; mean age: 64.2±8.6 years; range, 41 to 88 years) who underwent lung resection for an invasive adenocarcinoma were retrospectively analyzed. The patients were divided into subgroups as follows: acinar, lepidic, micropapillary, papillary, and solid. The maximum standardized uptake values in the imaging study and their relationship with survival were examined.
Results
There were 84 acinar (55%), 31 solid (20%), 23 lepidic (15%), nine papillary (5%), and five micropapillary (3%) cases. The positron emission tomography/computed tomography enhancement showed a statistically significant difference among the subgroups (p=0.004). The solid subgroup was the most involved (9.76), followed by micropapillary (8.98), acinar (8.06), papillary (5.82), and lepidic (4.23) subgroups, respectively. According to Tumor, Node, Metastasis staging, Stage I was present in 48.68% (n=74) of the cases, Stage II in 25.0% (n=38), Stage III in 25.0% (n=38), and Stage IV in 1.31% (n=2). The one-year, three-year, and five-year survival rates were significantly different among the disease stages (p=0.01). The longest survival duration was in the lepidic subgroup, although it did not reach statistical significance among the subgroups (p=0.587).
Conclusion
The evaluation of invasive adenocarcinomas based on maximum standardized uptake values provides valuable information and may guide neoadjuvant and adjuvant therapies in the future.
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Qiu X, Liang H, Zhong W, Zhao J, Chen M, Zhu Z, Xu Y, Wang M. Prognostic impact of maximum standardized uptake value on 18 F-FDG PET/CT imaging of the primary lung lesion on survival in advanced non-small cell lung cancer: A retrospective study. Thorac Cancer 2021; 12:845-853. [PMID: 33512768 PMCID: PMC7952805 DOI: 10.1111/1759-7714.13863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 01/09/2023] Open
Abstract
Background Positron emission tomography/computed tomography (PET/CT) has been recognized for diagnosing and staging lung cancer, but the prognostic value of standardized uptake value (SUV) on 18F‐FDG PET/CT imaging in patients with advanced non‐small cell lung cancer (NSCLC) remains controversial. Methods We performed a retrospective analysis of patients with advanced NSCLC who had undergone 18F‐FDG PET/CT before systemic treatment between June 2012 and June 2016. The relationship between the maximum SUV (SUVmax) of the pulmonary lesion and lesion size was evaluated via Spearman's correlation analysis. We collected patients' clinical and pathological data. Univariate and multivariate analyses were performed to analyze the factors influencing survival. Results We included 157 patients with advanced NSCLC. Among these, 135 died, 13 survived, and nine were lost to follow‐up (median follow‐up period, 69 months). SUVmax was correlated with lesion size and was significantly greater for tumors ≥3 cm than for tumors <3 cm (10.2 ± 5.4 vs. 5.6 ± 3.3, t = −6.709, p = 0.000). Univariate analysis showed that survival was associated with gender, tumor size, epidermal growth factor receptor gene mutation or anaplastic lymphoma kinase rearrangement, SUVmax of the primary lung lesion, and treatment lines. Multivariate analysis showed a significant correlation between SUVmax of the primary lung lesion and survival. The mortality risk of patients with SUVmax ≤6 was 35% lower than that of patients with SUVmax >6 (HR = 0.651, 95% confidence interval, 0.436–0.972; Wald value, 4.400; p = 0.036). Conclusions The SUVmax of the primary lung lesion on PET/CT is significantly correlated with survival in treatment‐naive patients with advanced NSCLC.
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Affiliation(s)
- Xiaoling Qiu
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Hematology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Hongge Liang
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Wei Zhong
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Zhao
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Minjiang Chen
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhaohui Zhu
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Xu
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mengzhao Wang
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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11
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Sun XY, Chen TX, Chang C, Teng HH, Xie C, Ruan MM, Lei B, Liu L, Wang LH, Yang YH, Xie WH. SUVmax of 18FDG PET/CT Predicts Histological Grade of Lung Adenocarcinoma. Acad Radiol 2021; 28:49-57. [PMID: 32113879 DOI: 10.1016/j.acra.2020.01.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/16/2020] [Accepted: 01/23/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The relationship between the 18FDG PET-CT maximum standard uptake value (SUVmax) and the type of lung adenocarcinoma is still not established. The aim of this study was to investigate the relationship between SUVmax value and histological grade and pathological subtype of lung adenocarcinoma, and to determine the optimum SUVmax cutoffs for distinguishing different histological grades. MATERIALS AND METHODS The data of 618 lung adenocarcinoma patients were retrospectively analyzed. The relationship between SUVmax measured on preoperative 18FDG-PET-CT and the histological grade and pathological subtype was examined. The Kruskal-Wallis test was used to compare differences among groups, and the Bonferroni-Dunn test for pairwise comparison among groups. ROC analysis was applied to determine the optimal cut-off values for distinguishing different groups. In addition, the cut-off value was verified in an independent cohort of 85 consecutive lung adenocarcinoma cases. RESULTS The SUVmax was significantly different between the low, intermediate, and high-grade groups(p < .001). SUVmax value increased with increase in the degree of malignancy. The optimal cut-off value for identifying low-grade tumors was 2.01 (sensitivity 90.4%, specificity 86.9%, area under the curve [AUC] = 0.928, 95% confidence interval: 0.91-0.95; p < .001). The optimal cutoff SUVmax value for identifying high-grade tumors was 7.41 (sensitivity 79.8%, specificity 73.5%, AUC = 0.830, 95% confidence interval: 0.79-0.87; p < .001). The validation experiment showed that the coincidence rate was 88.89% in the low-level group, 64.15% in the middle-level group, and 78.57% in the high-level group. CONCLUSION SUVmax can be used to predict pathological subtype and histological grade of lung adenocarcinoma. Thus, 18FDG PET-CT can serve as a noninvasive tool for precise diagnosis and help in the preoperative formulation of patient-specific treatment strategies.
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12
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Multiple Testing, Cut-Point Optimization, and Signs of Publication Bias in Prognostic FDG-PET Imaging Studies of Head and Neck and Lung Cancer: A Review and Meta-Analysis. Diagnostics (Basel) 2020; 10:diagnostics10121030. [PMID: 33271785 PMCID: PMC7761090 DOI: 10.3390/diagnostics10121030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/25/2020] [Accepted: 11/29/2020] [Indexed: 12/23/2022] Open
Abstract
Positron emission tomography (PET) imaging with 2-deoxy-2-[18F]-fluorodeoxyglucose (FDG) was proposed as prognostic marker in radiotherapy. Various uptake metrics and cut points were used, potentially leading to inflated effect estimates. Here, we performed a meta-analysis and systematic review of the prognostic value of pretreatment FDG–PET in head and neck squamous cell carcinoma (HNSCC) and non-small cell lung cancer (NSCLC), with tests for publication bias. Hazard ratio (HR) for overall survival (OS), disease free survival (DFS), and local control was extracted or derived from the 57 studies included. Test for publication bias was performed, and the number of statistical tests and cut-point optimizations were registered. Eggers regression related to correlation of SUVmax with OS/DFS yielded p = 0.08/p = 0.02 for HNSCC and p < 0.001/p = 0.014 for NSCLC. No outcomes showed significant correlation with SUVmax, when adjusting for publication bias effect, whereas all four showed a correlation in the conventional meta-analysis. The number of statistical tests and cut points were high with no indication of improvement over time. Our analysis showed significant evidence of publication bias leading to inflated estimates of the prognostic value of SUVmax. We suggest that improved management of these complexities, including predefined statistical analysis plans, are critical for a reliable assessment of FDG–PET.
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13
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Recent and Current Advances in FDG-PET Imaging within the Field of Clinical Oncology in NSCLC: A Review of the Literature. Diagnostics (Basel) 2020; 10:diagnostics10080561. [PMID: 32764429 PMCID: PMC7459495 DOI: 10.3390/diagnostics10080561] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 02/07/2023] Open
Abstract
Lung cancer is the leading cause of cancer-related deaths around the world, the most common type of which is non-small-cell lung cancer (NSCLC). Computed tomography (CT) is required for patients with NSCLC, but often involves diagnostic issues and large intra- and interobserver variability. The anatomic data obtained using CT can be supplemented by the metabolic data obtained using fluorodeoxyglucose F 18 (FDG) positron emission tomography (PET); therefore, the use of FDG-PET/CT for staging NSCLC is recommended, as it provides more accuracy than either modality alone. Furthermore, FDG-PET/magnetic resonance imaging (MRI) provides useful information on metabolic activity and tumor cellularity, and has become increasingly popular. A number of studies have described FDG-PET/MRI as having a high diagnostic performance in NSCLC staging. Therefore, multidimensional functional imaging using FDG-PET/MRI is promising for evaluating the activity of the intratumoral environment. Radiomics is the quantitative extraction of imaging features from medical scans. The chief advantages of FDG-PET/CT radiomics are the ability to capture information beyond the capabilities of the human eye, non-invasiveness, the (virtually) real-time response, and full-field analysis of the lesion. This review summarizes the recent advances in FDG-PET imaging within the field of clinical oncology in NSCLC, with a focus on surgery and prognostication, and investigates the site-specific strengths and limitations of FDG-PET/CT. Overall, the goal of treatment for NSCLC is to provide the best opportunity for long-term survival; therefore, FDG-PET/CT is expected to play an increasingly important role in deciding the appropriate treatment for such patients.
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14
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Chen J, Xia J, Huang J, Xu R. Effect of aspirin on PET parameters in primary non-small cell lung cancer and its relationship with prognosis. BMC Cancer 2020; 20:510. [PMID: 32493238 PMCID: PMC7268630 DOI: 10.1186/s12885-020-06983-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 05/20/2020] [Indexed: 11/19/2022] Open
Abstract
Background 18 F-FDG is a glucose analogue whose metabolic index SUV can effectively reflect the metabolic level of tumor microenvironment. Aspirin can affect the uptake of 18F-FDG by cancer cells, reducing the SUVmax value of primary tumors, exerting antitumor effect. This study aimed to evaluate the prognostic value of long-term aspirin and the relationship between aspirin intake and PET parameters value of primary tumor in non-small cell lung cancer (NSCLC). Methods Eighty-one NSCLC patients were recruited and divided into two groups: aspirin medication group and control group, who underwent surgery and had pathological diagnosis data between January 2012 and December 2016. Clinical characteristics were retrospective analyzed to evaluate the possibility of clinical prognosis, respectively. Kaplan-Meier curves and a Cox proportional hazard model were applied to evaluate the predictors of prognosis. Results The PET/CT SUVmax of the primary tumor in the aspirin group was lower than that in the control group (P < 0.05). Compared with the control group, the SUVmax, SUVmean and TLG of the primary tumor in aspirin group were lower, but the MTV value had no significant difference. Cox regression analysis showed that N stage and TNM stage were predictors of the prognosis. There was a significant difference in the use of aspirin in NSCLC patients. Conclusion Aspirin can reduce SUVmax, SUVmean and TLG in primary tumor and aspirin can improve the prognosis of patients with NSCLC.
