Metabolic tumor burden predicts prognosis of ovarian cancer patients who receive platinum‐based adjuvant chemotherapy

Volumetric parameters of positron emission tomography–computed tomography using 18F‐fludeoxyglucose (¹⁸F‐FDG PET/CT) that comprehensively reflect both metabolic activity and tumor burden are capable of predicting survival in several cancers. The aim of this study was to investigate the predictive performance of metabolic tumor burden measured by ¹⁸F‐FDG PET/CT in ovarian cancer patients who received platinum‐based adjuvant chemotherapy after cytoreductive surgery. Included in this study were 37 epithelial ovarian cancer patients. Metabolic tumor burden in terms of metabolic tumor volume (MTV) and total lesion glycolysis (TLG), clinical stage, histological type, residual tumor after primary cytoreductive surgery, baseline serum carbohydrate antigen 125 (CA125) level, and the maximum standardized uptake value (SUV_max) were determined, and compared for their performance in predicting progression‐free survival (PFS). Metabolic tumor volume correlated with CA125 (r = 0.547, P < 0.001), and TLG correlated with SUV_max and CA125 (SUV_max, r = 0.437, P = 0.007; CA125, r = 0.593, P < 0.001). Kaplan–Meier analysis showed a significant difference in PFS between the groups categorized by TLG (P = 0.043; log–rank test). Univariate analysis indicated that TLG was a statistically significant risk factor for poor PFS. Multivariate analysis adjusted according to the clinicopathological features was carried out for MTV, TLG, SUV_max, tumor size, and CA125. Only TLG showed a significant difference (P = 0.038), and a 3.915‐fold increase in the hazard ratio of PFS. Both MTV and TLG (especially TLG) could serve as potential surrogate biomarkers for recurrence in patients who undergo primary cytoreductive surgery followed by platinum‐based chemotherapy, and could identify patients at high risk of recurrence who need more aggressive treatment.     

FDG PET-CT代谢参数对NSCLC放疗患者预后影响

目的 探讨疗前FDG PET-CT获得的NSCLC原发灶代谢参数及其临床因素对NSCLC放疗患者预后影响。方法 回顾分析2007—2013年间在本院首程放疗前行PET-CT的170例NSCLC患者资料,分析其临床因素、原发灶SUV_max、SUV_{mean、MTV及TLG等参数与患者预后关系。应用Kaplan-Meier法计算生存率并Logrank检验和单因素分析,应用Cox模型进行多因素分析。}     

Pre-treatment Metabolic Tumor Volume and Total Lesion Glycolysis are Useful Prognostic Factors for Esophageal Squamous Cell Cancer Patients

Objectives: To study application of the maximum standardized uptake value (SUVmax), metabolic tumorvolume (MTV) and total lesion glycolysis (TLG) with 18F-FDG PET/CT for predicting prognosis of esophagealsquamous cell cancer (ESC) patients. Methods: Eighty-six patients with ESC staged from I to IV were prospectivelyenrolled. Cisplatin-based chemoradiotherapy (CCRT) or palliative chemoradiotherapy were the main treatmentmethods and none received surgery. 18F-FDG PET/CT scans were performed before the treatment. SUVmax,MTV, and TLG were measured for the primary esophageal lesion and regional lymph nodes. Receiver operatingcharacteristic curves (ROCs) were generated to calculate the P value of the predictive ability and the optimalthreshold. Results: MTV and TLG proved to be good indexes in the prediction of outcome for the ESC patients.An MTV value of 15.6 ml and a TLG value of 183.5 were optimal threshold to predict the overall survival (OS).The areas under the curve (AUC) for MTV and TLG were 0.74 and 0.70, respectively. Kaplan-Meier analysisshowed an MTV less than 15.6 ml and a TLG less than 183.5 to indicate good media survival time (p value <0.05).In the stage III-IV patient group, MTV could better predict the OS (P < 0.001), with a sensitivity and specificityof 0.80 and 0.67, respectively. Conclusions: Pre-treatment MTV and TLG are useful prognostic factors in nonsurgicalESC.     

