FDG PET/CT metabolic tumor volume and total lesion glycolysis predict prognosis in patients with advanced lung adenocarcinoma

J Cancer Res Clin Oncol. 2014 Jan;140(1):89-98. doi: 10.1007/s00432-013-1545-7. Epub 2013 Nov 6.


Purpose: We investigated fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT)-assessed metabolic tumor volume (MTV) and total lesion glycolysis (TLG) as prognostic factors in lung adenocarcinoma patients.

Methods: This retrospective study included 106 patients (19 stage I/II and 87 stage III/IV lung adenocarcinoma) who underwent FDG PET/CT before treatment. Standardized uptake value (SUV), MTV, and TLG (MTV × mean SUV) of each malignant lesion were measured. Whole MTV and whole TLG were the summation of all the MTV and TLG values in each patient. Survival analysis and FDG PET/CT parameters regarding epidermal growth factor receptor (EGFR) gene mutation status were evaluated.

Results: Univariate survival analysis of stage III/IV patients identified high whole MTV (≥90), high whole TLG (≥600), and stage IV as significant predictors of poor progression-free survival. For overall survival, high whole MTV (≥90), high whole TLG (≥600), EGFR mutation-negative, and stage IV were significant poor prognostic predictors. After multivariate survival analysis, high whole MTV (P = 0.001), high whole TLG (P = 0.027), and stage IV (P = 0.006) were independent predictors of poor progression-free survival. High whole MTV (P < 0.001), high whole TLG (P = 0.001), and EGFR mutation-negative (P = 0.001) were independent prognostic predictors for poor overall survival. In a survival analysis of stage I/II patients, none was an independent prognostic predictor. No significant differences were found in FDG PET/CT parameters for EGFR mutation-negative and EGFR mutation-positive patients.

Conclusions: Assessment of MTV and TLG by FDG PET/CT in advanced lung adenocarcinoma patients provides useful information regarding prognosis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenocarcinoma / diagnostic imaging
  • Adenocarcinoma / metabolism*
  • Adenocarcinoma / pathology
  • Adenocarcinoma / therapy
  • Adenocarcinoma of Lung
  • Adult
  • Aged
  • Aged, 80 and over
  • Disease-Free Survival
  • Female
  • Fluorodeoxyglucose F18*
  • Follow-Up Studies
  • Glycolysis
  • Humans
  • Lung Neoplasms / diagnostic imaging
  • Lung Neoplasms / metabolism*
  • Lung Neoplasms / pathology
  • Lung Neoplasms / therapy
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Neoplasm Staging
  • Positron-Emission Tomography / methods
  • Prognosis
  • Radiopharmaceuticals*
  • Retrospective Studies
  • Survival Analysis
  • Tomography, X-Ray Computed / methods
  • Treatment Outcome


  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18