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Affiliation(s)
- Jinghua Chen
- First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, 518020, P. R. China.,Second Clinical Medicine College, Jinan University, Shenzhen, 518020, P. R. China.,Department of Medical Oncology, Shenzhen People's Hospital, Shenzhen, 518020, P. R. China
| | - Junxian Xia
- First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, 518020, P. R. China.,Second Clinical Medicine College, Jinan University, Shenzhen, 518020, P. R. China.,Department of Medical Oncology, Shenzhen People's Hospital, Shenzhen, 518020, P. R. China
| | - Jiacheng Huang
- First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, 518020, P. R. China.,Second Clinical Medicine College, Jinan University, Shenzhen, 518020, P. R. China.,Department of Medical Oncology, Shenzhen People's Hospital, Shenzhen, 518020, P. R. China
| | - Ruilian Xu
- First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, 518020, P. R. China. .,Second Clinical Medicine College, Jinan University, Shenzhen, 518020, P. R. China. .,Department of Medical Oncology, Shenzhen People's Hospital, Shenzhen, 518020, P. R. China.
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15
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Yesil Cinkir H, Elboga U. The effect of systemic inflammation indexes and 18FDG PET metabolic parameters on survival in advanced lung adenocarcinoma. TUMORI JOURNAL 2020; 106:312-318. [PMID: 32326835 DOI: 10.1177/0300891620915789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To determine the effect of systemic inflammation indexes and fluorine-18 fluorodeoxyglucose (18FDG) positron emission tomography (PET) metabolic parameters on survival in advanced lung adenocarcinoma. METHODS A total of 133 patients who underwent 18FDG PET for initial staging were investigated retrospectively. Baseline patient characteristics, routine blood test results, 18FDG PET metabolic parameters, and treatment history were examined. Overall survival (OS) was demonstrated by Kaplan-Meier analysis, and the curves were compared by the log-rank test. Systemic inflammation response index (SIRI) was defined as neutrophil x monocyte/lymphocyte count. RESULTS Lymphocyte/monocyte ratio (LMR) and SIRI were found to be significant for OS. The cutoff point was 2.25 for LMR. Median OS was 8 months for ⩽2.25 and 14 months for >2.25 (p = 0.005). For SIRI, the cutoff point was 2. SIRI ⩽2 was associated with a median OS of 16 months compared to 10 months for patients with SIRI >2 (p = 0.043). Maximum of standardized uptake value, total lesion glycolysis, and metabolic tumor volume were not found to be significant for OS (p = 0.225, p = 0.061, p = 0.355, respectively). No correlation was found between inflammatory indexes and PET metabolic parameters. CONCLUSION Age and LMR parameters were prognostic for survival in Cox regression analysis. There was no correlation between 18FDG PET parameters and inflammatory indexes.
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Affiliation(s)
- Havva Yesil Cinkir
- Department of Medical Oncology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - Umut Elboga
- Department of Nuclear Medicine, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
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16
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Wang S, Lin D, Yang X, Zhan C, Zhao S, Luo R, Wang Q, Tan L. Clinical significance of PET/CT uptake for peripheral clinical N0 non-small cell lung cancer. Cancer Med 2020; 9:2445-2453. [PMID: 32056387 PMCID: PMC7131855 DOI: 10.1002/cam4.2900] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/09/2020] [Accepted: 01/21/2020] [Indexed: 12/14/2022] Open
Abstract
Objective In this cohort study, we determined the clinical value of the maximum standardized uptake value (SUVmax) of primary tumors in non‐small cell lung cancer (NSCLC). Study Design A retrospective review of NSCLC patients was performed from January 2011 to December 2017. Peripheral cN0 NSCLC patients with tumor size ≤2 cm were included. SUVmax was calculated as a continuous variable for semiquantitative analyses. A receiver operating characteristic curve was analyzed to assess the cutoff threshold of SUVmax on pathological (p) nodal metastasis. We further evaluated the clinical relevance of SUVmax in peripheral cN0 NSCLC patients. Results A total of 670 peripheral NSCLC patients with tumor size ≤2 cm were deemed cN0 by preoperative PET/CT scan. Statistical analyses suggested significant correlations of SUVmax with smoking status (P = .026), tumor volume (P = .001), pathology type (P = .008), tumor differentiation (P < .001), vessel invasion (P = .001), plural invasion (P < .001), pT stage (P < .001), nodal involvement (P < .001), and pathological tumor node metastasis stage (P < .001). A cutoff point of SUVmax of 3.8 (P < .001) could be used to predict pathological nodal metastasis. Multivariable analyses indicated that preoperative SUVmax >3.8 (odds ratio, 12.149; P < .001) was an independent predictor of nodal metastasis. Overall survival analyses further suggested that SUVmax was an independent prognostic indicator (hazard ratio, 2.050; P = .017). Conclusion Preoperative SUVmax is a predictor of pathological nodal metastasis and prognosis for peripheral cN0 NSCLC patients with tumor size ≤2 cm. Our results indicate that assessment of PET SUVmax could improve stratification of these patients.
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Affiliation(s)
- Shuai Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Dong Lin
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaodong Yang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Cheng Zhan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shihai Zhao
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Rongkui Luo
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lijie Tan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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17
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Chen HHW, Su WC, Guo HR, Lee BF, Chiu NT. Prognostic value of volumetric metabolic parameter changes determined by during and after radiotherapy-based 18 F-FDG PET/CT in stage III non-small cell lung cancer. Kaohsiung J Med Sci 2019; 35:151-159. [PMID: 30887722 DOI: 10.1002/kjm2.12027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 12/19/2018] [Indexed: 12/16/2022] Open
Abstract
The aim of this prospective study was to evaluate the prognostic value of volumetric metabolic parameters assessed by during and after radiation-based therapy 18 F-FDG PET/CT in patients with stage III non-small cell lung cancer (NSCLC). We enrolled stage III NSCLC patients who had planned to receive definitive chemo-radiation or radiotherapy (RT) and underwent 18 F-FDG PET/CT before treatment (PET1), during RT (at the fifth week, PET2) and after treatment (3 months later, PET3). By comparing with PET1, percentage changes of metabolic tumor volume (ΔMTV) and tumor total lesion glycolysis (ΔTLG) of PET2 and PET3 were calculated. We used medians of ΔTLG and ΔMTV as cut-off values to stratify patients. Their prognostic values were evaluated by progression-free survival (PFS) and overall survival (OS). Thirty patients were enrolled initially. Five were excluded due to multiple metastases or double cancer. The remaining 25 patients had PET2 at a median of 46 Gy. Data on PET3 were available in 19 patients. During-RT ΔTLG (cut-off: 65%) was a significant prognostic factor for PFS (P = 0.02) and OS (P < 0.01). During-RT ΔMTV (cut-off: 42%) had marginal significance for PFS (P = 0.07) and was significant for OS (P = 0.02). Of the PET3 parameters, neither ΔTLG nor ΔMTV was a significant prognostic factor for PFS and OS. We conclude that ΔTLG of during-RT 18 F-FDG PET/CT may predict treatment response and thus provide opportunities to modify treatment for poor responders.
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Affiliation(s)
- Helen H W Chen
- Departments of Radiation Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wu-Chou Su
- Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - How-Ran Guo
- Environmental and Occupational Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Bi-Fang Lee
- Nuclear Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Nan-Tsing Chiu
- Nuclear Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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18
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Harmon S, Seder CW, Chen S, Traynor A, Jeraj R, Blasberg JD. Quantitative FDG PET/CT may help risk-stratify early-stage non-small cell lung cancer patients at risk for recurrence following anatomic resection. J Thorac Dis 2019; 11:1106-1116. [PMID: 31179052 PMCID: PMC6531752 DOI: 10.21037/jtd.2019.04.46] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/03/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Preoperative identification of non-small cell lung cancer (NSCLC) patients at risk for disease recurrence has proven unreliable. The extraction of quantitative metrics from imaging based on tumor intensity and texture may enhanced disease characterization. This study evaluated tumor-specific 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computerized tomography (PET/CT) uptake patterns and their association with disease recurrence in early-stage NSCLC. METHODS Sixty-four stage I/II NSCLC patients who underwent anatomic resection between 2001 and 2014 were examined. Pathologically or radiographic confirmed disease recurrence within 5 years of resection comprised the study group. Quantitative imaging metrics were extracted within the primary tumor volume. Squamous cell carcinoma (SCC) (N=27) and adenocarcinoma (AC) (N=41) patients were compared using a Wilcoxon signed-rank test. Associations between imaging and clinical variables with 5-year disease-free survival (DFS) and overall survival (OS) were evaluated by Cox proportional-hazards regression. RESULTS Clinical and pathologic characteristics were similar between recurrence (N=34) and patients achieving 5-year DFS (N=30). Standardized uptake value (SUV)max and SUVmean varied significantly by histology, with SCC demonstrating higher uptake intensity and heterogeneity patterns. Entropy-grey-level co-occurrence matrix (GLCM) was a significant univariate predictor of DFS (HR =0.72, P=0.04) and OS (HR =0.65, P=0.007) independent of histology. Texture features showed higher predictive ability for DFS in SCC than AC. Pathologic node status and staging classification were the strongest clinical predictors of DFS, independent of histology. CONCLUSIONS Several imaging metrics correlate with increased risk for disease recurrence in early-stage NSCLC. The predictive ability of imaging was strongest when patients are stratified by histology. The incorporation of 18F-FDG PET/CT texture features with preoperative risk factors and tumor characteristics may improve identification of high-risk patients.