Potential Impact of Atelectasis and Primary Tumor Glycolysis on F-18 FDG PET/CT on Survival in Lung Cancer Patients

Background: Atelectasis is an important prognostic factor that can cause pleuritic chest pain, coughing ordyspnea, and even may be a cause of death. In this study, we aimed to investigate the potential impact of atelectasisand PET parameters on survival and the relation between atelectasis and PET parameters. Materials andMethods: The study consisted of patients with lung cancer with or without atelectasis who underwent 18F-FDGPET/CT examination before receiving any treatment. 18F-FDG PET/CT derived parameters including tumorsize, SUVmax, SUVmean, MTV, total lesion glycosis (TLG), SUV mean of atelectasis area, atelectasis volume,and histological and TNM stage were considered as potential prognostic factors for overall survival. Results:Fifty consecutive lung cancer patients (22 patients with atelectasis and 28 patients without atelectasis, medianage of 65 years) were evaluated in the present study. There was no relationship between tumor size and presenceor absence of atelectasis, nor between presence/absence of atelectasis and TLG of primary tumors. The overallone-year survival rate was 83% and median survival was 20 months (n=22) in the presence of atelectasis; theoverall one-year survival rate was 65.7% (n=28) and median survival was 16 months (p=0.138) in the absenceof atelectasis. With respect to PFS; the one-year survival rate of AT+ patients was 81.8% and median survivalwas 19 months; the one-year survival rate of AT- patients was 64.3% and median survival was 16 months(p=0.159). According to univariate analysis, MTV, TLG and tumor size were significant risk factors for PFS andOS (p<0.05). However, SUVmax was not a significant factor for PFS and OS (p>0.05). Conclusions: The presentstudy suggested that total lesion glycolysis and metabolic tumor volume were important predictors of survivalin lung cancer patients, in contrast to SUVmax. In addition, having a segmental lung atelectasis seems not to bea significant factor on survival.     

[F-18] FDG-PET/CT parameters as predictors of outcome in inoperable NSCLC patients

Background

We evaluated the prognostic significance of standardized uptake value (SUVmax), metabolic tumour volume (MTV), and total lesion glycolysis (TLG) in [F-18] FDG PET/CT findings in patients with inoperable non-small-cell lung cancer (NSCLC).

Patients and methods.

One hundred and three patients (mean age, 65.6 ± 16 years) underwent [F-18] FDG PET/CT before the chemotherapy. The SUVmax value, the MTV (cm³; 42% threshold) and the TLG (g) were registered. The patients were followed up to 18 months thereafter (range 12–55 months). Failure to respond without progression, progression and/or disease-related death constituted surrogate end-points. The optimal SUVmax, MTV and TLG cut-off to predict the patients’ outcome were estimated. PET/CT results were then related to disease outcome (progression free survival; PFS).

Results

The Kaplan-Meier survival analysis for SUVmax showed a significant shorter PFS in patients presenting with lower values as compared to those with higher (p < 0.05, log-rank test). MTV and TLG were not suitable for predicting PFS apart from the subset of patients with mediastinal nodal involvement.

Conclusions

Despite the availability of new tools for the quantitative assessment of disease activity on PET/CT, the SUVmax rather than MTV and TLG remains the only predictor for PFS in NSCLC patients. MTV holds a value only when concomitant nodal involvement occurs.     

疗前FDG PET-CT代谢参数与食管癌放疗预后关系初步研究

目的 探讨基于FDG PET-CT显像所采集的影像获取食管癌原发灶代谢参数——SUV_max、MTV、TLG及PTL对判断食管癌放疗或放疗联合治疗患者预后价值。方法 选择2006—2012年在本院行PET-CT放疗定位的Ⅰ—Ⅳ期食管癌患者55例入组,分析患者性别、年龄、原发灶部位、TNM分期、SUV_max、MTV、TLG、PTL、治疗手段与预后的关系。利用ROC寻找SUV_max、MTV、TLG及PTL最佳界值,将其分为高、低值组。Kaplan-Meier法生存分析并Logrank法检验。结果 全组患者中位OS时间为19.1个月(95%CI为8.1~30.1),1、2、3、4年OS率分别为59%、45%、35%、26%。SUV_max、MTV、TLG、PT低值组(SUV_max<11.4、MTV<8.27cm³、TLG<35.21、PTL<5.8 cm)有更好的预后(P=0.002、0.021、0.044、0.000)。结论 疗前SUV_max、MTV、TLG、PTL对判断食管癌患者预后有一定价值,放疗前可根据这些参数对患者进行危险分层,从而制订个体化治疗方案来改善预后。     

