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      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)

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          Abstract

          Purpose

          The aims were to determine if the maximum standardized uptake value (SUV max) 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.

          Methods

          A 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 SUV max yielding the maximal sensitivity plus specificity for predicting the overall survival. Survival curves stratified by median SUV max and optimal cutoff SUV max 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 SUV max’s independency of other prognostic factors for the prediction of overall survival.

          Results

          The median duration of follow-up was 981 days (2.7 years). The median SUV max 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 SUV max was 8.2 for all subjects. No optimal cutoff could be established for specific stages. In univariate analyses, each doubling of SUV max [i.e., each log (base 2) unit increase in SUV max] 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 SUV max 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 SUV max was not an independent predictor of overall survival ( p > 0.05).

          Conclusion

          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. Preoperative SUV max is not an independent predictor of overall survival.

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          Most cited references 21

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          The cost of dichotomising continuous variables.

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            Dangers of using "optimal" cutpoints in the evaluation of prognostic factors.

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              The Will Rogers phenomenon. Stage migration and new diagnostic techniques as a source of misleading statistics for survival in cancer.

              We found that a cohort of patients with lung cancer first treated in 1977 had higher six-month survival rates for the total group and for subgroups in each of the three main TNM stages (tumor, nodes, and metastases) than a cohort treated between 1953 and 1964 at the same institutions. The more recent cohort, however, had undergone many new diagnostic imaging procedures. According to the "old" diagnostic data for both cohorts, the recent cohort had a prognostically favorable "zero-time shift." In addition, by demonstrating metastases that had formerly been silent and unidentified, the new technological data resulted in a stage migration. Many patients who previously would have been classified in a "good" stage were assigned to a "bad" stage. Because the prognosis of those who migrated, although worse than that for other members of the good-stage group, was better than that for other members of the bad-stage group, survival rates rose in each group without any change in individual outcomes. When classified according to symptom stages that would be unaltered by changes in diagnostic techniques, the two cohorts had similar survival rates.
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                Author and article information

                Contributors
                +1-248-5069069 , magarwal@ymail.com
                kravikrishnan@beaumont.edu
                +1-248-8984132 , owong@beaumont.edu
                Journal
                Eur J Nucl Med Mol Imaging
                European Journal of Nuclear Medicine and Molecular Imaging
                Springer-Verlag (Berlin/Heidelberg )
                1619-7070
                1619-7089
                14 November 2009
                14 November 2009
                April 2010
                : 37
                : 4
                : 691-698
                Affiliations
                [1 ]Department of Internal Medicine, Oakland University William Beaumont School of Medicine Hospital, 3601 W 13 Mile Rd, Royal Oak, MI 48073-6769 USA
                [2 ]Department of Nuclear Medicine, Oakland University William Beaumont School of Medicine Hospital, 3601 W 13 Mile Rd, Royal Oak, MI 48073-6769 USA
                [3 ]Division of Pulmonary and Critical Care, Oakland University William Beaumont School of Medicine Hospital, 3601 W 13 Mile Rd, Royal Oak, MI 48073-6769 USA
                [4 ]Positron Diagnostic and Cyclotron Center, Oakland University William Beaumont School of Medicine Hospital, 3601 W 13 Mile Rd, Royal Oak, MI 48073-6769 USA
                Article
                1291
                10.1007/s00259-009-1291-x
                2844956
                19915840
                © The Author(s) 2009
                Categories
                Original Article
                Custom metadata
                © Springer-Verlag 2010

                Radiology & Imaging

                suv, prognosis, non-small cell lung cancer, 18f-fdg pet, survival

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