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Affiliation(s)
- Stephanie Harmon
- Department of Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Christopher W. Seder
- Department of Thoracic and Cardiovascular Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Song Chen
- Department of Medical Physics, University of Wisconsin, Madison, WI, USA
- Department of Nuclear Medicine, The 1st Hospital of China Medical University, Shenyang 110016, China
| | - Anne Traynor
- Department of Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Robert Jeraj
- Department of Medical Physics, University of Wisconsin, Madison, WI, USA
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19
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Hu WD, Wang HC, Wang YB, Cui LL, Chen XH. Correlation study on 18F-FDG PET/CT metabolic characteristics of primary lesion with clinical stage in lung cancer. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2019; 65:172-177. [PMID: 30916535 DOI: 10.23736/s1824-4785.19.03146-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND 18F-FDG PET/CT metabolic characteristics provide the crucial biologic and molecular information for tumors. To explore the relationships between 18F-FDG PET/CT derived parameters such as maximum standardized uptake value (SUV<inf>max</inf>), metabolic tumor volume (MTV), total lesion glycolysis (TLG) of primary tumor and clinical stage in different histopathologic subtypes of lung cancer. METHODS A total of 97 newly diagnosed lung cancer patients (69 males, 28 females; average age 65.1 years) with pathologically proven were retrospectively analyzed, who had undergone 18F-FDG PET/CT scan before treatment from September 2016 to November 2017. SUV<inf>max</inf>, MTV and TLG of primary tumor were measured. Clinical stage was mainly determined by 18F-FDG PET/CT, in conjunction with conventional imaging and endoscopic biopsy. Mann-Whitney U test, χ2 test, Spearman correlation test and ROC curve analysis were used for statistical analysis. RESULTS There were 53 adenocarcinomas (AC), 28 squamous carcinomas (SCC), 13 small cell carcinomas (SCLC), one adenosquamous carcinoma, one mucoepidermoid carcinoma, and one sarcomatoid carcinoma in 97 patients. Both AC and SCLC revealed more cases in stage IV than in stage I-III (P<0.01). There was no significant difference in four stages of SCC (P>0.05). Metabolic parameters of SCC were higher than AC including SUV<inf>max</inf>, MTV and TLG (P<0.01). SCLC showed a higher value than AC in TLG (P<0.05). No significant differences were found between AC and SCLC in SUV<inf>max</inf> and MTV, also between SCC and SCLC in SUV<inf>max</inf>, MTV and TLG (P>0.05). MTV and TLG except SUV<inf>max</inf> were positively correlated with stage in AC (P≤0.001). Only MTV showed a positive correlation with stage in SCC (P<0.05). Whereas there were no definitive relationships between metabolic parameters and stage in SCLC (P>0.05). AC with a higher MTV (MTV≥5.965 cm3) indicated a significantly higher rate of distant metastasis than those with a lower MTV (77.5% (31/40) vs. 30.8% (4/13), χ2=9.553, P<0.01), as well as AC with a higher TLG (TLG≥46.922) than those with a lower TLG (88.5% (23/26) vs. 44.4% (12/27), χ2=11.422, P<0.01). CONCLUSIONS Histopathologic subtypes have a significant influence on the relationships between MTV/TLG not SUV<inf>max</inf> of primary foci and stage in lung cancer. Primary MTV/TLG is related to clinical stage closely in AC, and a higher MTV/TLG results in a higher risk of distant metastasis.
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Affiliation(s)
- Wei-Dong Hu
- Department of Respiratory Medicine, Gansu Provincial Hospital, Lanzhou, China
| | - Hui-Chun Wang
- PET/CT Center, Gansu Provincial Hospital, Lanzhou, China -
| | - Yu-Bin Wang
- PET/CT Center, Gansu Provincial Hospital, Lanzhou, China
| | - Lan-Lan Cui
- PET/CT Center, Gansu Provincial Hospital, Lanzhou, China
| | - Xiao-Hong Chen
- PET/CT Center, Gansu Provincial Hospital, Lanzhou, China
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20
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Anwar H, Vogl TJ, Abougabal MA, Grünwald F, Kleine P, Elrefaie S, Nour-Eldin NEA. The value of different 18F-FDG PET/CT baseline parameters in risk stratification of stage I surgical NSCLC patients. Ann Nucl Med 2018; 32:687-694. [PMID: 30219989 DOI: 10.1007/s12149-018-1301-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 08/27/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Administration of postoperative chemotherapy to patients with completely resected stage I NSCLC is still a matter of debate. The aim of the present study was to evaluate the value of different baseline 18F-FDG PET parameters in identifying surgical stage I NSCLC patients who are at high risk of recurrence, and thus are indicated for further postoperative treatment. METHODS This is a retrospective study, which included 49 patients (28 males, 21 females) with the median age of 69 years (range 28-84), who had pathologically proven stage I NSCLC. All patients underwent 18F-FDG PET/CT at baseline followed by complete surgical resection of the tumor (R0). Baseline SUVmax, MTV and TLG were measured. Patients' follow-up records were retrospectively reviewed, and DFS (disease-free survival) was assessed. For each parameter, the most accurate cut-off value for the prediction of recurrence was calculated using the ROC curve analysis and the Youden index. DFS was evaluated for patients above and below the calculated cut-off value using the Kaplan-Meier method and the difference in survival between the two groups was estimated using the log-rank test. RESULTS Median observation time of the patients after surgery was 28.7 months (range 3.5-58.8 months). 9 patients developed recurrence. The calculated cut-off values for SUVmax, MTV and TLG were 6, 6.6 and 33.6, respectively. Using these cut-offs, the observed sensitivity for SUVmax, MTV and TLG for prediction of recurrence was 100%, 89% and 89%, respectively, while the observed specificity was 43%, 73% and 65%, respectively. The difference in survival between patients below and above the cut-off value was statistically significant in all three studied parameters. The highest AUC was observed for MTV (AUC = 0.825, p = 0.003), followed by TLG (AUC = 0.789, p = 0.007), and lastly SUVmax (AUC = 0.719, p = 0.041). ROC curve analysis showed that volumetric parameters had better predictive performance than SUVmax as regards recurrence. CONCLUSION PET-derived parameters at baseline were predictive of recurrence in stage I surgical NSCLC patients. Moreover, the metabolic volume of the tumor was the most significant parameter for this purpose among the studied indices.
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Affiliation(s)
- Hoda Anwar
- Nuclear Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology and Nuclear Medicine, Faculty of Medicine-Cairo University, Cairo, Egypt.
| | - Thomas J Vogl
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang von Goethe University Hospital, Frankfurt am Main, Germany
| | - Mahasen A Abougabal
- Nuclear Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology and Nuclear Medicine, Faculty of Medicine-Cairo University, Cairo, Egypt
| | - Frank Grünwald
- Department of Nuclear Medicine, Johann Wolfgang von Goethe University Hospital, Frankfurt am Main, Germany
| | - Peter Kleine
- Department of Cardiothoracic Surgery, Johann Wolfgang von Goethe University Hospital, Frankfurt am Main, Germany
| | - Sherif Elrefaie
- Nuclear Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology and Nuclear Medicine, Faculty of Medicine-Cairo University, Cairo, Egypt
| | - Nour-Eldin A Nour-Eldin
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang von Goethe University Hospital, Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, Cairo University Hospital, Cairo, Egypt
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Jomaa H, Mabrouk R, Khlifa N. Post-reconstruction-based partial volume correction methods: A comprehensive review. Biomed Signal Process Control 2018. [DOI: 10.1016/j.bspc.2018.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Yılmaz U, Batum Ö, Koparal H, Özbilek E, Kıraklı E. Prognostic value of primary tumor SUV max on pre-treatment 18 F-FDG PET/CT imaging in patients with stage III non-small cell lung cancer. Rev Esp Med Nucl Imagen Mol 2018. [DOI: 10.1016/j.remnie.2017.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Nygård L, Vogelius IR, Fischer BM, Kjær A, Langer SW, Aznar MC, Persson GF, Bentzen SM. A Competing Risk Model of First Failure Site after Definitive Chemoradiation Therapy for Locally Advanced Non–Small Cell Lung Cancer. J Thorac Oncol 2018; 13:559-567. [DOI: 10.1016/j.jtho.2017.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 12/22/2017] [Accepted: 12/24/2017] [Indexed: 12/25/2022]
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Yılmaz U, Batum Ö, Koparal H, Özbilek E, Kıraklı E. Prognostic value of primary tumor SUV max on pre-treatment 18F-FDG PET/CT imaging in patients with stage iii non-small cell lung cancer. Rev Esp Med Nucl Imagen Mol 2018; 37:S2253-654X(17)30216-0. [PMID: 29559214 DOI: 10.1016/j.remn.2017.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/10/2017] [Accepted: 11/14/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Concomitant chemoradiotherapy (CCRT) is widely used in the treatment of patients with stage iii non-small cell lung carcinoma (NSCLC). The early identification of patients with poor prognosis is the premise of personalized treatment for patients. The aim of the study was to evaluate the prognostic value of clinical parameters and primary tumor SUVmax on pre-treatment 18F-FDG PET/CT in patients with stage iii NSCLC. MATERIAL AND METHODS Clinical records of 79 stage iii-NSCLC patients with pre-treatment 18F-FDG PET/CT imaging, treated with definitive CCRT were retrospectively reviewed. The clinical endpoints in terms of progression-free survival (PFS) and overall survival (OS) were correlated with the median pre-treatment primary tumor SUVmax. Furthermore, other factors influencing patient outcome were analyzed. RESULTS The median age of patients was 58 years (range, 45-71) with 72 (91%) males. Squamous cell carcinoma (73%) was the most common histologic type. Performance status was very good (ECOG 0) in 64.5% of patients. Sixty (79%) patients had died at the time of this analysis. Median OS and PFS were 22.5 and 12.0 months, respectively. Patients were dichotomized according to pre-treatment primary tumor SUVmax≤15.0 vs.>15.0. There was no statistically significant difference for OS and PFS in both arms. Multivariate analysis showed that pre-treatment SUVmax was not a significant predictor of OS (HR 1.099, P=0.726) and PFS (HR 1.022, P=0.941). CONCLUSIONS SUVmax with threshold value of 15.0 on the primary tumor before treatment had no prognostic value in our patient group with stage iii NSCLC treated with definitive CCRT.