Prognostic role of baseline 18F‐FDG PET/CT parameters in MALT lymphoma

Mucosa‐associated lymphoid tissue (MALT) lymphoma is an indolent lymphoma with good prognosis and variable fluorine‐18 fluorodeoxyglucose (¹⁸F‐FDG) avidity. Many possible prognostic factors have been investigated with controversial results, but the possible prognostic role of ¹⁸F‐FDG positron emission tomography/computed tomography (PET/CT) remains unclear. Our aim was to evaluate the prognostic impact of qualitative and semiquantitative baseline PET/CT parameters on outcome of MALT lymphoma. We retrospectively enrolled 161 patients with histologically confirmed MALT lymphoma who underwent ¹⁸F‐FDG PET/CT before any treatment. PET images were qualitatively and semiquantitatively analyzed by measuring the maximum standardized uptake value body weight (SUVbw), lean body mass (SUVlbm), body surface area (SUVbsa), metabolic tumor volume (MTV), and total lesion glycolysis (TLG). The Kaplan‐Meier method was used to estimate the progression‐free survival (PFS) and overall survival (OS) times. Cox regression models were performed to determine the relation between PET/CT features and OS and PFS. Ninety‐eight patients had positive ¹⁸F‐FDG PET/CT showing ¹⁸F‐FDG uptake (mean SUVbw, 10.1; SUVlbm, 7.2; SUVbsa, 2.7; MTV, 88.8; and TLG, 526); the remaining 63 were not ¹⁸F‐FDG avid. ¹⁸F‐FDG avidity was significantly correlated with tumor size and Ki‐67 score. Relapse/progression of disease occurred in 47 patients with an average time of 40.2 months; death occurred in 12 patients with an average of 59 months. At a median follow‐up of 62 months, median PFS and OS were 52 and 62 months, respectively. Advanced tumor stage and extragastric site were demonstrated to be independent prognostic factors for PFS, while only tumor stage for OS. Instead, PET/CT parameters were not related to survival, despite positive correlation at univariate analysis between MTV and TLG with PFS and positive PET/CT with PFS and OS. In conclusion, a 61% rate of PET avidity in biopsy‐confirmed MALT lymphoma was found, and it was correlated with tumor size and Ki‐67 score. Only tumor stage and localization were independently correlated with PFS and OS.     

18F-FDG PET/CT代谢参数对ⅡB期宫颈癌放化疗疗效的预测价值

目的 探讨18F-FDG PET/CT代谢参数在ⅡB期宫颈癌放化疗疗效中的预测价值。方法 回顾性队列分析29例行同步放化疗的ⅡB期宫颈癌患者,治疗前均行18F-FDG PET /CT全身显像检查,并获取代谢参数如最大标准摄取值（maximum standardized uptake values,SUVmax）、平均标准摄取值（average standardized uptake values,SUVavg）、最小标准摄取值（minmum standardized uptake values,SUVmin）、峰值标准摄取值（peak standardized uptake values,SUVpeak）、肿瘤代谢体积（metabolic tumor volume,MTV）、病灶糖酵解总量（total lesion glycolysis,TLG）,根据疗效评价标准分为放化疗敏感组和放化疗抵抗组,分析18F-FDG PET/CT代谢参数与ⅡB期宫颈癌放化疗疗效的关系 ,并采用受试者工作特征（receiver operating characteristic,ROC）曲线评估其预测放化疗疗效的价值。结果 放化疗敏感组的SUVmax、SUVavg、SUVpeak、SUVmin值与放化疗抵抗组比较差异无统计学意义（均P>0.05）,放化疗敏感组与放化疗抵抗组的TLG、MTV比较差异有统计学意义（P=0.025,0.009）。TLG和MTV的ROC曲线下面积分别为0.753和0.793,MTV预测放化疗疗效的敏感度、特异度和准确度分别为77.8％、81.8％和79.3％;TLG分别为66.7％、81.8％和75.3％。结论 18F-FDG PET/CT代谢参数在ⅡB期宫颈癌放化疗疗效中具有良好的预测价值。     

