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

FDG-PET/CT tumor to liver SUV ratio (TLR), tumor SUVmax, and tumor size: can this help in differentiating squamous cell carcinoma from adenocarcinoma of the lung?

Background

PET/CT plays an essential role in the diagnosis, staging, and follow-up of lung cancer. We aimed to assess the ability of PET/CT to differentiate between adenocarcinomas (AC) and squamous cell carcinomas (SCC) of the lung using tumor size, tumor maximum standardized uptake value (SUVmax), lymph nodes SUVmax, and tumor to liver SUV ratio (TLR).

Results

A total of 60 patients pathologically proved to have non-small cell lung cancer either AC or SCC were retrospectively evaluated. The mean tumor size, SUVmax of the tumor, and TLR were significantly higher in SCC lesions compared to AC lesions. The mean SCC tumoral size was 7.96 ± 2.18 cm compared to 5.66 ± 2.57 cm in AC lesions (P = 0.008). The mean tumor SUVmax in SCC lesions was 18.95 ± 8.3 compared to 12.4 ± 7.55 in AC lesions (P = 0.04). While the mean TLR of SCC lesions was 10.32 ± 4.03 compared to 7.36 ± 4.61 in AC lesions (P = 0.028). All three parameters showed the same sensitivity (75%), while TLR showed the highest specificity (77.78%) followed by tumor size (76.47%) and then SUVmax of the tumor (72.22%).

Conclusions

SCC of the lung has a higher mean tumor size, SUVmax of the tumor, and TLR as compared to AC which can be helpful tools in differentiation between them using PET/CT.

Different Prognostic Values of Dual-Time-Point FDG PET/CT Imaging Features According to Treatment Modality in Patients with Non-Small Cell Lung Cancer

This study was aimed to investigate whether dual-time-point F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) imaging features had different prognostic values according to the treatment modality in patients with non-small cell lung cancer (NSCLC). We retrospectively reviewed 121 NSCLC patients with surgical resection (surgery group) and 69 NSCLC patients with chemotherapy and/or radiotherapy (CRT group), who underwent pretreatment dual-time-point FDG PET/CT. The maximum standardized uptake value (SUV), metabolic tumor volume (MTV), total lesion glycolysis (TLG), SUV histogram entropy of primary cancer, and the percent changes in these parameters (Δparameters) were measured. In multivariate analysis, MTV, TLG, and entropy on both early and delayed PET/CT scans were significantly associated with progression-free survival (PFS) in the surgery group, but all Δparameters failed to show a significant association. In the CRT group, TLG on the early PET, maximum SUV on the delayed PET, ΔMTV, and ΔTLG were significant independent predictors for PFS. In the surgery group, patients with high values of MTV, TLG, and entropy had worse survival, whereas, in the CRT group, patients with high values of ΔMTV and ΔTLG had better survival. Dual-time-point FDG PET/CT parameters showed different prognostic values between the surgery and CRT groups of NSCLC patients.

Prognostic Value of Dual-Time-Point [18F]FDG PET/CT for Predicting Distant Metastasis after Treatment in Patients with Non-Small Cell Lung Cancer

This study aimed to evaluate the prognostic significance of 2-Deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) uptake in the bone marrow (BM) and primary tumors on dual-time-point (DTP) PET/CT for predicting progression-free survival (PFS) and distant metastasis-free survival (DMFS) in patients with non-small cell lung cancer (NSCLC). We retrospectively analyzed DTP [18F]FDG PET/CT images from 211 patients with NSCLC. The maximum standardized uptake value (SUV) of primary lung cancer and mean [18F]FDG uptake of the BM (BM SUV) were measured from early and delayed PET/CT images, and the percent changes in these parameters (∆maximum SUV and ∆BM SUV) were calculated. On multivariate survival analysis, the maximum SUV and BM SUV on both early and delayed PET/CT scans were significantly associated with PFS, while the ∆maximum SUV and ∆BM SUV failed to show statistical significance. For DMFS, the ∆maximum SUV and ∆BM SUV were independent predictors along with the TNM stage. Distant progression was observed only in 1.3% of patients with low ∆maximum SUV and ∆BM SUV, whereas 28.2% of patients with high ∆maximum SUV and ∆BM SUV experienced distant progression. The ∆maximum SUV and ∆BM SUV on DTP [18F]FDG PET/CT were significant independent predictors for DMFS in patients with NSCLC.

Dual-time-point PET/CT study protocol can improve the larynx cancer diagnosis

Aim

To evaluate whether the sequential dual-time-point fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (DTP 18F-FDG PET/CT) study improves the differential diagnosis in the larynx.

Background

In some cases, the clinical and metabolic similarity of laryngitis and larynx cancer make differential diagnostics difficult when performing standard 18F-FDG PET/CT examinations; therefore, an additional study protocol performance seems to be of reasonable value.

