Revisiting the prognostic value of preoperative 18F-fluoro-2-deoxyglucose (18F-FDG) positron emission tomography (PET) in early-stage (I & II) non-small cell lung cancers (NSCLC)

Abstract

PurposeThe 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.MethodsA 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.ResultsThe 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).ConclusionEach 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.

Prediction of survival and cancer recurrence using F-18 FDG PET/CT in patients with surgically resected early stage (Stage I and II) non-small cell lung cancer

“…Similar disappointing result was also noted in advanced NSCLC. Why the SUVmax of the primary tumor could not be prognostic factor may be explained by various factors such as dichotomized age, absence of multivariate analysis, excluding age factor and tumor size in multivariate analysis, and small size of the primary tumor [23]. However, in the current, after considering of all these confounding factors, the SUV max was the most potent predictor of overall survival and DFS in surgically resected early stage NSCLC even after stratified by pathologic stages.…”

“…However, a recent study reported limited prognostic value of SUV max in early stage (stage I & II) NSCLC [23]. They found that each doubling of SUV max as determined by preoperative PET is associated with a 1.28-fold increase in hazard of death in early-stage (I & II) NSCLC.…”

“…First, the current study was the retrospective analysis of early stage NSCLC. Second, as previously reported [23], we could not set the tumor stage specific optimal cut-off values of SUV max because of relatively small population of pathologic stage II patients.…”

Tumor Heterogeneity and Permeability as Measured on the CT Component of PET/CT Predict Survival in Patients with Non–Small Cell Lung Cancer

“…Current NSCLC guidelines (2-4) reflect survival data based on multiple factors such as performance status (5,6) and staging (7). Other factors, such as tumor metabolism and vascularity, have been proposed as prognostic indicators (8,9). Imaging patients with NSCLC with positron emission tomography (PET) and computed tomography (CT) provides important staging information.…”

Role of Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Imaging in Diagnosis and Staging of Lung Cancer

“…Nitekim akciğer kanserinde yüksek SUV değerlerinin kötü prognoz ile ilişkili olduğu çeşitli çalışmalarda gösterilmiştir (42,43,44,45). Ancak bazı çalışmalarda bu ilişki gösterilememiştir (46,47,48). Bu nedenle klinik yönergelerde SUV değerinin risk belirleme amaçlı kullanımı yer almamaktadır (8).…”