18F-FDG PET-CT在弥漫大B细胞淋巴瘤预后判断中的价值

目的 探讨18F-FDG PET-CT在弥漫大B细胞淋巴瘤(DLBCL)预后判断中的价值.方法 回顾性分析2009年6月至2015年5月130例初诊DLBCL患者的临床资料及治疗前18F-FDG PET-CT检查结果.结果130例DLBCL患者18F-FDG PET-CT检查的最大标准摄取值(SUVmax)、病灶代谢体积(MTV)及病灶糖酵解总量(TLG)的中位数分别为19.93、34.45cm3、459.92.单因素分析结果显示:美国东部肿瘤协作组(ECOG)评分、AnnArbor分期、β2微球蛋白水平、乳酸脱氢酶水平、肿瘤直径、骨髓侵犯、改良国际预后指数(NCCN-IPI)评分、MTV、TLG均是患者无进展生存(PFS)率及总生存(OS)率的影响因素(均P<0.05);年龄是患者PFS率的影响因素(P<0.05).由于MTV与TLG高度相关,多因素分析时,二者中仅纳入TLG,结果显示:ECOG评分、Ann Arbor分期、NCCN-IPI评分及TLG是影响患者PFS率的独立因素(均P<0.05);NCCN-IPI评分及TLG是影响患者OS率的独立因素(均P<0.05).根据NCCN-IPI评分和TLG将患者分为低危组、中危组和高危组.低、中、高危组患者3年PFS率分别为66.0%、36.8%、26.1%,3年OS率分别为70.0%、49.1%、39.1%,差异均有统计学意义(均P<0.05).结论18F-FDG PET-CT所测得的TLG是影响DLBCL患者PFS及OS的独立预后因素,对DLBCL患者预后判断具有一定的参考价值.     

18F-FDG PET/CT代谢参数对局部进展期和晚期直肠癌原发灶的诊断价值

目的:探讨直肠癌原发灶18F-FDG PET/CT代谢参数在直肠癌局部进展期与晚期中的诊断价值。方法:回顾性分析从2008年1月至2016年4月在哈尔滨医科大学附属肿瘤医院进行诊治的直肠癌患者,于术前和其他治疗前行18F-FDG PET/CT检查,检查后两周内均进行手术的患者60例,其中局部进展期组38例,晚期组22例。记录患者年龄、性别、病理类型、组织学类型等临床病理参数及最大标准化摄取值（maximum standardized uptake value,SUVmax）、肿瘤代谢体积（metabolic tumor volume,MTV）和总糖酵解量（total lesion glycolysis,TLG）等代谢参数。先进行独立样本t检验计算以上各因素与不同分组之间的关系;分别绘制SUVmax、MTV、TLG诊断直肠癌局部进展期组和晚期组效能的ROC曲线,得到相应的曲线下面积、最佳截断点、以及相应的灵敏度、特异性。结果:局部进展期组和晚期组之间的年龄、性别、病理类型、组织学类型、SUVmax无统计学差异（P＞0.05）,而两组之间的MTV、TLG存在统计学差异（P＜0.05）。ROC曲线统计结果显示,MTV、TLG 和SUVmax的最佳截断点分别为13.18、152.06和15.80,曲线下面积（AUC）分别为0.802、0.804、0.575;诊断两组的灵敏度分别为77.3%、63.6%、54.5%;特异性分别为76.3%、81.6%、57.9%。结论:直肠癌原发灶的18F-FDG PET/CT代谢参数MTV和TLG在诊断局部进展期和晚期方面明显优于SUVmax;可以为进一步临床精准分期及治疗提供帮助。     

18F-FDG PET/CT代谢参数与结直肠癌临床病理特征的关系

目的 探讨结直肠癌（CRC）原发灶的代谢参数与临床病理特征的相关性。方法 回顾性分析84例CRC患者术前行18F-FDG PET/CT检查的资料,检测原发灶的最大标准摄取值（SUVmax）、平均标准摄取值（SUVmean）、代谢体积（MTV）,并计算病灶糖酵解总量（TLG）,分析上述代谢参数与临床病理特征的相关性。结果 84例CRC原发灶的SUVmax、SUVmean、MTV、TLG分别为11.79（5.36,29.48）、7.11（3.10,19.51）、14.67（3.22,54.77）cm3、96.47（13.18,936.93）g。原发灶SUVmax、SUVmean、MTV、TLG与肿瘤部位、分化程度和最大直径有关（P＜0.05）。原发灶SUVmax、SUVmean、MTV、TLG与T分期有关（r=0.318,r=0.281,r=0.390,r=0.416,P＜0.05）,与N、M分期均无关（P＞0.05）。TLG仅与TNM分期呈正相关（r=0.355,P=0.001）。结论 CRC原发灶代谢参数与临床病理因素具有较好的相关性,在一定程度上可反映肿瘤的部分病理特征。     

