Prognostic Importance of the Standardized Uptake Value on <sup>18</sup>F-Fluoro-2-Deoxy-Glucose–Positron Emission Tomography Scan in Non–Small-Cell Lung Cancer: An Analysis of 125 Cases

Vansteenkiste, Johan; Stroobants, Sigrid; Dupont, Patrick; Leyn, Paul R. De; Verbeken, Erik; Deneffe, Georges; Mortelmans, Luc; Demedts, Maurits

doi:10.1200/jco.1999.17.10.3201

Cited by 426 publications

(262 citation statements)

References 15 publications

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“…It is not surprising therefore that the present results mirror those for lung cancer, where SUV has proved to be a significant prognostic indicator (Ahuja et al, 1998;Saunders et al, 1999;Vansteenkiste et al, 1999). Vansteenkiste et al (1999) suggested a SUV of seven, and Ahuja et al (1998) one of 10 as a cut-off value that distinguishes good and bad prognostic groups, although there is probably a range of 6 -11 where prognosis deteriorates. Previous studies in head and neck cancer have found SUV important in differentiating benign and malignant disease but were unable to define a cut-off value (Nowak et al, 1999).…”

Section: Discussionsupporting

confidence: 72%

“…Firstly, most patients with advanced disease present with large tumours, and FDG uptake may simply reflect the larger tumour burden in these patients. Indeed some of the lung studies have shown that size as well as SUV has prognostic value (Saunders et al, 1999;Vansteenkiste et al, 1999). However in the current study increasing tumour diameter had little effect on FDG uptake (SUV), suggesting that tumour burden alone cannot account for these findings.…”

Section: Discussioncontrasting

confidence: 66%

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FDG–PET. A possible prognostic factor in head and neck cancer

et al. 2002

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Previous studies have shown that high uptake of 18 F-fluoro-2-deoxy-glucose in head and neck cancer, as determined by the standardized uptake value on positron emission tomography scan, was associated with poor survival. The aim of this study was to confirm the association and to establish whether a high standardized uptake value had prognostic significance. Seventythree consecutive patients with newly diagnosed squamous cell carcinoma of the head and neck underwent a positron emission tomography study before treatment. Age, gender, performance status tumour grade, stage, maximal tumour diameter and standardized uptake value were analyzed for their possible association with survival. The median standardized uptake value for all primary tumours was 7.16 (90% range 2.30 to 18.60). In univariate survival analysis the cumulative survival was decreased as the stage, tumour diameter and standardized uptake value increased. An standardized uptake value of 10 was taken as a cut-off for high and low uptake tumours. When these two groups were compared, an standardized uptake value 410 predicted for significantly worse outcome (P=0.003). Multivariate analysis demonstrated that an standardized uptake value 410 provided prognostic information independent of the tumour stage and diameter (P=0.002). We conclude that high FDG uptake (standardized uptake value410) on positron emission tomography is an important marker for poor outcome in primary squamous cell carcinoma of the head and neck. Standardized uptake value may be useful in distinguishing those tumours with a more aggressive biological nature and hence identifying patients that require intensive treatment protocols including hyperfractionated radiotherapy and/or chemotherapy.

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Section: Discussionsupporting

confidence: 72%

Section: Discussioncontrasting

confidence: 66%

FDG–PET. A possible prognostic factor in head and neck cancer

et al. 2002

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“…Several studies have shown that high glucose uptake or Glut-1 expression predicts poor prognosis and that Glut-1 levels often are elevated in 18F-FDG-avid tumors, [30][31][32][33][34][35][36][37][38][39][40][41] but their regional or microregional spatial association has seldom been studied and remains unclear. Our colocalization analysis of 18 F-FDG uptake and Glut-1 expression shows some, albeit weak, spatial linkage and again the strongest correlation was observed in the relatively nonglycolytic tumor model (Table I).…”

Section: Discussionmentioning

confidence: 99%

Aerobic glycolysis in cancers: Implications for the usability of oxygen‐responsive genes and fluorodeoxyglucose‐PET as markers of tissue hypoxia