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Affiliation(s)
- U Yılmaz
- Department of Pulmonology, Dr. Suat Seren Chest Disease and Surgery Training and Research Hospital, İzmir, Turquía.
| | - Ö Batum
- Department of Pulmonology, Dr. Suat Seren Chest Disease and Surgery Training and Research Hospital, İzmir, Turquía
| | - H Koparal
- Department of Nuclear Medicine, Dr. Suat Seren Chest Disease and Surgery Training and Research Hospital, İzmir, Turquía
| | - E Özbilek
- Department of Nuclear Medicine, Dr. Suat Seren Chest Disease and Surgery Training and Research Hospital, İzmir, Turquía
| | - E Kıraklı
- Department of Radiation Oncology, Dr. Suat Seren Chest Disease and Surgery Training and Research Hospital, İzmir, Turquía
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Abstract
Background We previously proposed measuring tumor size using mediastinal window setting on high-resolution computed tomography (CT) as a simple and useful modality for preoperative prognostication of small adenocarcinoma. Hence, the importance of tumor volume and positron emission tomography (PET) for preoperative prognostication of clinical stage IA (cIA) adenocarcinoma was studied. Materials and Methods We retrospectively evaluated total 324 patients who underwent pulmonary resection of cIA adenocarcinoma between July 2008 and August 2015. Reconstructed three-dimensional (3D) images from 1–1.5 mm-sliced CT were evaluated for whole tumor volume including ground grass opacity, consolidation volume on lung window setting, and mediastinal window volume (MWV). The values examined by PET were total lesion glycolysis (TLG), and maximum standardized uptake (SUV max) and mean. Pathologic status was evaluated according to tumor maximum size, invasive size (IS), lymphatic and vascular vessels, pleural invasion (ly/v/pl), and TNM staging. Results According to ly/v/pl invasion and lymph node positivity, no variables were superior to IS. We used Mean/MWV (SUV mean x MWV) to evaluate tumor quality and quantity in the role of surrogate TLG. Mean/MWV were superior to IS. Additionally, Mean/MV was associated with lymph node metastases. Among the various histologic subtypes, solid-predominant had the highest expression of Mean/MV. The higher Mean/MV significantly contributed to unfavorable disease-free survival in cIA adenocarcinomas, but not to overall survival. Conclusions The mean/MWV value determination on 3D-reconstructed CT images was a simple and useful preoperative modality for predicting invasive facet in cIA adenocarcinoma. However, higher values didn't significantly affect overall survival.
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Vanhove K, Mesotten L, Heylen M, Derwael R, Louis E, Adriaensens P, Thomeer M, Boellaard R. Prognostic value of total lesion glycolysis and metabolic active tumor volume in non-small cell lung cancer. Cancer Treat Res Commun 2017; 15:7-12. [PMID: 30207286 DOI: 10.1016/j.ctarc.2017.11.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 07/14/2017] [Accepted: 11/14/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION To predict the outcome of patients with non-small cell lung cancer (NSCLC) the currently used prognostic system (TNM) is not accurate enough. The prognostic significance of the SUVmax measured by PET remains controversial. This study aims to evaluate the prognostic value in overall survival and progression free survival of SUVmax, the total lesion glycolysis (TLG) and the mean metabolic active volume (MATV) in NSCLC. METHODS We retrospectively reviewed 105 patients (72 males, 33 females) with a new diagnosis of NSCLC (TNM stage I: 27.6%, II: 10.5%, III: 40.9% and IV: 21.0%) who underwent scanning with a PET/CT. For VOI definition a semi-automatic delineation tool was used. On PET images SUVmax, SUVmean and MATV of the primary tumor and the whole tumor burden were measured. TLG and MATV were measured by using a threshold of 50% of SUVmax. RESULTS OS and PFS are found to be higher in patients with low-SUVTmax and low-TLGT values. OS and PFS were significantly higher for low-SUVWTBmax, low-MATVWTB and low-TLGWTB values of the whole-tumor burden. Multivariate analysis of the whole-tumor burden revealed that the most important prognostic factors for OS are high MATVWTB and TLGWTB values, increasing stage and male gender. TLGWTB and stage are also independent prognosticators in PFS. CONCLUSION Only whole-body TLG is of prognostic value in NSCLC for both OS and PFS. Stratification of patients by TLGWTB might complement outcome prediction but the TNM stage remains the most important determinant of prognosis. MICROABSTRACT In order to predict the outcome of patients with non-small cell lung cancer (NSCLC) the currently used prognostic system (TNM) is not accurate enough. The prognostic significance of the standard uptake value (SUV) measured by PET remains controversial. This study aims to evaluate the prognostic value in overall survival (OS) and progression free survival (PFS) of the standard uptake value (SUV), the total lesion glycolysis (TLG) and the mean metabolic active volume (MATV) in NSCLC. The study reveals that TLG of the whole-tumor burden is an independent prognostic factor for OS and PFS in patients with NSCLC.
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Affiliation(s)
- Karolien Vanhove
- Hasselt University, Faculty of Medicine and Life Sciences, Martelarenlaan 42, B-3500 Hasselt, Belgium
| | - Liesbet Mesotten
- Hasselt University, Faculty of Medicine and Life Sciences, Martelarenlaan 42, B-3500 Hasselt, Belgium; Ziekenhuis Oost Limburg, Schiepse Bos 6, 3600 Genk, Belgium.
| | - Micheline Heylen
- Hasselt University, Faculty of Medicine and Life Sciences, Martelarenlaan 42, B-3500 Hasselt, Belgium
| | - Ruben Derwael
- Hasselt University, Faculty of Medicine and Life Sciences, Martelarenlaan 42, B-3500 Hasselt, Belgium
| | - Evelyne Louis
- Hasselt University, Faculty of Medicine and Life Sciences, Martelarenlaan 42, B-3500 Hasselt, Belgium
| | - Peter Adriaensens
- Hasselt University, Institute for Materials Research, Applied and Analytical Chemistry, Agoralaan Building D, B-3590 Diepenbeek, Belgium
| | - Michiel Thomeer
- Hasselt University, Faculty of Medicine and Life Sciences, Martelarenlaan 42, B-3500 Hasselt, Belgium; Ziekenhuis Oost Limburg, Schiepse Bos 6, 3600 Genk, Belgium
| | - Ronald Boellaard
- VU University Medical Center, Department of Radiology & Nuclear Medicine, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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Cheng G, Huang H. Prognostic Value of 18F-Fluorodeoxyglucose PET/Computed Tomography in Non-Small-Cell Lung Cancer. PET Clin 2017; 13:59-72. [PMID: 29157386 DOI: 10.1016/j.cpet.2017.08.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Non-small cell lung cancer (NSCLC) is a leading cause of cancer-related death with a poor prognosis. Numerous factors contribute to treatment outcome. 18F-fluorodeoxyglucose (FDG) uptake reflects tumor metabolic activity and is an important prognosticator in patients with NSCLC. Volume-based FDG-PET parameters reflect the metabolic status of a malignancy more accurately than maximum standardized uptake value and thus are better prognostic markers in lung cancer. FDG-avid tumor burden parameters may help clinicians to predict treatment outcomes before and during therapy so that treatment can be adjusted to achieve the best possible outcomes while avoiding side effects.
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Affiliation(s)
- Gang Cheng
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| | - He Huang
- Department of Nuclear Medicine, Luzhou People's Hospital, Luzhou, Sichuan Province, People's Republic of China
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Cysouw MCF, Kramer GM, Schoonmade LJ, Boellaard R, de Vet HCW, Hoekstra OS. Impact of partial-volume correction in oncological PET studies: a systematic review and meta-analysis. Eur J Nucl Med Mol Imaging 2017; 44:2105-2116. [PMID: 28776088 PMCID: PMC5656693 DOI: 10.1007/s00259-017-3775-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/02/2017] [Indexed: 11/03/2022]
Abstract
Purpose Positron-emission tomography can be useful in oncology for diagnosis, (re)staging, determining prognosis, and response assessment. However, partial-volume effects hamper accurate quantification of lesions <2–3× the PET system’s spatial resolution, and the clinical impact of this is not evident. This systematic review provides an up-to-date overview of studies investigating the impact of partial-volume correction (PVC) in oncological PET studies. Methods We searched in PubMed and Embase databases according to the PRISMA statement, including studies from inception till May 9, 2016. Two reviewers independently screened all abstracts and eligible full-text articles and performed quality assessment according to QUADAS-2 and QUIPS criteria. For a set of similar diagnostic studies, we statistically pooled the results using bivariate meta-regression. Results Thirty-one studies were eligible for inclusion. Overall, study quality was good. For diagnosis and nodal staging, PVC yielded a strong trend of increased sensitivity at expense of specificity. Meta-analysis of six studies investigating diagnosis of pulmonary nodules (679 lesions) showed no significant change in diagnostic accuracy after PVC (p = 0.222). Prognostication was not improved for non-small cell lung cancer and esophageal cancer, whereas it did improve for head and neck cancer. Response assessment was not improved by PVC for (locally advanced) breast cancer or rectal cancer, and it worsened in metastatic colorectal cancer. Conclusions The accumulated evidence to date does not support routine application of PVC in standard clinical PET practice. Consensus on the preferred PVC methodology in oncological PET should be reached. Partial-volume-corrected data should be used as adjuncts to, but not yet replacement for, uncorrected data. Electronic supplementary material The online version of this article (doi:10.1007/s00259-017-3775-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matthijs C F Cysouw
- Department of Radiology and Nuclear Medicine, VU University Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, Netherlands
| | - Gerbrand M Kramer
- Department of Radiology and Nuclear Medicine, VU University Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, Netherlands
| | - Linda J Schoonmade
- Department of Medical Library, VU University Medical Centre, Amsterdam, Netherlands
| | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine, VU University Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, Netherlands.,Department of Nuclear Medicine & Molecular Imaging, University Medical Centre Groningen, Groningen, Netherlands
| | - Henrica C W de Vet
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, Netherlands
| | - Otto S Hoekstra
- Department of Radiology and Nuclear Medicine, VU University Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, Netherlands.
