Cancer Res Treat.  2014 Apr;46(2):165-171.

Metabolic Burden Measured by 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Is a Prognostic Factor in Patients with Small Cell Lung Cancer

• Kim MH
• Lee JS
• Mok JH
• Lee K
• Kim KU
• Park HK
• Kim SJ
• Lee MK

Abstract

PURPOSE
Evidence regarding the usefulness of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in predicting the prognosis of non-small cell lung cancer is increasing. However, data on small cell lung cancer (SCLC) are scarce. The aim of this study was to evaluate the prognostic value of metabolic parameters measured using 18F-FDG PET/CT in patients with SCLC.
MATERIALS AND METHODS
We conducted a retrospective review of 114 patients with pathologically proven SCLC (26 cases of limited disease and 88 cases of extensive disease) who underwent pretreatment 18F-FDG PET/CT. The maximal SUV (SUVmax) was used quantitatively for determination of FDG PET activity. The SUVmax of the primary tumor (primary SUVmax), the sum of SUVmax values of malignant lesions (SUVsum), and the mean SUVmax of malignant lesions were calculated.
RESULTS
The patient population was subdivided using a median SUVsum value of 24.6. High SUVsum showed a significant association with known factors for poor prognosis, including higher neuron-specific enolase (p=0.010), CYFRA 21-1 (p=0.014), and extensive disease status (p=0.007). Patients with high SUVsum had significantly shorter median overall survival (6.6 months vs. 13.0 months, p<0.001) and progression-free survival (5.2 months vs. 8.0 months, p<0.001) than patients with low SUVsum. Results of multivariate analysis showed that SUVsum, chemotherapy cycles, and the response to first-line treatment were significant prognostic factors of survival. In contrast, mean SUVmax and primary SUVmax were not significant predictors of survival.
CONCLUSION
In this study, metabolic burden represented by SUVsum from pretreatment 18F-FDG PET/CT was an independent prognostic factor in patients with SCLC.

Keyword

Small cell lung carcinoma; Tumor burden; Neoplasms; Prognosis; Positron-emission tomography and computed tomography

MeSH Terms

Carcinoma, Non-Small-Cell Lung
Disease-Free Survival
Drug Therapy
Electrons*
Fluorodeoxyglucose F18
Humans
Multivariate Analysis
Phosphopyruvate Hydratase
Positron-Emission Tomography and Computed Tomography
Prognosis
Retrospective Studies
Small Cell Lung Carcinoma*
Tumor Burden
Fluorodeoxyglucose F18
Phosphopyruvate Hydratase

Figure

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  Fig. 1 Kaplan-Meier survival curves for overall survival (p<0.001) (A) and progression-free survival (p<0.001) (B) of the two groups, which were divided based on the median value of sum of standardized uptake value (SUVsum) of pretreatment 18F-fluorodeoxyglucose positron emission tomography/computed tomography of 114 patients with small cell lung cancer.

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  Fig. 2 Kaplan-Meier survival curves for progression-free survival (p<0.001) (A) and overall survival (p<0.001) (B) of four groups according to the combined criteria of sum of standardized uptake value (SUVsum) and tumor stage of 114 patients with small cell lung cancer.

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