Fluorine-18 fluorodeoxyglucose positron emission tomographic maximal standardized uptake value predicts survival independent of clinical but not pathologic TNM staging of resected non-small cell lung cancer
ABSTRACT Positron emission tomographic maximal standardized uptake value has been shown to predict survival after resection of non-small cell lung cancer. The relative prognostic benefit of maximal standardized uptake value with respect to other clinical/pathologic variables has not been defined.
We reviewed patients who had positron emission tomographic imaging and an R0 resection for non-small cell lung cancer between January 1, 2000, and December 31, 2004, without induction or adjuvant therapy. The associations between overall survival, histology, pathologic TNM stage, pathologic tumor diameter, and standardized uptake value were tested.
Four hundred eighty-seven patients met the study criteria. Median follow-up was 25.8 months. By using the median values for tumor size (2.5 cm) and standardized uptake value (5.3), standardized uptake value was an independent predictor of survival (P = .03), adjusting for tumor size (P = .02) and histology (P < .01). The optimal standardized uptake value for stratification was identified as 4.4, and this value was identified as an independent predictor of survival (P = .03) after adjusting for clinical TNM stage. Standardized uptake value was not an independent predictor of survival (P = .09), adjusting for pathologic TNM stage (stage IA vs IB vs stage II-IV, P < .01).
Standardized uptake value does not add to the prognostic significance of pathologic TNM stage. Standardized uptake value was an independent prognostic factor from clinical TNM stage.
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ABSTRACT: Distant metastases are the dominant mode of failure after stereotactic body radiotherapy (SBRT) for early-stage non-small cell lung cancer (NSCLC). The primary study objective was to evaluate if the maximum standardized uptake value (SUV(max)) on pre-treatment FDG-PET/CT predicted clinical outcomes. Secondary objectives were to correlate 3-month post-SBRT SUV(max) and change in SUV(max) with outcomes. Consecutive patients with medically inoperable early-stage NSCLC and an FDG-PET/CT scan before (n=82) and 3 months after (n=62) SBRT. Median follow up was 2 years. On univariate analysis baseline SUV(max) predicted for distant failure (p=0.0096), relapse free survival (RFS) (p=0.037) and local failure (p=0.044). On multivariate analysis baseline SUV(max) predicted for RFS (p=0.037). Baseline SUV(max) of above 5 was the most statistically significant cut off point for predicting distant failure (p=0.0002). Baseline SUV(max) ≥4.75 (median) was correlated with a higher risk of distant failure (p=0.012) and poorer RFS (p=0.04). Patients with a post-SBRT SUV(max) ≥2 and a reduction of <2.55 had a significantly higher rate of distant failure. Pre-SBRT SUV(max) on FDG-PET/CT correlated most strongly with distant failure. A cut off of ≥5 was the most significant. Post-SBRT SUV(max) ≥2 and a reduction of <2.55 were associated with a higher risk of distant failure.Radiotherapy and Oncology 06/2012; 104(1):62-6. DOI:10.1016/j.radonc.2012.04.019 · 4.86 Impact Factor
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ABSTRACT: Tesis Univ. Granada. Departamento de Radiología y Medicina Interna. Leída el 1 de julio de 2009
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ABSTRACT: Purpose The aims were to determine if the maximum standardized uptake value (SUVmax) of the primary tumor as determined by preoperative 18F-fluoro-2-deoxyglucose (18F-FDG) positron emission tomography (PET) is an independent predictor of overall survival and to assess its prognostic value after stratification according to pathological staging. Methods A retrospective clinicopathologic review of 363 patients who had a preoperative 18F-FDG PET done before undergoing attempted curative resection for early-stage (I & II) non-small cell lung cancer (NSCLC) was performed. Patients who had received any adjuvant or neoadjuvant chemotherapy or radiation therapy were excluded. The primary outcome measure was duration of overall survival. Receiver-operating characteristic (ROC) curves were plotted to find out the optimal cutoff values of SUVmax yielding the maximal sensitivity plus specificity for predicting the overall survival. Survival curves stratified by median SUVmax and optimal cutoff SUVmax were estimated by the Kaplan-Meier method and statistical differences were assessed using the log-rank test. Multivariate proportional hazards (Cox) regression analyses were applied to test the SUVmax’s independency of other prognostic factors for the prediction of overall survival. Results The median duration of follow-up was 981 days (2.7 years). The median SUVmax was 5.9 for all subjects, 4.5 for stage IA, 8.4 for stage IB, and 10.9 for stage IIB. The optimal cutoff SUVmax was 8.2 for all subjects. No optimal cutoff could be established for specific stages. In univariate analyses, each doubling of SUVmax [i.e., each log (base 2) unit increase in SUVmax] was associated with a 1.28-fold [95% confidence interval (CI): 1.03–1.59, p = 0.029] increase in hazard of death. Univariate analyses did not show any significant difference in survival by SUVmax when data were stratified according to pathological stage (p = 0.119, p = 0.818, and p = 0.882 for stages IA, IB, and IIB, respectively). Multivariate analyses demonstrated that SUVmax was not an independent predictor of overall survival (p > 0.05). Conclusion Each doubling of SUVmax as determined by preoperative PET is associated with a 1.28-fold increase in hazard of death in early-stage (I & II) NSCLC. Preoperative SUVmax is not an independent predictor of overall survival.European journal of nuclear medicine and molecular imaging 04/2010; 37(4):691-698. DOI:10.1007/s00259-009-1291-x · 5.22 Impact Factor