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Zhou X, Chen R, Huang G, Liu J. Potential clinical value of PET/CT in predicting occult nodal metastasis in T1-T2N0M0 lung cancer patients staged by PET/CT. Oncotarget 2017; 8:82437-82445. [PMID: 29137276 PMCID: PMC5669902 DOI: 10.18632/oncotarget.19535] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 03/16/2017] [Indexed: 11/25/2022] Open
Abstract
We assessed the clinical value of 2-fluoro-2-deoxyglucose (18F-FDG) PET/CT imaging for predicting occult nodal metastasis in non-small cell lung cancer (NSCLC) patients. This retrospective study included 54 patients with T1-2N0M0 NSCLC who had undergone 18F-FDG PET/CT before surgery. Occult nodal metastasis was detected in 25.9% (14/54) of the patients. Immunohistochemical analysis revealed that increased glucose transporter 1 expression was associated with occult nodal metastasis, but hexokinase 2 expression was not. Compared to the negative nodal metastasis group, the positive nodal metastasis group was associated with increased maximum standardized uptake value (SUVmax) and tumor size. Multivariate analysis indicated that SUVmax and tumor size were associated with nodal metastasis. Nodal metastasis could be predicted with a sensitivity of 92.9% and a specificity of 55.0% when the SUVmax cutoff was 4.35. When patients were divided into low-risk (tumor size ≤ 2.5 cm and SUVmax ≤ 4.35), moderate-risk (tumor size ≤ 2.5 cm and SUVmax > 4.35 or tumor size > 2.5 cm and SUVmax ≤ 4.35) and high-risk (tumor size > 2.5 cm and SUVmax > 4.35) groups, the lymph node metastasis rates were 4.3%, 22.7%, and 88.9%, respectively. These results indicate that the combination of SUVmax and tumor size has potential clinical value for predicting occult nodal metastasis in NSCLC patients.
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Affiliation(s)
- Xiang Zhou
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ruohua Chen
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Gang Huang
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jianjun Liu
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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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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Bazan JG, Duan F, Snyder BS, Horng D, Graves EE, Siegel BA, Machtay M, Loo BW. Metabolic tumor volume predicts overall survival and local control in patients with stage III non-small cell lung cancer treated in ACRIN 6668/RTOG 0235. Eur J Nucl Med Mol Imaging 2017; 44:17-24. [PMID: 27645692 PMCID: PMC5121029 DOI: 10.1007/s00259-016-3520-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 09/07/2016] [Indexed: 12/13/2022]
Abstract
PURPOSE To determine whether higher pre-treatment metabolic tumor volume (tMTV-pre) is associated with worse overall survival (OS) in patients with inoperable NSCLC treated with definitive chemoradiation (CRT). METHODS This is a secondary analysis of the American College of Radiology Imaging Network (ACRIN) 6668/Radiation Therapy Oncology Group 0235 trial. Pre-treatment PET scans were performed on ACRIN-qualified scanners. Computer-aided MTV measurement was performed using RT_Image. Kaplan-Meier curves and Cox proportional hazards regression models were used to assess the association between tMTV and OS. RESULTS Of the 250 patients enrolled on the study, 230 were evaluable for tMTV-pre. Patients with MTV-pre >32 mL (median value) vs. ≤32 mL had worse median OS (14.8 vs. 29.7 months, p < 0.001). As a continuous variable, higher tMTV-pre (per 10-mL increase) remained associated with worse OS (HR = 1.03, p < 0.001) after controlling for other variables. A significant interaction between radiation dose and tMTV-pre occurred for OS (p = 0.002), demonstrating that the negative prognostic impact of tMTV-pre decreased as radiotherapy dose increased. Among patients with tMTV-pre ≤32 mL, there was no difference in survival according to radiotherapy dose delivered (p = 0.694). However, median OS was inferior in patients with tMTV-pre >32 mL who received ≤60 Gy compared with those who received 61-69 Gy or ≥70 Gy (p = 0.001). CONCLUSIONS Higher tMTV-pre is associated with significantly worse OS in inoperable stage III NSCLC treated with definitive CRT. Our findings suggest that for patients with large tMTV-pre, achieving a therapeutic radiation dose may help maximize OS. Prospective studies are needed to confirm this finding.
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Affiliation(s)
- Jose G Bazan
- Department of Radiation Oncology, The Ohio State University, 460 W. 10th Avenue, Columbus, OH, 43210, USA.
| | - Fenghai Duan
- Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Bradley S Snyder
- Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Dunstan Horng
- ECOG-ACRIN Cancer Research Group, Philadelphia, PA, USA
| | - Edward E Graves
- Department of Radiation Oncology, Stanford Cancer Institute, School of Medicine, Stanford University, 875 Blake Wilbur Drive, Stanford, CA, 94305-5847, USA
| | - Barry A Siegel
- Mallinckrodt Institute of Radiology and the Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Mitchell Machtay
- Case Comprehensive Cancer Center and Case Western Reserve University, University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | - Billy W Loo
- Department of Radiation Oncology, Stanford Cancer Institute, School of Medicine, Stanford University, 875 Blake Wilbur Drive, Stanford, CA, 94305-5847, USA.
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Role of CT and PET Imaging in Predicting Tumor Recurrence and Survival in Patients with Lung Adenocarcinoma: A Comparison with the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society Classification of Lung Adenocarcinoma. J Thorac Oncol 2016; 10:1785-94. [PMID: 26473646 DOI: 10.1097/jto.0000000000000689] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Recently, a new lung adenocarcinoma classification scheme was published. The prognostic value of this new classification has not been elaborated together with the value of imaging biomarkers including computed tomography (CT) and positron emission tomography (PET). METHODS We reviewed pathologic specimens and imaging characteristics of primary tumors from 723 consecutive patients who underwent surgical resection for lung adenocarcinoma. On pathology, the predominant histologic subtype and pattern group were quantified. Tumor-shadow disappearance ratio (TDR) on CT and maximum standardized uptake value (SUVmax) on PET were assessed. The relationships between those variables and survival (overall survival [OS] and disease-free survival) were analyzed by using Kaplan-Meier curves and Cox regression analyses. RESULTS The median follow-up period was 3.8 years. There were 137 patients (19%) with recurrence and 167 patients (23%) with metastasis after surgical resection. Among 723 patients, 35 patients (4.8%) had adenocarcinoma in situ, 34 patients (4.7%) had minimally invasive adenocarcinoma, 125 patients (17.3%) had lepidic predominant, 314 patients (43.4%) had acinar predominant, 65 patients (9.0%) had papillary predominant, 23 patients (3.2%) had micropapillary predominant, 113 patients (15.6%) had solid predominant, and 14 patients (1.9%) had variant adenocarcinomas. OS and disease-free survival rates were significantly different according to TDR on CT and SUVmax on PET, predominant subtypes, and pattern groups. On multivariate analysis, the SUVmax (p < 0.001), TDR (p = 0.038), and pattern group (p = 0.015) were independent predictors of OS. CONCLUSIONS TDR on CT, SUVmax on PET, and the new histologic classification schemes appear to be promising parameters for the prognostic stratification of patients with lung adenocarcinomas, allowing for the triage of patients who necessitate further staging workup and adjuvant therapy.
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Volume-based predictive biomarkers of sequential FDG-PET/CT for sunitinib in cancer of unknown primary: identification of the best benefited patients. Eur J Nucl Med Mol Imaging 2016; 44:199-205. [DOI: 10.1007/s00259-016-3504-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 08/25/2016] [Indexed: 01/17/2023]
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Prognostic value of early response assessment using 18F-FDG PET/CT in chemotherapy-treated patients with non-small-cell lung cancer. Nucl Med Commun 2016; 36:1187-94. [PMID: 26375438 DOI: 10.1097/mnm.0000000000000382] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE We aimed to evaluate the prognostic value of early response assessment using a volumetric fluorine-18-fluorodeoxyglucose (F-FDG) PET analysis in chemotherapy-treated patients with non-small-cell lung cancer (NSCLC). MATERIALS AND METHODS We retrospectively reviewed 33 patients with NSCLC who received first-line chemotherapy and performed F-FDG PET/computed tomography before (baseline PET) and after two cycles of chemotherapy (interim PET). The maximum standardized uptake value (SUVmax) and metabolic tumor volume (MTV) of the total malignant lesion were measured in baseline (SUV1 and MTV1) and interim (SUV2 and MTV2) PET images, and percentage changes in SUVmax (ΔSUV) and MTV (ΔMTV) were calculated between the two images. We compared PET parameters and clinicopathologic variables in terms of the 2-year overall survival (OS). RESULTS The median follow-up period was 14.3 months and the 2-year OS was 31%. In PET images, the mean SUV1, MTV1, SUV2, MTV2, ΔSUV, and ΔMTV were 13.1±4.5, 307.9±340.0 cm, 9.5±5.1, 180.4±29.6 cm, 27±28%, and 42±65%, respectively. In univariable analysis, M stage, TNM stage, and all six PET parameters associated significantly with OS. Both the MTV1 and the ΔMTV were tested against OS controlling for M stage, one at time, and the effect remained significant in multivariable analyses. CONCLUSION A smaller baseline MTV and greater decrease in MTV between baseline and interim PET images are associated with a significantly prolonged OS. A volume-based F-FDG PET analysis would facilitate prediction of clinical outcome and identification of treatment-resistant patients early during chemotherapy and could thus be used in personalized treatment approaches for patients with NSCLC.
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Jin F, Zhu H, Fu Z, Kong L, Yu J. Prognostic value of the standardized uptake value maximum change calculated by dual-time-point (18)F-fluorodeoxyglucose positron emission tomography imaging in patients with advanced non-small-cell lung cancer. Onco Targets Ther 2016; 9:2993-9. [PMID: 27284249 PMCID: PMC4881733 DOI: 10.2147/ott.s104919] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose The purpose of this study was to investigate the prognostic value of the standardized uptake value maximum (SUVmax) change calculated by dual-time-point 18F-fluorodeoxyglucose positron emission tomography (PET) imaging in patients with advanced non-small-cell lung cancer (NSCLC). Patients and methods We conducted a retrospective review of 115 patients with advanced NSCLC who underwent pretreatment dual-time-point 18F-fluorodeoxyglucose PET acquired at 1 and 2 hours after injection. The SUVmax from early images (SUVmax1) and SUVmax from delayed images (SUVmax2) were recorded and used to calculate the SUVmax changes, including the SUVmax increment (ΔSUVmax) and percent change of the SUVmax (%ΔSUVmax). Progression-free survival (PFS) and overall survival (OS) were determined by the Kaplan–Meier method and were compared with the studied PET parameters, and the clinicopathological prognostic factors in univariate analyses and multivariate analyses were constructed using Cox proportional hazards regression. Results One hundred and fifteen consecutive patients were reviewed, and the median follow-up time was 12.5 months. The estimated median PFS and OS were 3.8 and 9.6 months, respectively. In univariate analysis, SUVmax1, SUVmax2, ΔSUVmax, %ΔSUVmax, clinical stage, and Eastern Cooperative Oncology Group (ECOG) scores were significant prognostic factors for PFS. Similar results were significantly correlated with OS, except %ΔSUVmax. In multivariate analysis, ΔSUVmax and %ΔSUVmax were significant factors for PFS. On the other hand, ECOG scores were only identified as independent predictors of OS. Conclusion Our results demonstrated the prognostic value of the SUVmax change in predicting the PFS of patients with advanced NSCLC. However, SUVmax change could not predict OS.