Total lesion glycolysis in oral squamous cell carcinoma as a biomarker derived from pre-operative FDG PET/CT outperforms established prognostic factors in a newly developed multivariate prediction model

Purpose: Retrospective study to investigate the impact of image derived biomarkers from [¹⁸F]FDG PET/CT prior to surgical resection in patients with initial diagnosis of oral squamous cell carcinoma (OSCC), namely SUV_max, SUV_mean, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of the primary tumor to predict overall survival (OS).Materials and Methods: 127 subsequent patients with biopsy-proven OSCC were included who underwent [¹⁸F]FDG PET/CT before surgery. SUV_max, SUV_mean, MTV and TLG of the primary tumor were measured. OS was estimated according to Kaplan-Meier and compared between median-splitted groups by the log-rank test. Prognostic parameters were analyzed by uni-/multivariate Cox-regression.Results: During follow-up 52 (41%) of the patients died. Median OS was longer for patients with lower MTV or lower TLG. SUV_max and SUV_mean failed to be significant predictors for OS. Univariate Cox-regression identified MTV, TLG, lymph node status and UICC stage as prognostic factors. By multivariate Cox-regression MTV and TLG turned out to be independent prognostic factors for OS.Conclusions: The pre-therapeutic [¹⁸F]FDG PET/CT parameters MTV and TLG in the primary tumor are prognostic for OS of patients with an initial diagnosis of OSCC. TLG is the strongest independent prognostic factor for OS and outperforms established prognostic parameters in OSCC.     

18F-FDG PET/CT相关代谢参数评估胰腺癌患者的预后

目的:利用18F-FDG PET/CT显像中的MTV、TLG评估胰腺癌患者预后的价值。方法:回顾性分析2011年1月至2015年1月间治疗前行18F-FDG PET/CT检查、经临床证实并有随访结果的60例胰腺癌患者（男36例,女24例,中位年龄58.5岁）资料。所入组患者在PET/CT检查前1周均行血清CA19-9检测。在PET/CT图像上分别测量胰腺癌原发灶SUVmax、MTV和TLG,同时进行PET/CT分期评估。全部患者随访截止至2016年6月。应用ROC曲线Kaplan-Meier法及Cox比例风险模型分析血清CA19-9、MTV、TLG、SUVmax、PET/CT分期、年龄、性别及治疗手段与预后的关系。结果:60例患者的中位生存时间为（11.20±7.25）个月。MTV、TLG、SUVmax及血清CA19-9水平评估预后的AUC值分别为0.772、0.748、0.604和0.474。Kaplan-Meier单因素分析表明不同治疗前原发灶MTV（＜8.43 cm3与≥8.43 cm3）、TLG（＜40.06 cm3与≥40.06 cm3）、SUVmax（＜8.86与≥8.86）、PET/CT分期（Ⅰ/Ⅱ期与Ⅲ/Ⅳ期）及治疗手段组（手术治疗组与非手术治疗组）间的生存差异具有统计学意义（log-rank检验,χ2=14.844、13.667、5.600、6.182、4.854,均P<0.05）;Cox回归模型单因素分析示患者的1年生存率与胰腺癌治疗前原发病灶MTV［危险比（HR） =0.333,P=0.001］、TLG［危险比（HR）=2.811,P=0.001］、PET/CT分期［危险比（HR）=1.891,P=0.022］、SUVmax（HR=1.794,P=0.030）、治疗手段［危险比（HR）=0.506,P=0.044］相关;Cox回归模型多因素分析显示MTV及TLG是患者生存预后的独立影响因素。结论:MTV和TLG可以作为胰腺癌患者预后的评估指标,也有助于临床为高危患者制定有针对性的治疗方案。     

