Prognostic Value of 18-FDG Uptake in Early Stage NSCLC

Abstract

Background: We assessed whether the standard uptake of 18-fluorodeoxyglucose (18-FDG) in non-small cell lung cancers (NSCLC) differed between stage I and non-stage I tumors. Methods: We reviewed 163 patients with NSCLC who underwent surgical lymph node dissection after tumor resection in 2002–2003. Patients with clinical stage I NSCLC who were investigated with preoperative positron emission tomography integrated computed tomography (PET‐CT) scans using 18-FDG uptake were included; those with N2 disease were excluded. We reviewed 55 patients with a mean follow-up of 68 months. Results: We analyzed 36 patients with stage I (Group 1) and 19 patients with non-stage I NSCLC (Group 2; 8 stage II, 7 stage III and 4 stage IV). There were no statistical differences in sex, age, tumor size, histological type, location or tumor differentiation between the groups. Group 1 had lower maximum standard 18-FDG uptake values (SUVmax) than Group 2 (4.9 ± 2.7 vs. 8.1 ± 3.8; p = 0.001). Using multiple logistic regression, patients with higher preoperative SUVmax and serum carcinoembryonic antigen (CEA) levels showed advanced tumor stages postoperatively (SUVmax > 4.7, odds ratio 7.65; CEA > 3.5 ng/mL, odds ratio 8.39). High 18-FDG uptake was significantly associated with reduced median survival (62.69 months for SUVmax < 4.7 and 40.89 months for SUVmax > 4.7). Conclusions: High preoperative 18-FDG uptake of tumors was significantly associated with reduced overall patient survival. The SUVmax of the tumor and serum CEA levels demonstrated aggressive tumors and could be helpful preoperatively when considering patients for induction therapy or resection.

thoracic surgery - PET‐CT - NSCLC - SUV

References

• 1 Cerfolio R J, Ojha B, Bryant A S, Bass C S, Bartalucci A A, Mountz J M. The role of FDG-PET scan in staging patients with non-small cell carcinoma.  Ann Thorac Surg. 2003;  76 (3) 861-866
• 2 Cerfolio R J, Ojha B, Bryant A S, Raghuveer V, Mountz J M, Bartolucci A A. The accuracy of integrated PET-CT compared with dedicated PET alone for the staging of patients with non-small cell lung cancer.  Ann Thorac Surg. 2004;  78 (3) 1017-1023 discussion 1023
• 3 Cerfolio R J, Bryant A S, Ohja B, Bartolucci A A. The maximum standardized uptake values on positron emission tomography of a non-small cell lung cancer predict stage, recurrence and survival.  J Thorac Cardiovasc Surg. 2005;  130 (1) 151-159
• 4 Jadvar H, Segall G M. False-negative fluorine-18-FDG PET in metastatic carcinoid.  J Nucl Med. 1997;  38 (9) 1382-1383
• 5 Kim B T, Kim Y, Lee K S, Yoon S B, Cheon E M, Kwon O J et al. Localized form of bronchioloalveolar carcinoma: FDG PET findings.  AJR Am J Roentgenol. 1998;  170 (4) 935-939
• 6 Ohtsuka T, Nomori H, Watanabe K, Kaji M, Naruke T, Suemasu K et al. Prognostic significance of [(18)F] fluorodeoxyglucose uptake on positron emission tomography in patients with pathologic stage I lung adenocarcinoma.  Cancer. 2006;  107 (10) 2468-2473
• 7 Hellwing A L, Tauson A H, Skrede A. Effect of bacterial protein meal on protein and energy metabolism in growing chickens.  Arch Anim Nutr. 2006;  60 (5) 365-381
• 8 Davies A, Tan C, Paschalides C, Barrington S F, O'Doherty M, Utley M et al. FDG-PET maximum standardised uptake value is associated with variation in survival: analysis of 498 lung cancer patients.  Lung Cancer. 2007;  55 (1) 75-78
• 9 Tann M, Sandrasegaran K, Winer-Muram H T, Jennings S G, Welling M E, Fletcher J W. Can FDG-PET be used to predict growth of stage I lung cancer?.  Clin Radiol. 2008;  63 (8) 856-863