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Affiliation(s)
- Feng Jin
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, People's Republic of China; Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, People's Republic of China
| | - Hui Zhu
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, People's Republic of China
| | - Zheng Fu
- Department of Nuclear Medicine, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, People's Republic of China
| | - Li Kong
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, People's Republic of China
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, People's Republic of China
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Liu J, Dong M, Sun X, Li W, Xing L, Yu J. Prognostic Value of 18F-FDG PET/CT in Surgical Non-Small Cell Lung Cancer: A Meta-Analysis. PLoS One 2016; 11:e0146195. [PMID: 26727114 PMCID: PMC4699812 DOI: 10.1371/journal.pone.0146195] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 12/13/2015] [Indexed: 12/14/2022] Open
Abstract
Background The identification of surgical non-small cell lung cancer (NSCLC) patients with poor prognosis is a priority in clinical oncology because of their high 5-year mortality. This meta-analysis explored the prognostic value of maximal standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) on disease-free survival (DFS) and overall survival (OS) in surgical NSCLC patients. Materials and Methods MEDLINE, EMBASE and Cochrane Libraries were systematically searched until August 1, 2015. Prospective or retrospective studies that evaluated the prognostic roles of preoperative 18F-FDG PET/CT with complete DFS and OS data in surgical NSCLC patients were included. The impact of SUVmax, MTV or TLG on survival was measured using hazard ratios (HR). Sub-group analyses were performed based on disease stage, pathological classification, surgery only and cut-off values. Results Thirty-six studies comprised of 5807 patients were included. The combined HRs for DFS were 2.74 (95%CI 2.33–3.24, unadjusted) and 2.43 (95%CI: 1.76–3.36, adjusted) for SUVmax, 2.27 (95%CI 1.77–2.90, unadjusted) and 2.49 (95%CI 1.23–5.04, adjusted) for MTV, and 2.46 (95%CI 1.91–3.17, unadjusted) and 2.97 (95%CI 1.68–5.28, adjusted) for TLG. The pooled HRs for OS were 2.54 (95%CI 1.86–3.49, unadjusted) and 1.52 (95%CI 1.16–2.00, adjusted) for SUVmax, 2.07 (95%CI 1.16–3.69, unadjusted) and 1.91 (95%CI 1.13–3.22, adjusted) for MTV, and 2.47 (95%CI 1.38–4.43, unadjusted) and 1.94 (95%CI 1.12–3.33, adjusted) for TLG. Begg’s test detected publication bias, the trim and fill procedure was performed, and similar HRs were obtained. The prognostic role of SUVmax, MTV and TLG remained similar in the sub-group analyses. Conclusions High values of SUVmax, MTV and TLG predicted a higher risk of recurrence or death in patients with surgical NSCLC. We suggest the use of FDG PET/CT to select patients who are at high risk of disease recurrence or death and may benefit from aggressive treatments.
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Affiliation(s)
- Jing Liu
- Department of Radiation Oncology and Shandong Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
| | - Min Dong
- Department of Oncology, the People’s Hospital of Pingyi County, Pingyi, Shandong, China
| | - Xiaorong Sun
- Department of Radiology, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
| | - Wenwu Li
- Department of Radiology, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
| | - Ligang Xing
- Department of Radiation Oncology and Shandong Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
- * E-mail:
| | - Jinming Yu
- Department of Radiation Oncology and Shandong Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
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Lee JY, Choi JY, Heo JH, Han J, Jang SJ, Kim K, Kim J, Shim YM, Kim BT. Prognostic significance of volume-based 18F-FDG PET/CT parameter in patients with surgically resected non-small cell lung cancer. Comparison with immunohistochemical biomarkers. Nuklearmedizin 2015; 55:7-14. [PMID: 26875430 DOI: 10.3413/nukmed-0754-15-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/30/2015] [Indexed: 12/22/2022]
Abstract
AIM We investigated the prognostic value of volume-based 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) parameters compared with other factors including several immunohistochemical biomarkers in patients with surgically resected non-small cell lung cancer (NSCLC). PATIENTS, METHODS STUDY PARTICIPANTS 290 patients with surgically resected and histopathologically confirmed NSCLC. The maxmum standardized uptake value (SUVmax) and metabolic tumour volume (MTV) of the primary tumour were obtained on 18F-FDG PET/ computed tomography (CT) for initial staging and Ki-67 labeling index (LI), p16, CD31 and cyclin E were evaluated in the primary tumours by immunohistochemical staining. Survival analyses for variables including PET parameters, immunohistochemical biomarker and other clinical factors were performed using the Kaplan-Meier method and Cox proportional hazards regression analysis. RESULTS In univariate analyses, tumour stage, tumour size, and MTV were significant prognostic factors for decreased overall survival (OS) and disease-free survival (DFS). Multivariate analyses showed MTV and tumour stage were significant predictors of poor OS (MTV, hazard ratio (HR) = 1.135, p = 0.015; stage, HR = 0.644, p = 0.025) and DFS (MTV, HR = 1.128, p = 0.043; stage, HR = 0.541, p = 0.009). CONCLUSION The MTV of primary tumours is a significant prognostic factor for survival along with tumour stage in patients with surgically resected NSCLC. The MTV can predict OS and DFS better than immunohistochemical biomarkers.
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Affiliation(s)
| | - J Y Choi
- Joon Young Choi, MD, PhD, Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 lrwon-dong, Gangnam-gu, 135-710 Seoul, Republic of Korea, Tel. +82/2/34 10 26 48; Fax +82/2/34 10 26 39,
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Volume-Based Assessment With 18F-FDG PET/CT Improves Outcome Prediction for Patients With Stage IIIA-N2 Non-Small Cell Lung Cancer. AJR Am J Roentgenol 2015; 205:623-8. [PMID: 26295651 DOI: 10.2214/ajr.14.13847] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE We evaluated the prognostic impact of volume-based assessment by pretreatment (18)F-FDG PET/CT in patients who had clinical stage IIIA-N2 non-small cell lung cancer (NSCLC) treated with neoadjuvant concurrent chemoradiotherapy (CCRT) followed by surgical resection. MATERIALS AND METHODS We reviewed 161 consecutive patients who had stage IIIA-N2 NSCLC treated with neoadjuvant CCRT followed by surgery. In all cases, N2 disease was pathologically confirmed by mediastinoscopic biopsy, endobronchial ultrasound-guided transbronchial needle aspiration, or video-assisted thoracoscopic surgery. We measured the total metabolic tumor volume (total MTV) and the maximum standardized uptake value (SUVmax), including a primary tumor and metastatic nodes on the pretreatment scan. Overall survival (OS) and disease-free survival (DFS) were assessed using the Kaplan-Meier method. The association of PET parameters with OS and DFS was determined by univariable and multivariable analyses performed using the Cox regression model. RESULTS A higher total MTV was significantly associated with poor DFS (hazard ratio [HR], 1.82; p = 0.036) and OS (HR = 2.97; p = 0.012) in the multivariable analysis. In contrast, a higher SUVmax was not significantly associated with poor DFS and OS. Patients with a high total MTV (> 22 cm(3)) had a median survival time that was significantly shorter than that of patients with a low total MTV (median DFS, 11.3 vs 42.0 months, respectively [p < 0.001]; median OS, 38.3 months vs not reached [p < 0.001]). Kaplan-Meier curves showed significant differences on the basis of total MTV in patients with or without mediastinal downstaging after CCRT. Patients with a high total MTV had significantly worse DFS when they had post-neoadjuvant pathologic (yp) stage 0-II disease (p = 0.020) or yp stage III disease (p = 0.036). Higher total MTV was also associated with worse OS in patients with yp stage 0-II disease (p = 0.013) or yp stage III disease (p = 0.007). CONCLUSION A higher pretreatment total MTV is associated with worse outcome, independent of yp stage, in patients with stage IIIA-N2 NSCLC treated with neoadjuvant CCRT followed by surgery.
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Yıldırım F, Yurdakul AS, Özkaya S, Akdemir ÜÖ, Öztürk C. Total lesion glycolysis by 18F-FDG PET/CT is independent prognostic factor in patients with advanced non-small cell lung cancer. CLINICAL RESPIRATORY JOURNAL 2015; 11:602-611. [DOI: 10.1111/crj.12391] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 08/30/2015] [Accepted: 09/24/2015] [Indexed: 12/22/2022]
Affiliation(s)
- Fatma Yıldırım
- Department of Pulmonary Medicine; Gazi University Faculty of Medicine; Ankara Turkey
| | - Ahmet Selim Yurdakul
- Department of Pulmonary Medicine; Gazi University Faculty of Medicine; Ankara Turkey
| | - Sevket Özkaya
- Department of Pulmonary Medicine; Bahçeşehir University Faculty of Medicine; Istanbul Turkey
| | - Ümit Özgür Akdemir
- Department of Nuclear Medicine; Gazi University Faculty of Medicine; Ankara Turkey
| | - Can Öztürk
- Department of Pulmonary Medicine; Gazi University Faculty of Medicine; Ankara Turkey
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Sun H, Zhu A, Zhang L, Zhang J, Zhong Z, Wang F. Knockdown of PKM2 Suppresses Tumor Growth and Invasion in Lung Adenocarcinoma. Int J Mol Sci 2015; 16:24574-87. [PMID: 26501265 PMCID: PMC4632765 DOI: 10.3390/ijms161024574] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 09/22/2015] [Accepted: 09/23/2015] [Indexed: 11/16/2022] Open
Abstract
Accumulating evidence shows that activity of the pyruvate kinase M2 (PKM2) isoform is closely related to tumorigenesis. In this study, we investigated the relationship between PKM2 expression, tumor invasion, and the prognosis of patients with lung adenocarcinoma. We retrospectively analyzed 65 cases of patients with lung adenocarcinoma who were divided into low and a high expression groups based on PKM2 immunohistochemical staining. High PKM2 expression was significantly associated with reduced patient survival. We used small interfering RNA (siRNA) technology to investigate the effect of targeted PKM2-knockout on tumor growth at the cellular level. In vitro, siRNA-mediated PKM2-knockdown significantly inhibited the proliferation, glucose uptake (25%), ATP generation (20%) and fatty acid synthesis of A549 cells, while the mitochondrial respiratory capacity of the cells increased (13%).Western blotting analysis showed that PKM2-knockout significantly inhibited the expression of the glucose transporter GLUT1 and ATP citrate lyase, which is critical for fatty acid synthesis. Further Western blotting analysis showed that PKM2-knockdown inhibited the expression of matrix metalloproteinase 2 (MMP-2) and vascular endothelial growth factor (VEGF), which are important in degradation of the extracellular matrix and angiogenesis, respectively. These observations show that PKM2 activates both glycolysis and lipid synthesis, thereby regulating cell proliferation and invasion. This information is important in elucidating the mechanisms by which PKM2 influences the growth and metastasis of lung adenocarcinoma at the cellular and molecular level, thereby providing the basic data required for the development of PKM2-targeted gene therapy.