Materials and methods

90 patients (mean age: 61 ± 11 years, range: 41-84 years): 23 women (mean age: 63 ± 10 years, range: 51-84 years) and 67 men (mean age: 61 ± 11 years, range: 41-80 years) underwent delayed 18F-FDG PET/CT examinations at 60 and 90 min post intravenous injection (p.i.) of the radiopharmaceutical 18F-FDG. We compared the metabolic activity of 90 structures divided into following groups: normal larynx (30 patients), laryngitis (30 lesions) and larynx cancer (30 tumors) with maximal and mean standardized uptake value (SUVmax, SUVmean) and the retention index (RI-SUVmax). We used the receiver operating characteristics (ROC) curve to evaluate the SUVmax cut-off values.

Results

The SUVmax cut-off value at 60 and 90 min p.i. of 2.3 (sensitivity/specificity: 96.4%/100%) and 2.4 (94.2%/100%), respectively, distinguished normal and abnormal metabolic activity in the larynx. When laryngitis and tumors were compared, the SUVmax cut-off values obtained after initial and delayed imaging were 3.6 (87.5%/52.0%) and 6.1 (58.3%/84%), respectively. The RI-SUVmax of 1.3% (71.4%/88.1%) suggested abnormality, while RI-SUVmax of 6.6%, malignant etiology (75.0%/80.0%).

Conclusions

In this study, the sequential DTP scanning protocol improved the sensitivity and specificity of the PET/CT method in terms of differential diagnosis within the larynx.

The maximum standardized uptake value increment calculated by dual-time-point 18F-fluorodeoxyglucose positron emission tomography predicts survival in patients with oral tongue squamous cell carcinoma

The aim of this study was to investigate the prognostic value of dual-time-point (DTP) ¹⁸F-fluorodeoxyglucose positron emission tomography (¹⁸F-FDG PET) imaging in primary oral tongue squamous cell carcinoma (OTSCC). The study included 52 patients who underwent preoperative ¹⁸F-FDG PET scans at two time points, namely 1 h and 2 h after injection. The following PET parameters were calculated: maximum standardized uptake value (SUVmax) for both time points (SUV early, SUV delayed); retention index (RI); and SUVmax increment (ΔSUVmax). Receiver operating characteristic (ROC) curve analysis was performed to define the optimal cutoff point for these parameters. Overall survival was calculated using the Kaplan–Meier method. Prognostic factors for patients with OTSCC were evaluated using the univariate log-rank test and a multivariate Cox proportional hazards model. ROC analysis revealed that the area under the curve was higher and more accurate for ΔSUVmax than for the other parameters. Additionally, patients with a ΔSUVmax ≥0.9 had significantly worse survival outcomes (28.9% vs 92.6%; p < 0.01). Univariate analysis showed that prognosis was significantly correlated with clinical T stage, local recurrence, perineural invasion, vascular invasion, and PET parameters (p < 0.05 for all). Multivariate analysis showed that local recurrence (hazard ratio = 3.60; p = 0.02) and ΔSUVmax (hazard ratio = 8.43; p < 0.01) were independent prognostic factors. ΔSUVmax determined using DTP ¹⁸F-FDG PET may be an additional prognostic factor in OTSCC patients.

Prognostic impact of C-reactive protein/albumin ratio on the overall survival of patients with advanced nonsmall cell lung cancers receiving palliative chemotherapy

Recent studies have indicated that the C-reactive protein (CRP)/albumin (CRP/Alb) ratio is associated with clinical outcomes in patients with various carcinomas. However, no studies have explored the association between the ratio of CRP/Alb and clinical outcome of inoperable patients with nonsmall cell lung cancers (NSCLCs). We examined the prognostic impact of CRP/Alb ratio on 165 stage IV NSCLC receiving palliative chemotherapy. The optimal cutoff level of CRP/Alb ratio was set at 0.195. The median follow-up time was 9 months (range, 1-74 months). On univariate analysis, high CRP/Alb ratio (≥0.195) was correlated (P < .001) with poorer overall survival (OS). Subgroup analysis of adenocarcinoma showed that CRP/Alb ratio was significantly (P < .001) associated with OS. Multivariate analysis showed that CRP/Alb ratio was an independent prognostic factor for OS (hazard ratio: 2.227, P = .001). Subgroup analysis revealed that the CRP/Alb ratio had a significant (P = .001) prognostic impact on adenocarcinoma patients receiving platinum chemotherapy. Elevated CRP/Alb ratio was significantly associated with male gender (P = .002) and smoking history (P = .009). The results of this study suggest that the CRP/Alb ratio might be used as a simple, inexpensive, and independent prognostic factor for OS of patients with advanced lung adenocarcinomas receiving platinum chemotherapy.