Background: Integrated positron emission tomography and computed tomography (PET/ TC) is widely used in the preoperative staging and prognostic assessment of non-small cell lung cancer patients. Aims of this study were to evaluate the prognostic signicance of maximum standardized uptake (SUVmax) of primary tumor in patients undergoing surgical treatment and, in order to minimize technical interferences, to verify whether SUVmax normalized by SUVmax liver and SUVmax blood pool provided additional prognostic information. Methods: Retrospective, single institution study of 413 consecutive patients with non-small cell lung cancer who underwent potentially curative surgical resection after PET/CT had been obtained in the same PET center between August 2004 and January 2010. The SUVmax was calculated drawing region of interest (ROI) around the primitive tumour, the liver and the aortic arch in PET images (i.e. the plane with the hottest tumour voxel was found and SUVmax for that plane was measured), using the formula: SUV = activity (MBq/mL) x body weight (kg) / injected dose (MBq). The same procedure was performed for two adjacent planes and the average of these measures was considered in the statistical analysis. Kaplan-Meier method, log-rank test, and Cox model were used in the statistical analysis. Results: Nine patients were considered 30-day postoperative deaths and were excluded from the analysis. At the end of the study in December 2010, 312 (77.2%) out of the 404 remaining patients were living (median follow-up, 24.7 months; range, 1.4 - 71.9) and 92 had died (median survival, 15.7 months; range, 1.2 – 64.6). Median (range) SUVmax of primary tumor, median (range) SUVmax primary tumor/SUVmax blood pool ratio, and median (range) SUVmax primary tumor/SUVmax liver ratio were 8.6 (1.1-54), 5 (0.6-30), and 3.7 (0.5-16.9), respectively. Using univariate analysis, sex (p=0.03), T stage (p=0.00004), N stage (p<0.000001), TNM stage (p<0.000001), primary tumor characteristics including presence of necrosis (p=0.004), presence of vascular invasion (p=0.0012) and grading (p=0.001), primary tumor SUVmax (p=0.00016), primary tumor SUVmax/SUVmax blood pool ratio (p=0.0005), and primary tumor SUVmax/SUVmax liver ratio (p=0.00017) were found to be signicant prognostic factors. At multivariate analysis, T stage, N stage, TNM stage, primary tumor grading and SUVmax were the parameters that retained signicant independent prognostic impact. All the remaining variables did not enter the model. Conclusion: Maximum standardized uptake value of primary tumor is an independent predictor for survival in non-small cell lung cancer patients undergoing surgery and might be helpful in identifying patients at increased risk of death so as to guide adjuvant treatment strategies. Maximum standardized uptake value of primary tumor normalized by SUV blood pool or SUV liver does not provide additional prognostic information. Keywords: Maximum Standardized Uptake Value, prognostic value, Non small cell lung cancer, PET/CT
The prognostic significance of maximum standardized uptake value of primary tumor in non-small cell lung cancer patients surgically treated:analysis of 413 cases.
ARDISSONE, Francesco
2011-01-01
Abstract
Background: Integrated positron emission tomography and computed tomography (PET/ TC) is widely used in the preoperative staging and prognostic assessment of non-small cell lung cancer patients. Aims of this study were to evaluate the prognostic signicance of maximum standardized uptake (SUVmax) of primary tumor in patients undergoing surgical treatment and, in order to minimize technical interferences, to verify whether SUVmax normalized by SUVmax liver and SUVmax blood pool provided additional prognostic information. Methods: Retrospective, single institution study of 413 consecutive patients with non-small cell lung cancer who underwent potentially curative surgical resection after PET/CT had been obtained in the same PET center between August 2004 and January 2010. The SUVmax was calculated drawing region of interest (ROI) around the primitive tumour, the liver and the aortic arch in PET images (i.e. the plane with the hottest tumour voxel was found and SUVmax for that plane was measured), using the formula: SUV = activity (MBq/mL) x body weight (kg) / injected dose (MBq). The same procedure was performed for two adjacent planes and the average of these measures was considered in the statistical analysis. Kaplan-Meier method, log-rank test, and Cox model were used in the statistical analysis. Results: Nine patients were considered 30-day postoperative deaths and were excluded from the analysis. At the end of the study in December 2010, 312 (77.2%) out of the 404 remaining patients were living (median follow-up, 24.7 months; range, 1.4 - 71.9) and 92 had died (median survival, 15.7 months; range, 1.2 – 64.6). Median (range) SUVmax of primary tumor, median (range) SUVmax primary tumor/SUVmax blood pool ratio, and median (range) SUVmax primary tumor/SUVmax liver ratio were 8.6 (1.1-54), 5 (0.6-30), and 3.7 (0.5-16.9), respectively. Using univariate analysis, sex (p=0.03), T stage (p=0.00004), N stage (p<0.000001), TNM stage (p<0.000001), primary tumor characteristics including presence of necrosis (p=0.004), presence of vascular invasion (p=0.0012) and grading (p=0.001), primary tumor SUVmax (p=0.00016), primary tumor SUVmax/SUVmax blood pool ratio (p=0.0005), and primary tumor SUVmax/SUVmax liver ratio (p=0.00017) were found to be signicant prognostic factors. At multivariate analysis, T stage, N stage, TNM stage, primary tumor grading and SUVmax were the parameters that retained signicant independent prognostic impact. All the remaining variables did not enter the model. Conclusion: Maximum standardized uptake value of primary tumor is an independent predictor for survival in non-small cell lung cancer patients undergoing surgery and might be helpful in identifying patients at increased risk of death so as to guide adjuvant treatment strategies. Maximum standardized uptake value of primary tumor normalized by SUV blood pool or SUV liver does not provide additional prognostic information. Keywords: Maximum Standardized Uptake Value, prognostic value, Non small cell lung cancer, PET/CT
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