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Affiliation(s)
- Hong Sun
- Department of Clinical Laboratory Science, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China.
| | - Anyou Zhu
- Department of Clinical Laboratory Science, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China.
| | - Lunjun Zhang
- Department of Clinical Laboratory Science, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China.
| | - Jie Zhang
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China.
| | - Zhengrong Zhong
- Department of Clinical Laboratory Science, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China.
| | - Fengchao Wang
- Department of Clinical Laboratory Science, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China.
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Shimizu K, Okita R, Saisho S, Yukawa T, Maeda A, Nojima Y, Nakata M. Clinical significance of dual-time-point 18F-FDG PET imaging in resectable non-small cell lung cancer. Ann Nucl Med 2015; 29:854-60. [PMID: 26254228 PMCID: PMC4666280 DOI: 10.1007/s12149-015-1013-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 07/30/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The maximal standardized uptake value (SUVmax) of pulmonary lesions on dual-time-point (DTP) fluorodeoxyglucose positron emission tomography (FDG-PET) has been shown to be useful for differentiation between malignant and non-malignant pulmonary lesions, and also to be of value for intrathoracic nodal staging of non-small cell lung cancer (NSCLC). However, a few NSCLC lesions have been found to show decreased FDG uptake on delayed images, and the significance of this finding remains unknown. PATIENTS AND METHODS We conducted a retrospective review of the data of 284 patients with NSCLC who underwent DTP FDG-PET before surgery. Cases of adenocarcinoma in situ and minimally invasive adenocarcinoma were excluded, because these lesions show little FDG uptake. Each patient was scanned at 60 min (early acquisition; SUV-E) and 115 min (delayed acquisition; SUV-D) after the radiopharmaceutical injection. The intratumoral retention index (RI) of 18F-FDG was measured for each examination by the DTP method. Recurrence-free survival (RFS) was determined by the Kaplan-Meier method and compared in relation to the SUV-E, SUV-D, and RI by univariate and multivariate analysis using models including the clinico-pathological prognostic factors. RESULTS Of the 284 cases, the RI ≤ 0 was in 49 cases (17.3%). This group of patients showed lower values of SUV-E and SUV-D, a smaller tumor size, and a lower rate of lymphatic invasion or vascular invasion. It was particularly noteworthy that lymph node metastasis was not histopathologically confirmed in any of these patients. Univariate analysis identified the RI, SUV-E and SUV-D, besides age, tumor size, lymph node metastasis, and tumor differentiation grade as predictors of the RFS. On the other hand, multivariate analysis identified the RI and lymph node metastasis, but not the SUV-E and SUV-D, as independent predictors of the RFS. CONCLUSIONS This study demonstrated that DTP FDG-PET of the primary tumor in NSCLC can be useful to predict the RFS of the patients. In addition, this method may also be useful to predict the presence/absence of intrathoracic lymph node metastasis in these patients.
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Affiliation(s)
- Katsuhiko Shimizu
- Department of General Thoracic Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
| | - Riki Okita
- Department of General Thoracic Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Shinsuke Saisho
- Department of General Thoracic Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Takuro Yukawa
- Department of General Thoracic Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Ai Maeda
- Department of General Thoracic Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Yuji Nojima
- Department of General Thoracic Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Masao Nakata
- Department of General Thoracic Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
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Cho KM, Oh DY, Kim TY, Lee KH, Han SW, Im SA, Kim TY, Bang YJ. Metabolic Characteristics of Advanced Biliary Tract Cancer Using 18F-Fluorodeoxyglucose Positron Emission Tomography and Their Clinical Implications. Oncologist 2015; 20:926-33. [PMID: 26099746 DOI: 10.1634/theoncologist.2014-0356] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 04/21/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In advanced biliary tract cancer (BTC), the metabolic landscape has not been evaluated by (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) yet. Furthermore, reports of the clinical implications of these metabolic features are limited. We aimed to evaluate the metabolic features and their clinical relevance in advanced BTC using (18)F-FDG PET. PATIENTS AND METHODS We consecutively enrolled patients with advanced BTC who underwent (18)F-FDG PET prior to palliative chemotherapy between 2003 and 2013. We evaluated the findings of PET, such as SUV(max), the number of lesions and organs with FDG uptake, pathologic findings, and clinical outcomes. RESULTS A total of 106 patients were enrolled: (53 intrahepatic cholangiocarcinoma [ICC], 7 extrahepatic BTC, 30 gallbladder cancer [GB Ca], and 16 ampulla of Vater cancer [AoV Ca]). The median SUV(max) differed according to the primary origin (ICC, 9.10; extrahepatic BTC, 5.90; GB Ca, 9.10; and AoV Ca, 6.37; p = .008) and histologic differentiation (well differentiated, 4.95; moderately differentiated, 6.60; poorly differentiated, 14.50; p = .004). Patients in the high metabolic group (SUV(max) of ≥7.5) had more poorly differentiated histology and more organs and lesions with FDG uptake than did those in the low metabolic group (SUV(max) of <7.5). The low metabolic group had a significantly longer OS (11.4 vs. 7.4 months, p = .007) and PFS (6.6 vs. 4.3 months, p = .024) than high metabolic group. In multivariate analysis, SUV(max) was a significant prognostic factor for overall survival (OS; p = .047) and progression-free survival (PFS; p = .039). CONCLUSION Metabolic characteristics of advanced BTC differ according to primary origin and histology. These metabolic features could be prognostic factors for OS and PFS in advanced BTC.
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Affiliation(s)
- Kyoung-Min Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Do-Youn Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tae-Yong Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyung Hun Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sae-Won Han
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seock-Ah Im
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tae-You Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yung-Jue Bang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
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Formula corrected maximal standardized uptake value in FDG-PET for partial volume effect and motion artifact is not a prognostic factor in stage I non-small cell lung cancer treated with stereotactic body radiotherapy. Ann Nucl Med 2015; 29:666-73. [DOI: 10.1007/s12149-015-0991-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 05/19/2015] [Indexed: 10/23/2022]
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Duan XY, Wang W, Li M, Li Y, Guo YM. Predictive significance of standardized uptake value parameters of FDG-PET in patients with non-small cell lung carcinoma. ACTA ACUST UNITED AC 2015; 48:267-72. [PMID: 25651460 PMCID: PMC4381948 DOI: 10.1590/1414-431x20144137] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 10/22/2014] [Indexed: 12/30/2022]
Abstract
18F-fluoro-2-deoxyglucose (FDG) positron emission tomography
(PET)/computed tomography (CT) is widely used to diagnose and stage non-small cell
lung cancer (NSCLC). The aim of this retrospective study was to evaluate the
predictive ability of different FDG standardized uptake values (SUVs) in 74 patients
with newly diagnosed NSCLC. 18F-FDG PET/CT scans were performed and
different SUV parameters (SUVmax, SUVavg, SUVT/L,
and SUVT/A) obtained, and their relationship with clinical characteristics
were investigated. Meanwhile, correlation and multiple stepwise regression analyses
were performed to determine the primary predictor of SUVs for NSCLC. Age, gender, and
tumor size significantly affected SUV parameters. The mean SUVs of squamous cell
carcinoma were higher than those of adenocarcinoma. Poorly differentiated tumors
exhibited higher SUVs than well-differentiated ones. Further analyses based on the
pathologic type revealed that the SUVmax, SUVavg, and
SUVT/L of poorly differentiated adenocarcinoma tumors were higher than
those of moderately or well-differentiated tumors. Among these four SUV parameters,
SUVT/L was the primary predictor for tumor differentiation. However, in
adenocarcinoma, SUVmax was the determining factor for tumor
differentiation. Our results showed that these four SUV parameters had predictive
significance related to NSCLC tumor differentiation; SUVT/L appeared to be
most useful overall, but SUVmax was the best index for adenocarcinoma
tumor differentiation.
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Affiliation(s)
- X-Y Duan
- PET-CT Center, The First Affiliated Hospital of Xi'an, Jiaotong University, Xi'an, Shaanxi, China
| | - W Wang
- PET-CT Center, The First Affiliated Hospital of Xi'an, Jiaotong University, Xi'an, Shaanxi, China
| | - M Li
- PET-CT Center, The First Affiliated Hospital of Xi'an, Jiaotong University, Xi'an, Shaanxi, China
| | - Y Li
- PET-CT Center, The First Affiliated Hospital of Xi'an, Jiaotong University, Xi'an, Shaanxi, China
| | - Y-M Guo
- PET-CT Center, The First Affiliated Hospital of Xi'an, Jiaotong University, Xi'an, Shaanxi, China
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Shimizu K, Maeda A, Yukawa T, Nojima Y, Saisho S, Okita R, Nakata M. Difference in prognostic values of maximal standardized uptake value on fluorodeoxyglucose-positron emission tomography and cyclooxygenase-2 expression between lung adenocarcinoma and squamous cell carcinoma. World J Surg Oncol 2014; 12:343. [PMID: 25392182 PMCID: PMC4254182 DOI: 10.1186/1477-7819-12-343] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 10/29/2014] [Indexed: 11/30/2022] Open
Abstract
Background The maximal standardized uptake value (SUVmax) on fluorodeoxyglucose-positron emission tomography (FDG-PET) for primary tumors is correlated with clinicopathological and prognostic factors in patients with non-small cell lung cancer. However, previous investigations have discussed the role of SUVmax without distinguishing among the histological subtypes of lung cancer. Herein, we investigated the correlations among the SUVmax on FDG-PET, clinicopathological or prognostic factors, and the expression of tumor angiogenic biomarkers according to histological subtypes. Methods We conducted a retrospective review of data from 52 patients with invasive adenocarcinoma (ADC) and 32 patients with squamous cell carcinoma (SQC) measuring less than 3 cm in diameter. Immunohistochemical staining for cyclooxygenase-2 (Cox-2), Ki-67, and vascular endothelial growth factor, which might influence cancer progression, was performed and the correlations between the expressions of these biomarkers and the SUVmax were evaluated. Results Among ADC patients, a statistically significant correlation was observed between the SUVmax and the major clinicopathological factors; among SQC patients, however, no statistically significant association was observed. The disease-free survival (DFS) period of the ADC patients with a high SUVmax was significantly poorer than that of the patients with a low SUVmax, but the DFS of the SQC patients with a high SUVmax was not significantly poorer. In a multivariate analysis, the pathological stage and the SUVmax were independent prognostic factors of the DFS among the ADC patients. Among the SQC patients, however, only Cox-2 expression was an independent prognostic factor of DFS. Conclusions Some clear differences in prognostic values of the SUVmax on FDG-PET and Cox-2 expression exist between patients with ADC and those with SQC. Based on these relationships between the SUVmax and clinicopathological or biological factors that influence cancer progression, the importance of the SUVmax appears to be quite different for patients with ADC and those with SQC.