FDG PET-CT显像代谢参数与食管癌放疗预后相关性研究

目的 研究放疗前FDG PET-CT显像代谢参数作为食管癌患者预后评估指标的价值。方法 回顾性分析2010—2015年安徽省立医院治疗的37例Ⅱ—Ⅲ期食管鳞癌患者,均于放疗前4周内完善PET-CT扫描,整理患者年龄、性别、原发灶部位、临床分期、治疗方案等信息,获得原发灶SUVmax、SUVmean、MTV、PTL并计算TLG,利用ROC曲线找出最优界值。采用Kaplan-Meier法生存分析,Logrank法检验及单因素分析,Cox模型对有意义临床变量进行多因素分析。结果 ROC曲线下面积提示MTV>TLG>PTL=0.713>0.679>0.670,生存分析显示当MTV<27.44 cm³、TLG<166.2 g、PTL<36.74 mm时患者有更好的生存期(P<0.05)。多因素分析显示MTV是放疗预后影响因素(P=0.000)。结论 放疗前PET-CT代谢参数MTV、TLG及PTL对食管癌患者预后评估具有参考价值,对患者临床治疗方案的选择及调整、提高患者生存率及改善预后具有一定意义。     

New positron emission tomography derived parameters as predictive factors for recurrence in resected stage I non-small cell lung cancer

Background

The recurrence rate for stage I non-small cell lung cancer is high, with 20–40% of patients that relapse after surgery. The aim of this study was to evaluate new F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) derived parameters, such as standardized uptake value index (SUV_index), metabolic tumor volume (MTV) and total lesion glycolysis (TLG), as predictive factors for recurrence in resected stage I non-small cell lung cancer.

Methods

We retrospectively reviewed 99 resected stage I non-small cell lung cancer patients that were grouped by SUV_index, TLG and MTV above or below their median value. Disease free survival was evaluated as primary end point.

Results

The 5-year overall survival and the 5-year disease free survival rates were 62% and 73%, respectively. The median SUV_index, MTL and TLG were 2.73, 2.95 and 9.61, respectively. Patients with low SUV_index, MTV and TLG were more likely to have smaller tumors (p ≤ 0.001). Univariate analysis demonstrated that SUV_index (p = 0.027), MTV (p = 0.014) and TLG (p = 0.006) were significantly related to recurrence showing a better predictive performance than SUV_max (p = 0.031). The 5-year disease free survival rates in patients with low and high SUV_index, MTV and TLG were 84% and 59%, 86% and 62% and 88% and 60%, respectively. The multivariate analysis showed that only TLG was an independent prognostic factor (p = 0.014) with a hazard ratio of 4.782.

Conclusion

Of the three PET-derived parameters evaluated, TLG seems to be the most accurate in stratifying surgically treated stage I non-small cell lung cancer patients according to their risk of recurrence.     

18F-FDG PET/CT代谢参数与非小细胞肺癌组织中PD-L1表达的相关性

目的:探讨18F-FDG PET/CT显像代谢参数与非小细胞肺癌(non-small cell lung cancer,NSCLC）原发灶程序性细胞死亡配体1(programmed cell death-ligand 1,PD-L1)表达水平的关系。方法:回顾性分析56例经病理证实的非小细胞肺癌患者的临床病理资料及治疗前18F-FDG PET/CT影像,所有患者均使用免疫组化法检测PD-L1表达状态,分析18F-FDG PET/CT的代谢参数与原发灶PD-L1表达水平的相关性。结果:与PD-L1阴性患者比较,阳性患者原发灶SUVmax、MTV、TLG均较高（P＜0.05）。通过Spearman相关性分析,PD-L1的表达与 SUVmax、MTV、TLG均有显著的相关性（r=0.537,P=0.000;r=0.413,P=0.002;r=0.457,P=0.000）。经多变量分析,SUVmax被确定为预测肿瘤PD-L1表达的唯一独立因素（OR:2.132,95%CI:1.694~2.578,P=0.006）。结论:非小细胞肺癌原发灶FDG摄取与PD-L1表达存在相关性,PD-L1阳性更易发生在高SUVmax、MTV和TLG患者中。     

