PET-Based Primary Tumor Volumetric Parameters and Survival of Patients With Non—Small Cell Lung Carcinoma
Department of Radiology, Boston University School of Medicine, Boston, MA. American Journal of Roentgenology
(Impact Factor: 2.73).
03/2013; 200(3):635-40. DOI: 10.2214/AJR.12.9138
The purpose of the study was to assess metabolic tumor volume and total glycolytic activity of the primary tumor as prognostic parameters for outcome in patients with non-small cell lung carcinoma (NSCLC).
Thirty-nine patients who had undergone a baseline staging PET/CT examination at our institution for the diagnosis of NSCLC were retrospectively identified. The maximum standardized uptake value (SUV(max)), metabolic tumor volume, and total glycolytic activity were segmented from PET using the gradient method; 12-month survival and overall survival at the end of follow-up were used as outcome measures. Multivariate logistic regression, receiver operating characteristic curve analysis, and Kaplan-Meier curves for survival analysis were generated and compared using the Mantel-Cox log-rank test.
The mean gradient-based metabolic tumor volume and gradient-based total glycolytic activity were significantly greater in the patients who died (93.3 mL and 597.5 g) than in those who survived (19.3 mL and 193.9 g, respectively) (p < 0.003 and p < 0.031). There was no statistically significant difference in the mean SUV(max) between the patients who survived (12.7) at 12 months and those who had died (13.1) (p = 0.85). On multivariate analysis, gradient-based metabolic tumor volume was the only variable associated with 12-month mortality when adjusted for all other factors.(.) The area under the curve (AUC) for gradient-based metabolic tumor volume was 0.77 (p < 0.006). A significant difference in the time to survival was observed between high and low gradient-based metabolic tumor volume (log-rank p < 0.05) cohorts using the median gradient-based metabolic tumor volume (9.7 mL) as the cut point.
PET-based volumetric imaging parameters are potential prognostic markers of outcome in patients with NSCLC.
Available from: Bill O'Brien-Penney
- "However, unfortunately, substantial variation persists in patient survival even within the same TNM stage , suggesting that TNM stage alone (together with secondary clinical factors) is not completely satisfactory as a prognostic factor. Metabolic tumor burden (MTB), such as the whole-body metabolic tumor volume (MTV WB ), has been shown to have prognostic value for NSCLC patients, beyond that of TNM stage and other factors such as patient age, gender, performance status, treatment type, and tumor histology             . Furthermore, MTV WB has been shown of greater prognostic value than the standardized uptake value (SUV)          . "
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ABSTRACT: Whole-body metabolic tumor volume (MTVWB) has been shown of prognostic value for non-small cell lung cancer (NSCLC) beyond that of TNM stage, age, gender, performance status, and treatment selection. The current TNM staging system does not incorporate tumor volumetric information. We propose a new PET/CT volumetric prognostic (PVP) index that combines the prognostic value of MTVWB and TNM stage.
Based on 328 consecutive NSCLC patients with a baseline PET/CT scan before treatment, from which MTVWB was measured semi-automatically, we estimated hazard ratios (HRs) for ln(MTVWB) and TNM stage from a Cox proportional hazard regression model that consisted of only ln(MTVWB) and TNM stage as prognostic variables of overall survival. We used the regression coefficients, which gave rise to the HRs, as weights to formulate the PET/CT volumetric prognostic (PVP) index. We also compared the prognostic value of the PVP index against that of TNM stage alone and ln(MTVWB) alone with univariate and multivariate survival analyses and C-statistics.
Univariate analysis C-statistic for the PVP index (C=0.71) was statistically significantly greater than those for TNM stage alone (C=0.67, p<0.01) and for ln(MTVWB) alone (C=0.69, p=0.033). Multivariate analyses showed that the PVP index yielded significantly greater discriminatory power (C=0.74) than similar models based on either TNM stage (C=0.72, p<0.01) or ln(MTVWB) (C=0.73, p<0.01). Lower values of the PVP index were associated with significantly better overall survival (adjusted HR=2.70, 95%CI [2.16, 3.37]).
The PVP index provides a practical means for clinicians to combine the prognostic value of MTVWB and TNM stage and offers significantly better prognostic accuracy for overall survival of NSCLC patients than the current TNM staging system or metabolic tumor burden alone.
Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
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ABSTRACT: In clinical pneumology there is an established role in nuclear medicine for positron emission tomography-computed tomography (PET-CT) using 18-fluorodeoxyglucose (18-FDG). It is frequently applied for staging and restaging of non-small cell lung cancer (NSCLC) and shows recognized benefits for patients as a non-invasive method for whole body staging. Further indications are the assessment of dignity and differentiation of suspicious lung nodules as well as in small cell lung cancer (SCLC) to confirm limited disease if a curative approach is still intended. Conventional nuclear medicine techniques of interest in pneumology include lung perfusion and ventilation diagnostic methods as well as bone scintigraphy. Lung perfusion studies are used to detect pulmonary embolisms and to assess postoperative lung function in correlation to preoperative forced expiratory volume (FEV1). Bone scintigraphy is needed as the basic diagnostic investigation to detect or rule out and monitor therapy control of skeletal metastases.
Available from: Rathan M Subramaniam
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ABSTRACT: Human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) represents an emerging disease that differs from HPV-negative OPSCC in natural history and prognosis. Contrast-enhanced PET/CT is essential to accurately stage the primary site when there are smaller tumors; neck nodal metastases, which tend to have a more cystic component; and distant metastases that manifest in unusual sites (disseminating phenotype) such as bones and other solid organs, including brain. Metastases tend to appear later in the disease course during follow-up for HPV-positive OPSCC than for HPV-negative OPSCC. Because HPV-positive OPSCC patients have a better clinical outcome, there is a need for treatment deintensification to spare the patient from treatment-related toxicities. (18)F-FDG PET/CT would play a role in monitoring patients with deintensified treatments to ensure that no adverse outcome is introduced. The better prognosis and outcome of HPV-positive OPSCC patients would warrant imaging follow-up that is less intense but continues longer because of the manifestation of distant metastases later in the disease course and at unusual sites. All these clinical paradigms facilitate a definite role for PET/CT imaging in the management of HPV-positive OPSCC.
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