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Affiliation(s)
- Katsuhiko Shimizu
- Department of General Thoracic Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan.
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Kim HS, Lee KS, Ohno Y, van Beek EJ, Biederer J. PET/CT versus MRI for diagnosis, staging, and follow-up of lung cancer. J Magn Reson Imaging 2014; 42:247-60. [DOI: 10.1002/jmri.24776] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 09/27/2014] [Indexed: 12/19/2022] Open
Affiliation(s)
- Hyun Su Kim
- Department of Radiology and Center for Imaging Science; Samsung Medical Center, Sungkyunkwan University School of Medicine; Seoul Korea
| | - Kyung Soo Lee
- Department of Radiology and Center for Imaging Science; Samsung Medical Center, Sungkyunkwan University School of Medicine; Seoul Korea
| | - Yoshiharu Ohno
- Division of Functional and Diagnostic Imaging Research; Department of Radiology; and Advanced Biomedical Imaging Research Centre, Kobe University Graduate School of Medicine; Kobe Japan
| | | | - Juergen Biederer
- Radiologie Darmstadt; Gross-Gerau County Hospital; Gross-Gerau Germany
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Rasmussen JH, Vogelius IR, Fischer BM, Friborg J, Aznar MC, Persson GF, Håkansson K, Kristensen CA, Bentzen SM, Specht L. Prognostic value of 18F-fludeoxyglucose uptake in 287 patients with head and neck squamous cell carcinoma. Head Neck 2014; 37:1274-81. [DOI: 10.1002/hed.23745] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 05/05/2014] [Indexed: 11/09/2022] Open
Affiliation(s)
- Jacob H. Rasmussen
- Department of Oncology; Section of Radiotherapy, Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Ivan R. Vogelius
- Department of Oncology; Section of Radiotherapy, Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Barbara M. Fischer
- PET and Cyclotron Unit; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Jeppe Friborg
- Department of Oncology; Section of Radiotherapy, Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Marianne C. Aznar
- Department of Oncology; Section of Radiotherapy, Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Gitte F. Persson
- Department of Oncology; Section of Radiotherapy, Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Katrin Håkansson
- Department of Oncology; Section of Radiotherapy, Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Claus A. Kristensen
- Department of Oncology; Section of Radiotherapy, Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Søren M. Bentzen
- Division of Biostatistics and Bioinformatics; University of Maryland Greenebaum Cancer Center, and Department of Epidemiology and Public Health, University of Maryland School of Medicine; Baltimore Maryland
| | - Lena Specht
- Department of Oncology; Section of Radiotherapy, Rigshospitalet, University of Copenhagen; Copenhagen Denmark
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Obara P, Pu Y. Prognostic value of metabolic tumor burden in lung cancer. Chin J Cancer Res 2014; 25:615-22. [PMID: 24385688 DOI: 10.3978/j.issn.1000-9604.2013.11.10] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 11/29/2013] [Indexed: 12/20/2022] Open
Abstract
Accurate prognosis in patients with lung cancer is important for clinical decision making and treatment selection. The TNM staging system is currently the main method for establishing prognosis. Using this system, patients are grouped into one of four stages based on primary tumor extent, nodal disease, and distant metastases. However, each stage represents a range of disease extent and may not on its own be the best reflection of individual patient prognosis. (18)F-fluorodeoxyglucose-positron emission tomography ((18)F-FDG-PET) can be used to evaluate the metabolic tumor burden affecting the whole body with measures such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG). MTV and TLG have been shown to be significant prognostic factors in patients with lung cancer, independent of TNM stage. These metabolic tumor burden measures have the potential to make lung cancer staging and prognostication more accurate and quantitative, with the goal of optimizing treatment choices and outcome predictions.
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Affiliation(s)
- Piotr Obara
- Department of Radiology, University of Chicago, Chicago 60637, USA
| | - Yonglin Pu
- Department of Radiology, University of Chicago, Chicago 60637, USA
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Komar G, Lehtiö K, Seppänen M, Eskola O, Levola H, Lindholm P, Sipilä H, Seppälä J, Grénman R, Solin O, Minn H. Prognostic value of tumour blood flow, [¹⁸F]EF5 and [¹⁸F]FDG PET/CT imaging in patients with head and neck cancer treated with radiochemotherapy. Eur J Nucl Med Mol Imaging 2014; 41:2042-50. [PMID: 24898846 DOI: 10.1007/s00259-014-2818-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 05/19/2014] [Indexed: 12/22/2022]
Abstract
PURPOSE In order to improve the treatment of squamous cell carcinoma of the head and neck, precise information on the treated tumour's biology is required and the prognostic importance of different biological parameters needs to be determined. The aim of our study was to determine the predictive value of pretreatment PET/CT imaging using [(18)F]FDG, a new hypoxia tracer [(18)F]EF5 and the perfusion tracer [(15)O]H₂O in patients with squamous cell cancer of the head and neck treated with radiochemotherapy. METHODS The study group comprised 22 patients with confirmed squamous cell carcinoma of the head and neck who underwent a PET/CT scan using the above tracers before any treatment. Patients were later treated with a combination of radiochemotherapy and surgery. Parametric blood flow was calculated from dynamic [(15)O]H₂O PET images using a one-tissue compartment model. [(18)F]FDG images were analysed by calculating standardized uptake values (SUV) and metabolically active tumour volumes (MATV). [(18)F]EF5 images were analysed by calculating tumour-to-muscle uptake ratios (T/M ratio). A T/M ratio of 1.5 was considered a significant threshold and used to determine tumour hypoxic subvolumes (HS) and hypoxic fraction area. The findings were finally correlated with the pretreatment clinical findings (overall stage and TNM stage) as well as the outcome following radiochemotherapy in terms of local control and overall patient survival. RESULTS Tumour stage and T-classification did not show any significant differences in comparison to the patients' metabolic and functional characteristics measured on PET. Using the Cox proportional hazards model, a shorter overall survival was associated with MATV (p = 0.008, HR = 1.108), maximum [(18)F]EF5 T/M ratio (p = 0.0145, HR = 4.084) and tumour HS (p = 0.0047, HR = 1.112). None of the PET parameters showed a significant effect on patient survival in the log-rank test, although [(18)F]EF5 maximum T/M ratio was the closest (p = 0.109). By contrast, tumour blood flow was not correlated with any of the clinical endpoints. There were no statistically significant correlations among [(18)F]FDG SUVmax, [(18)F]EF5 T/M ratio and blood flow. CONCLUSION Our study in a limited number of patients confirmed the importance of MATV in the prognosis of locally advanced squamous cell carcinoma of the head and neck. It is of interest that high uptake of the hypoxia tracer [(18)F]EF5 showed a stronger correlation with a poor clinical outcome than [(18)F]FDG uptake. This confirms the importance of hypoxia in treatment outcome and suggests that [(18)F]EF5 may act as a surrogate marker of radioresistance.
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Affiliation(s)
- Gaber Komar
- Turku PET Centre, Kiinamyllynkatu 4-8, 20521, Turku, Finland,
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Lemonnier I, Guillemin F, Arveux P, Clément-Duchêne C, Velten M, Woronoff-Lemsi MC, Jolly D, Baumann C. Quality of life after the initial treatments of non-small cell lung cancer: a persistent predictor for patients' survival. Health Qual Life Outcomes 2014; 12:73. [PMID: 24884836 PMCID: PMC4026822 DOI: 10.1186/1477-7525-12-73] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 05/06/2014] [Indexed: 12/13/2022] Open
Abstract
Background Health-related quality of life (HRQoL) before treatment may predict survival of patients with non-small-cell lung cancer (NSCLC). We investigated the predictive role of HRQoL after the initial treatments, on the survival of these patients. Methods A prospective multi-center study conducted in northeastern France. The SF-36 and European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core-30 (QLQ C-30) were mailed to patients 3 months after the end of the diagnostic process. High scores for functioning dimensions on both questionnaires indicated better QoL, and low scores for symptom dimensions on the QLQ C-30 indicated few symptoms. Cox regression modeling was used to identify predictive factors of survival. Results In total, 230 (63.5%) patients responded to the SF-36 and QLQ C-30. Before completing the questionnaires, almost 60% of patients had undergone some chemotherapy, about 10% underwent radio/chemotherapy or both and more than 30% underwent surgery or surgery plus chemo/radiotherapy. On SF-36, the highest mean score was for social functioning dimension (55.5 ± 28), and the lowest was for the physical role dimension (17.9 ± 32.2). On QLQ C-30, for the functioning dimensions, the highest mean score was for cognitive functioning (74.6 ± 25.9) and the lowest was for role functioning (47.2 ± 34.1). For symptom dimensions, the lowest score was for diarrhoea (11.5 ± 24.2) and the highest was for fatigue (59.7 ± 27.7). On multivariate analysis, high bodily pain, social functioning and general health scores (SF-36) were associated with a lower risk of death (hazard ratio 0.580; 95% confidence interval [0.400–0.840], p = 0.004; HR 0.652 [0.455–0.935], p < 0.02; HR 0.625 [0.437–0.895] respectively). Better general QoL on QLQ C-30 was related to lower risk of death (HR 0.689 [0.501–0.946], p = 0.02). Conclusion Adding to previous knowledge about factors that may influence patients QoL, this study shows a persisting relationship between better perceived health in HRQoL after the initial treatment of NSCLC and better survival.
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