Prognostic significance of total lesion glycolysis in patients with advanced non-small cell lung cancer receiving chemotherapy

Eur J Radiol. 2012 Dec;81(12):4179-84. doi: 10.1016/j.ejrad.2012.07.009. Epub 2012 Aug 9.


Background: [¹⁸F]fluorodeoxyglucose positron emission tomography (FDG-PET) imaging has been employed as a non-invasive diagnostic tool for malignant tumors. Total lesion glycolysis (TLG) on FDG-PET is calculated by multiplying the mean standardized uptake value (SUVmean) by the tumor volume. Unlike the maximum standardized uptake value (SUVmax), which represents the point of greatest metabolic activity within tumors, TLG has been suggested to reflect global metabolic activity in whole tumors.

Methods: We retrospectively examined whether or not FDG-PET measurements, including SUVmean, SUVmax, and TLG, could predict progression-free survival (PFS) or overall survival (OS) in patients with non-small cell lung cancer (NSCLC) receiving chemotherapy.

Results: This study involved 81 consecutive patients with NSCLC who received chemotherapy. All of the patients underwent FDG-PET examination before treatment. SUVmean, SUVmax, and TLG on FDG-PET were significantly associated with gender, smoking status, and tumor histology. With adjustment for several other variables, Cox regression analysis showed that TLG was significantly prognostic for both PFS [hazard ratio=2.34; 95% confidence interval, 1.18-4.64; P=0.015] and OS (hazard ratio=2.80; 95% confidence interval, 1.12-6.96; P=0.003), whereas SUVmean and SUVmax had no significant association with PFS (P=0.693 and P=0.322, respectively) or OS (P=0.587 and P=0.214, respectively).

Conclusions: Our findings suggest that TLG may be more useful than SUVmean and SUVmax for predicting PFS and OS in NSCLC patients receiving chemotherapy. The TLG measurement on FDG-PET imaging could be routinely recommended to advanced NSCLC patients.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents / therapeutic use*
  • Carcinoma, Non-Small-Cell Lung / drug therapy*
  • Carcinoma, Non-Small-Cell Lung / metabolism*
  • Carcinoma, Non-Small-Cell Lung / mortality
  • Female
  • Fluorodeoxyglucose F18 / pharmacokinetics*
  • Glycolysis / drug effects
  • Humans
  • Lung Neoplasms / drug therapy
  • Lung Neoplasms / metabolism*
  • Lung Neoplasms / mortality
  • Male
  • Middle Aged
  • Positron-Emission Tomography / methods
  • Positron-Emission Tomography / statistics & numerical data
  • Prevalence
  • Prognosis
  • Radiopharmaceuticals / pharmacokinetics
  • Reproducibility of Results
  • Republic of Korea / epidemiology
  • Retrospective Studies
  • Sensitivity and Specificity
  • Survival Analysis
  • Survival Rate
  • Treatment Outcome


  • Antineoplastic Agents
  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18