Prognostic Value of Whole-Body Total Lesion Glycolysis at Pretreatment FDG PET/CT in Non–Small Cell Lung Cancer

Chen, Helen H.W.; Chiu, Nan Tsing; Su, Wu Chou; Guo, How‐Ran; Lee, Bi Fang

doi:10.1148/radiol.12111148

Cited by 218 publications

(188 citation statements)

References 37 publications

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“…It is possible that once a lung tumour shows metastatic spread, the anatomic extent of the tumour is more important in predicting prognosis than the metabolic activity of the primary tumour only. Although this supposition should be confirmed with a larger number of patients with stage IV disease, this might be the reason why the introduction of other measures of metabolic activity such as tumour glycolysis and metabolic volume as well as heterogeneity and texture analysis are very promising as prognostic factors [44][45][46][47][48][49]. However, these "new" derived metabolic parameters seem to be more interesting in large tumours, due to the inability of PET to characterise tracer distribution within small tumours because of its limited spatial resolution.…”

Section: Discussionmentioning

confidence: 99%

Primary tumour standardised uptake value is prognostic in nonsmall cell lung cancer: a multivariate pooled analysis of individual data

et al. 2015

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18 F-fluoro-2-deoxy-D-glucose positron emission tomography (PET) complements conventional imaging for diagnosing and staging lung cancer. Two literature-based meta-analyses suggest that maximum standardised uptake value (SUVmax) on PET has univariate prognostic value in nonsmall cell lung cancer (NSCLC). We analysed individual data pooled from 12 studies to assess the independent prognostic value of binary SUVmax for overall survival.After searching the published literature and identifying unpublished data, study coordinators were contacted and requested to provide data on individual patients. Cox regression models stratified for study were used. Data were collected for 1526 patients (median age 64 years, 60% male, 34% squamous cell carcinoma, 47% adenocarcinoma, 58% stage I-II). The combined univariate hazard ratio for SUVmax was 1.43 (95% CI 1.22-1.66) and nearly identical if the SUV threshold was calculated stratifying for histology. Multivariate analysis of patients with stage I-III disease identified age, stage, tumour size and receipt of surgery as independent prognostic factors; adding SUV (HR 1.58, 95% CI 1.27-1.96) improved the model significantly. The only detected interaction was between SUV and stage IV disease.SUV seems to have independent prognostic value in stage I-III NSCLC, for squamous cell carcinoma and for adenocarcinoma. @ERSpublications SUV has independent prognostic value in stage I-III NSCLC, both for squamous cell carcinoma and for adenocarcinoma

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Section: Discussionmentioning

confidence: 99%

Primary tumour standardised uptake value is prognostic in nonsmall cell lung cancer: a multivariate pooled analysis of individual data

et al. 2015

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“…Only recently has the prognostic value of TLG in NSCLC been elucidated (20)(21)(22). Chen et al (20) demonstrated that a whole-body TLG is a potentially useful indicator for PFS in NSCLC, because a high whole-body TLG (.655) is associated with poor prognosis.…”

Section: Discussionmentioning

confidence: 99%

¹⁸F-FDG PET Early Response Evaluation of Locally Advanced Non–Small Cell Lung Cancer Treated with Concomitant Chemoradiotherapy

et al. 2013

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The potential of 18 F-FDG PET changes was evaluated for prediction of response to concomitant chemoradiotherapy in patients with locally advanced non-small cell lung cancer (NSCLC). Methods: For 28 patients, 18 F-FDG PET was performed before treatment, at the end of the second week of treatment, and at 2 wk and 3 mo after the completion of treatment. Standardized uptake value (SUV), maximum SUV, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were obtained. Early metabolic changes were defined as fractional change (DTLG) when 18 F-FDG PET at the end of the second week was compared with pretreatment 18 F-FDG PET. In-treatment metabolic changes, as measured by serial 18 F-FDG PET, were correlated with standard criteria of response evaluation of solid tumors by means of CT imaging (Response Evaluation Criteria In Solid Tumors 1.1). Parameters were analyzed for stratification in progression-free survival (PFS). Results: When compared with early metabolic nonresponders, a DTLG decrease of 38% or more was associated with a significantly longer PFS (1-y PFS 80% vs. 36%, P 5 0.02). Pretreatment TLG was found to be a prognostic factor for PFS. Conclusion: The degree of change in TLG was predictive for response to concomitant chemoradiotherapy as early as the end of the second week into treatment for patients with locally advanced NSCLC. Pretreatment TLG was prognostic for PFS.