Metabolic tumor burden predicts for disease progression and death in lung cancer

PURPOSE: In lung cancer, stage is an important prognostic factor for disease progression and survival. However, stage may be simply a surrogate for underlying tumor burden. Our purpose was to assess the prognostic value of tumor burden measured by 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) imaging. PATIENTS AND METHODS: We identified 19 patients with lung cancer who had staging PET-CT scans before any therapy, and adequate follow-up (complete to time of progression for 18, and death for 15 of 19). Metabolically active tumor regions were segmented on pretreatment PET scans semi-automatically using custom software. We determined the relationship between times to progression (TTP) and death (OS) and two PET parameters: total metabolic tumor volume (MTV), and standardized uptake value (SUV). RESULTS: The estimated median TTP and OS for the cohort were 9.3 months and 14.8 months. On multivariate Cox proportional hazards regression analysis, an increase in MTV of 25 ml (difference between the 75th and 25th percentiles) was associated with increased hazard of progression and of death (5.4-fold and 7.6-fold), statistically significant (p = 0.0014 and p = 0.001) after controlling for stage, treatment intent (definitive or palliative), age, Karnofsky performance status, and weight loss. We did not find a significant relationship between SUV and TTP or OS. CONCLUSIONS: In this study, high tumor burden assessed by PET MTV is an independent poor prognostic feature in lung cancer, promising for stratifying patients in randomized trials and ultimately for selecting risk-adapted therapies. These results will need to be validated in larger cohorts with longer follow-up, and evaluated prospectively.     

Ⅲ期非小细胞肺癌FDG PET-CT体积与预后关系分析

目的 探讨Ⅲ期非小细胞肺癌(NSCLC)氟标记脱氧葡萄(FDG)PET-CT原发灶代谢肿瘤体积(MTV)与预后相关性,通过MTV和最大标准摄取值(SUVmax)对预后影响的对比分析寻找预测预后的最佳指标.方法 搜集本院2004-2007年行FDG PET-CT全身扫描的56例Ⅲ期NSCLC患者,治疗前行PET-CT检查,治疗均采取同步放化疗,随访至治疗结束后2年.计算MTV与SUVmax值,进一步分析总生存与MTV和SUVmax的关系.结果 56例患者平均总生存时间为14.5个月,KaplanMeier法分析显示MTV对总生存影响有统计学意义(x2=5.42,P=0.014);SUVmax与总生存无关(x2=0.74,P=0.391).Cox回归模型分析显示MTV、SUVmax与总生存相关(x2=5.54,P=0.019;x2=4.47,P=0.031).结论 Ⅲ期NSCLC患者的FDG PET-CT MTV与总生存密切相关,有可能作为预测因子用于评价和预测预后.     

Prognostic Value of Metabolic Parameters of Metastatic Lymph Nodes on 18F-FDG PET/CT in Patients With Limited-stage Small-cell Lung Cancer With Lymph Node Involvement

Introduction

We assessed the prognostic value of the metabolic parameters of different lesions, including primary tumors and metastatic lymph nodes (LNs), measured by fluorine-18 fluorodeoxyglucose positron emission tomography (PET)/computed tomography in patients with limited-stage small-cell lung cancer (LS-SCLC) with LN metastasis.

The correlation between cell-free DNA and tumour burden was estimated by PET/CT in patients with advanced NSCLC

Background:

Cell-free DNA (cfDNA) circulating in the blood holds a possible prognostic value in malignant diseases. Under malignant conditions, the level of cfDNA increases but the biological mechanism remains to be fully understood. We aimed to examine the correlation between cfDNA and total tumour burden defined by positron emission tomography (PET) parameters.

Methods:

Patients with advanced non-small cell lung cancer (NSCLC) were enrolled into a prospective biomarker trial. Before treatment, plasma was extracted and the level of cfDNA was determined by qPCR. An ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) PET/computed tomography (CT) scan was performed and evaluated in terms of metabolic tumour volume (MTV) and total lesion glycolysis (TLG). Tumour contours were delineated semi-automatically by a threshold standardised uptake value (SUV) of 2.5. The primary end point was correlation among cfDNA, MTV and TLG. The secondary end point was overall survival (OS) according to cfDNA, MTV and TLG.

Results:

Fifty-three patients were included. There were no correlations between cfDNA and MTV (r=0.1) or TLG (r=0.1). cfDNA >75th percentile was correlated with shorter OS (P=0.02), confirmed in a multivariate analysis. MTV>the median was associated with a significantly shorter OS (P=0.02). There was no significant difference in OS according to TLG (P=0.08).

Conclusion:

Cell-free DNA may not be a simple measure of tumour burden, but seems to reflect more complex mechanisms of tumour biology, making it attractive as an independent prognostic marker.