Usefulness of 18F-FDG PET/computed tomography metabolic parameters in predicting sarcopenia and prognosis of treatment-naive patients with non-small cell lung cancer

Abstract

Purpose Sarcopenia tremendously impacts the quality of life but remains debatable in prognostication in treatment-naive patients with non-small cell lung cancer (NSCLC). Hence, this study aimed to find a clinically feasible approach using 18F-FDG PET/computed tomography (CT) imaging parameters and clinical characteristics to predict sarcopenia and determine independent prognostic factors. Methods Clinical characteristics and 18F-FDG PET/CT metabolic parameters, including maximum standard uptake value, metabolic tumor volume, and total lesion glycolysis of primary tumor (SUVmax_P, MTV_P, and TLG_P) and combination of whole-body lesions (MTV_C and TLG_C) were collected in 344 treatment-naive patients with NSCLC. Skeletal muscle index at the third lumbar vertebra was calculated to determine sarcopenia. SUVmax of the psoas major muscle (SUVmax_M) was measured at the third lumbar vertebra as well. The diagnostic endpoint is the probability of sarcopenia, and the survival endpoints include progression-free survival (PFS) and overall survival (OS). Results Among 344 patients with NSCLC there were 271 patients with adenocarcinoma and 73 with squamous cell carcinoma (SCC). One hundred forty-seven patients (42.7%) were diagnosed with sarcopenia. Higher age, male, lower BMI, SCC, and lower SUVmax_M were correlated with a higher incidence of sarcopenia (P < 0.05), while age, sex and SUVmax_M were independently predictive of sarcopenia. Multivariate Cox-regression analysis revealed that BMI, advanced stage and TLG_C were independent predictors of PFS and OS, while sex was independently predictive of OS. Conclusions The incidence of sarcopenia increased with declining SUVmax of muscle. BMI, tumor stage, and TLG_C, but not sarcopenia, were found independently predictive of both PFS and OS.

Implications of Sarcopenia and Glucometabolism Parameters of Muscle Derived From Baseline and End-of-Treatment 18F-FDG PET/CT in Diffuse Large B-Cell Lymphoma

“…Compared with non-sarcopenic patients, the SUVmax and SUVmean of muscle were lower in sarcopenic patients at both baseline and end-of-treatment, indicating that a reduction in glucose metabolism of muscle suggests an increased risk of sarcopenia. Even though the mechanism underlying the correlation between glucose metabolism of muscle and sarcopenia remains unclear, a similar phenomenon was observed in our previous studies [ 13 15 ]. Chu et al [ 23 ] and Besutti et al [ 24 ] found that skeletal muscle density evaluated using mean attenuation on CT was lower in sarcopenia than in non-sarcopenia.…”

“…It can offer both anatomic information derived from CT and metabolic information derived from PET, thus simultaneously obtaining the SMA and glucose metabolic parameters of muscle such as the maximum standardized uptake value (SUVmax) and mean standardized uptake value (SUVmean) at L3. Our previous studies [ 12 13 14 15 ] have confirmed that the SUVmax of muscle at L3 was lower in sarcopenic patients compared with non-sarcopenic patients before treatment, and the incidence of sarcopenia increased with declining SUVmax in patients with malignancy. Moreover, compared with SMI, the SUVmax offers a more straightforward and convenient way to predict sarcopenia [ 14 15 ].…”

“…Our previous studies [ 12 13 14 15 ] have confirmed that the SUVmax of muscle at L3 was lower in sarcopenic patients compared with non-sarcopenic patients before treatment, and the incidence of sarcopenia increased with declining SUVmax in patients with malignancy. Moreover, compared with SMI, the SUVmax offers a more straightforward and convenient way to predict sarcopenia [ 14 15 ].…”

“…Hence, sarcopenia can be analyzed using the CT component of PET/CT images, which has been proven safe and accurate [ 16 ]. Moreover, our previous studies found that the SUVmax of muscle at L3 was lower in sarcopenia than in non-sarcopenia [ 12 13 14 15 ]. Thus, we have used 18 F-FDG PET/CT to conduct many studies on sarcopenia and glucose metabolism of muscle in patients with malignancies such as T-cell lymphoblastic lymphoma, non-small cell lung cancer, and pancreatic cancer [ 12 13 14 15 ].…”