Prognostic value of metabolic parameters on baseline 18F-FDG PET/CT in small cell lung cancer

Q J Nucl Med Mol Imaging. 2022 Mar;66(1):61-66. doi: 10.23736/S1824-4785.19.03169-8. Epub 2019 Jul 1.

Abstract

Background: Maximum standardized uptake value (SUV<inf>max</inf>) is the primary quantitave parameter given in 18F-FDG PET/CT reports. Calculations derived from three dimensional metabolic volumetric images have been proposed to be more successful than SUV<inf>max</inf> alone in prognostification with a lower interobserver variability in many cancers. We aimed to determine the prognostic value of metabolic parameters derived from 18F-FDG PET/CT studies in small cell lung cancer (SCLC) patient population with a long follow-up time.

Methods: In this study, 38 consecutive SCLC patients (34M, 4F, age:65.76 ±8.18 years) who were referred to 18F-FDG PET/CT for staging between October 2006-January 2011 were included. SUV<inf>max</inf>, SUV<inf>mean</inf>, SUV<inf>peak</inf>, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were calculated. Overall survival (OS) was calculated from the date of the initial PET/CT to death from any cause. Survival tables were obtained and Kaplan Meier curves were reconstructed. Mantel-Cox regression analysis was performed in order to investigate if any of these parameters have an effect on survival along with other clinical risk factors.

Results: Median SUV<inf>max</inf>, SUV<inf>mean</inf>, SUV<inf>peak</inf>, MTV, TLG and LDH values were calculated as 13.9 g/dL, 6.4 g/dL,10.69 g/dL, 147 cm3, 1898.52 and 375U/L respectively. Median follow-up was 761.23±873.21 days (25.37 months, range:110-3338 days). Since basal 18F-FDG PET/CT scans, all patients were lost in the follow-up except for two patients. MTV was a significant prognostic factor in SCLC patients. Estimated mean survival times were 261.0±45.6 (95% CI: 171.6-350.3) days in patients with MTV value above the calculated median 147, and 577.0±124.0 (95% CI: 333.7-820.2) days in patients with MTV<147. The difference was statistically significant with a P=0.037.

Conclusions: Baseline whole body MTV reflecting total tumor load is a prognostic index in SCLC. SUV is insufficient to predict prognosis.

MeSH terms

  • Aged
  • Fluorodeoxyglucose F18 / metabolism
  • Humans
  • Lung Neoplasms* / metabolism
  • Middle Aged
  • Positron Emission Tomography Computed Tomography
  • Prognosis
  • Retrospective Studies
  • Small Cell Lung Carcinoma* / diagnostic imaging
  • Small Cell Lung Carcinoma* / metabolism
  • Tumor Burden

Substances

  • Fluorodeoxyglucose F18