Prognostic impact of maximum standardized uptake value on ¹⁸F‐FDG PET/CT imaging of the primary lung lesion on survival in advanced non‐small cell lung cancer: A retrospective study

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.

Predictive Value of Total Metabolic Tumor Burden Prior to Treatment in NSCLC Patients Treated with Immune Checkpoint Inhibition

“…In knowledge of recently published investigations from 2019 to this date, the following observations should be further discussed before confronting our results with the current literature [18,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36].…”

Four-dimensional quantitative analysis using FDG-PET in clinical oncology

“…Quantitative analyses of FDG uptake have been performed for prognostic studies in patients with lung cancer. The SUV has been used for assessing either the likelihood of malignancy or aggressiveness in lung masses and as a result, the prognosis of known lung cancer has been assessed in many studies [9][10][11][12][13][14][15][16][17]. For instance, an earlier meta-analysis of 13 such studies evaluated the use of SUV for prognostic stratification of non-small cell lung cancers (NSCLCs) [9].…”

“…For instance, an earlier meta-analysis of 13 such studies evaluated the use of SUV for prognostic stratification of non-small cell lung cancers (NSCLCs) [9]. Several recent reports have suggested SUV analytical values for predicting patient outcomes in lung cancer [10][11][12][13][14][15][16][17]. A similar quantitative analysis of FDG uptake has also been applied in prognostic studies of other cancers [18][19][20][21].…”

“…Numerous studies have considered biochemical changes assessed using FDG-PET as a sensitive marker compared with morphological changes estimated using computed tomography (CT) or magnetic resonance imaging (MRI). In addition, patients with a complete metabolic response after therapy may show better disease-free survival and overall survival than those with any other responses [9][10][11][12][13][14][15][16][17][18][19][20][21]. Precise assessment of treatment response is required, mainly because of the rapid progress in new treatments for various cancers.…”

Predictive Value of Baseline FDG-PET/CT for the Durable Response to Immune Checkpoint Inhibition in NSCLC Patients Using the Morphological and Metabolic Features of Primary Tumors

“…The annual mortality rate of lung cancer is still rising worldwide, with 1.80 million deaths in 2020 [ 1 , 2 , 3 , 4 ]. Nonsmall cell lung cancer (NSCLC) accounts for 80–85% of the cases, with small cell lung cancer SCLC contributing the remaining 15–20% [ 2 , 5 , 6 ]. At diagnosis, more than 60% of NSCLC patients display either a locally advanced or metastatic disease and are therefore no longer eligible for surgical treatment alone, requiring further treatment options [ 2 ].…”