Busk

Horsman

Kristjansen

et al. 2008

Intl Journal of Cancer

108

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The hypoxia-responsiveness of the glycolytic machinery may allow pretreatment identification of hypoxic tumors from HIF-1 targets (e.g., Glut-1) or [18F]-fluorodeoxyglucose positron emission tomography but results have been mixed. We hypothesized that this discrepancy is an inevitable consequence of elevated aerobic glycolysis in tumors (Warburg effect) as energetics in predominantly glycolytic cells is little affected by hypoxia. Accordingly, we characterized glycolytic and mitochondrial ATP generation in normoxic and anoxic cell lines. Measurements demonstrated that most cancer cells rely largely on aerobic glycolysis as it accounts for 56-63% of their ATP budget, but in the cervical carcinoma SiHa, ATP synthesis was mainly mitochondrial. Moreover, the stimulatory effect of anoxia on glycolytic flux was inversely correlated to the relative reliance on aerobic glycolysis. Next, tumor cells representing a Warburg or a nonglycolytic phenotype were grown in mice and spatial patterns of hypoxia (pimonidazolestained), Glut-1 expression and 18 F-FDG uptake were analysed on sectioned tumors. Only in SiHa tumors did foci of elevated glucose metabolism consistently colocalize with regions of hypoxia and elevated Glut-1 expression. In contrast, spatial patterns of Glut-1 and pimonidazole staining correlated reasonably well in all tumors. In conclusion, Glut-1's value as a hypoxia marker is not severely restricted by aerobic glycolysis. In contrast, the specificity of 18 F-FDG uptake and Glut-1 expression as markers of regional hypoxia and glucose metabolism, respectively, scales inversely with the intensity of the Warburg effect. This linkage suggests that multi-tracer imaging combining FDG and hypoxia-specific markers may provide therapeutically relevant information on tumor energetic phenotypes. ' 2008 Wiley-Liss, Inc.Key words: hypoxia; Warburg; Pasteur; fluorodeoxyglucose; Glut-1 German biologist Otto Warburg 1 changed our understanding of tumor energy metabolism, by demonstrating that cancer cells deviate from their nontransformed counterparts by a vigorous formation of lactate even in the presence of oxygen (i.e., aerobic glycolysis). Mitochondrial defects are widespread in cancers and Warburg rationally hypothesized that impaired respiratory capacity leads to a compensatory increase in glycolysis. However, the cause and effect relationship between the oxidative phosphorylation (OXPHOS) and aerobic glycolysis is unclear, as at least some cancer cell lines are able to increase oxygen consumption rate (OCR) when glycolysis is inhibited or when treated with mitochondrial uncouplers. 2,3 Cancer cell energy metabolism has received renewed interest recently, when some common oncogenic mutations have been directly linked to the glycolytic phenotype, 4,5 but tumor hypoxia is common, and the imposed ATP deficit could be an important trigger of high glucose consumption in vivo (Pasteur effect).Tumor hypoxia, in particular in squamous cell carcinomas (SCCs), adversely affects prognosis by enhancing resistance to radio-and ch...

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“…PET/CT provides quantitative data on the level of metabolic activity by calculating the degree of F-18 FDG uptake, known as the standardized uptake value (SUV). PET/CT also has been suggested to have a considerable prognostic utility in various cancers [10][11][12][13]. In a previous study, primary tumor maximum SUV (pSUVmax) exhibited a strong relationship to known prognostic parameters of invasive ductal cancer (IDC) of the breast and could be used as a good surrogate marker for the prediction of progression in patients with IDC [14].…”

Section: Originalmentioning

confidence: 99%

Correlation of hypoxia inducible transcription factor in breast cancer and SUVmax of F-18 FDG PET/CT

Jeong

Jung

Cho³

et al. 2017

Nucl. Med. Rev.

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Prognostic Importance of the Standardized Uptake Value on ¹⁸F-Fluoro-2-Deoxy-Glucose–Positron Emission Tomography Scan in Non–Small-Cell Lung Cancer: An Analysis of 125 Cases

Abstract: We conclude that the FDG uptake in primary NSCLC on PET has an important prognostic value and could be complementary to other well-known factors in the decision on adjuvant treatment protocols.

Cited by 426 publications

References 15 publications

FDG–PET. A possible prognostic factor in head and neck cancer

FDG–PET. A possible prognostic factor in head and neck cancer

Aerobic glycolysis in cancers: Implications for the usability of oxygen‐responsive genes and fluorodeoxyglucose‐PET as markers of tissue hypoxia

Correlation of hypoxia inducible transcription factor in breast cancer and SUVmax of F-18 FDG PET/CT

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Prognostic Importance of the Standardized Uptake Value on 18F-Fluoro-2-Deoxy-Glucose–Positron Emission Tomography Scan in Non–Small-Cell Lung Cancer: An Analysis of 125 Cases

Abstract: We conclude that the FDG uptake in primary NSCLC on PET has an important prognostic value and could be complementary to other well-known factors in the decision on adjuvant treatment protocols.

Cited by 426 publications

References 15 publications

FDG–PET. A possible prognostic factor in head and neck cancer

FDG–PET. A possible prognostic factor in head and neck cancer

Aerobic glycolysis in cancers: Implications for the usability of oxygen‐responsive genes and fluorodeoxyglucose‐PET as markers of tissue hypoxia

Correlation of hypoxia inducible transcription factor in breast cancer and SUVmax of F-18 FDG PET/CT

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Prognostic Importance of the Standardized Uptake Value on ¹⁸F-Fluoro-2-Deoxy-Glucose–Positron Emission Tomography Scan in Non–Small-Cell Lung Cancer: An Analysis of 125 Cases