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“…For non-small cell lung cancer (NSCLC), 18 F-FDG PET/CT image quantification has been shown to provide prognostic information. PET image-derived features, including metabolically active tumor volume (MATV), mean standardized uptake value (SUV mean ), and total lesion glycolysis (TLG, defined as MATV · SUV mean ), have been shown to provide an accurate assessment of tumor burden with potentially higher prognostic value than standard maximum SUV (SUV max ), for both surgical and nonsurgical patients (5)(6)(7)(8)(9).…”

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Visual Versus Quantitative Assessment of Intratumor ¹⁸F-FDG PET Uptake Heterogeneity: Prognostic Value in Non–Small Cell Lung Cancer

et al. 2014

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The goal of this study was to compare visual assessment of intratumor 18 F-FDG PET uptake distribution with a textural-features (TF) automated quantification and to establish their respective prognostic value in non-small cell lung cancer (NSCLC). Methods: The study retrospectively included 102 consecutive patients. Only primary tumors were considered. Intratumor heterogeneity was visually scored (3-level scale [H visu ]) by 2 nuclear medicine physicians. Tumor volumes were automatically delineated, and heterogeneity was quantified with TF. Mean and maximum standardized uptake value were also included. Visual interobserver agreement and correlations with quantitative assessment were evaluated using the κ test and Spearman rank (ρ) coefficient, respectively. Association with overall survival and recurrencefree survival was investigated using the Kaplan-Meier method and Cox regression models. Results: Moderate correlations (0.4 , ρ , 0.6) between TF parameters and H visu were observed. Interobserver agreement for H visu was moderate (κ 5 0.64, discrepancies in 27% of the cases). High standardized uptake value, large metabolic volumes, and high heterogeneity according to TF were associated with poorer overall survival and recurrence-free survival and remained an independent prognostic factor of overall survival with respect to clinical variables. Conclusion: Quantification of 18 F-FDG uptake heterogeneity in NSCLC through TF was correlated with visual assessment by experts. However, TF also constitutes an objective heterogeneity quantification, with reduced interobserver variability, and independent prognostic value potentially useful for patient stratification and management. PET/ CT imaging with 18 F-FDG is today a well-established tool for diagnostic oncology applications (1). Its exploitation for tumor delineation in the planning of radiotherapy treatment (2) or monitoring of response to therapy (3,4) is increasing. For non-small cell lung cancer (NSCLC), 18 F-FDG PET/CT image quantification has been shown to provide prognostic information. PET image-derived features, including metabolically active tumor volume (MATV), mean standardized uptake value (SUV mean ), and total lesion glycolysis (TLG, defined as MATV · SUV mean ), have been shown to provide an accurate assessment of tumor burden with potentially higher prognostic value than standard maximum SUV (SUV max ), for both surgical and nonsurgical patients (5-9).Intratumor 18 F-FDG uptake heterogeneity has been associated with treatment failure (10), and its quantification has recently generated interest (11-14), including in lung cancer (15). Several methodologies have been proposed to assess intratumor heterogeneity, including visual evaluation (16), SUV coefficient of variation (SUV COV ) (17), area under the curve of the cumulative histogram (CH AUC ) (18), and textural-features (TF) analysis (17,19).TF analysis can generate many features quantifying heterogeneity within a delineated MATV. Recent studies have identified a few of these features that are ...

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Prognostic Value of Whole-Body Total Lesion Glycolysis at Pretreatment FDG PET/CT in Non–Small Cell Lung Cancer

Abstract: Whole-body TLG is of prognostic value for NSCLC. It may be a promising tool for stratifying patients with NSCLC for risk-adapted therapies.

Cited by 218 publications

References 37 publications

Primary tumour standardised uptake value is prognostic in nonsmall cell lung cancer: a multivariate pooled analysis of individual data

Primary tumour standardised uptake value is prognostic in nonsmall cell lung cancer: a multivariate pooled analysis of individual data

¹⁸F-FDG PET Early Response Evaluation of Locally Advanced Non–Small Cell Lung Cancer Treated with Concomitant Chemoradiotherapy

Visual Versus Quantitative Assessment of Intratumor ¹⁸F-FDG PET Uptake Heterogeneity: Prognostic Value in Non–Small Cell Lung Cancer

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Prognostic Value of Whole-Body Total Lesion Glycolysis at Pretreatment FDG PET/CT in Non–Small Cell Lung Cancer

Abstract: Whole-body TLG is of prognostic value for NSCLC. It may be a promising tool for stratifying patients with NSCLC for risk-adapted therapies.

Cited by 218 publications

References 37 publications

Primary tumour standardised uptake value is prognostic in nonsmall cell lung cancer: a multivariate pooled analysis of individual data

Primary tumour standardised uptake value is prognostic in nonsmall cell lung cancer: a multivariate pooled analysis of individual data

18F-FDG PET Early Response Evaluation of Locally Advanced Non–Small Cell Lung Cancer Treated with Concomitant Chemoradiotherapy

Visual Versus Quantitative Assessment of Intratumor 18F-FDG PET Uptake Heterogeneity: Prognostic Value in Non–Small Cell Lung Cancer

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¹⁸F-FDG PET Early Response Evaluation of Locally Advanced Non–Small Cell Lung Cancer Treated with Concomitant Chemoradiotherapy

Visual Versus Quantitative Assessment of Intratumor ¹⁸F-FDG PET Uptake Heterogeneity: Prognostic Value in Non–Small Cell Lung Cancer