Prognostic value of quantitative PET/CT in patients with a non-small cell lung cancer and another primary cancer

Abstract

Objective

The staging and management of patients with newly diagnosed non-small cell lung cancer (NSCLC) in the setting of recently diagnosed other (metachronous or synchronous) primary cancer are challenging. This retrospective cohort study was conducted to test our hypothesis that baseline FDG PET/CT parameters, including whole-body metabolic tumor volume (MTV _WB), total lesion glycolysis (TLG _WB) and maximum standardised uptake value (SUV _maxWB) are associated with overall survival (OS) of such patients.

Materials and Methods

A total of 110 NSCLC patients (52 men and 58 women, aged 68.6 ± 7.8 years) with other primary malignant cancers who had baseline FDG PET/CT scans were retrospectively reviewed. MTV _WB, TLG _WB and SUV _maxWB were measured. Kaplan-Meier analysis with the log-rank test and Cox regression models were used to assess the association of OS with FDG PET/CT parameters and clinical risk factors.

Results

Kaplan-Meier analysis and univariate Cox regression models demonstrated significant associations of OS with ln(MTV _WB), ln(TLG _WB), ln(SUV _maxWB), TNM stage, and treatment type (surgery versus no treatment). Multivariable Cox regression models showed a significant relationship of OS with ln(MTV _WB) ( HR = 1.368, P = 0.001), ln(TLG _WB) ( HR = 1.313, P < 0.001) and ln(SUV _maxWB) ( HR = 1.739, P = 0.006), adjusted for age, treatment type, tumor histology, and TNM stage. TNM stage was not significantly associated with OS when MTV _WB, TLG _WB or SUV _maxWB were included in the multivariable models.

Conclusion

MTV _WB, TLG _WB, and SUV _maxWB from baseline FDG PET/CT are individually associated with OS of patients with both NSCLC and other primary malignant tumors; independent on age, treatment type, tumor histology and TNM stage.