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. 2020 Jun;9(3):541-548.
doi: 10.21037/tlcr.2020.04.04.

Maximum standardized uptake value of primary tumor (SUVmax_PT) and horizontal range between two most distant PET-positive lymph nodes predict patient outcome in inoperable stage III NSCLC patients after chemoradiotherapy

Olarn Roengvoraphoj  1 , Lukas Käsmann  1   2   3 , Chukwuka Eze  1 , Julian Taugner  1 , Arteda Gjika  1 , Amanda Tufman  2   4 , Indrawati Hadi  1 , Minglun Li  1 , Erik Mille  5 , Kathrin Gennen  1 , Claus Belka  1   2   3 , Farkhad Manapov  1   2   3
Affiliations

Maximum standardized uptake value of primary tumor (SUVmax_PT) and horizontal range between two most distant PET-positive lymph nodes predict patient outcome in inoperable stage III NSCLC patients after chemoradiotherapy

Olarn Roengvoraphoj et al. Transl Lung Cancer Res. 2020 Jun.

Abstract

Background: 18F-FDG-positron emission tomography (PET)/computed tomography (CT) is a standard for initial staging in patients with locally advanced stage III non-small cell lung cancer (NSCLC). We evaluated a PET/CT staging score to characterize disease extension and patient outcome in this disease.

Methods: Ninety-nine consecutive patients with NSCLC stage IIIA-B (UICC 7th edition), who underwent 18F-FDG-PET/CT before the start of chemoradiotherapy (CRT) were analyzed. Maximum standardized uptake value of primary tumor (SUVmax_PT) and range between two most distant PET-positive (SUV ≥2.5) lymph nodes in two directions were analyzed for their correlation with patient outcome. The vertical distance was defined as A- and the horizontal as a B-line.

Results: According to the results of univariate analysis, score included the SUVmax_PT and horizontal B-line, patients were divided into three risk subgroups: low, intermediate and high-risk subgroups. Subgroups were defined as SUVmax_PT <8 and B-line <3.7 cm, SUVmax_PT >8 or B-line >3.7 cm and SUVmax_PT >8 plus B-line >3.7 cm, respectively. Twenty-eight (28%), 45 (46%) and 26 (26%) patients were assigned to the low, intermediate and high-risk subgroup, respectively. Median event-free survival (EFS) in low, intermediate and high-risk subgroups was 16 (95% CI: 7-25), 13 (95% CI: 12-15) and 10 (95% CI: 7-13) months (P=0.002, log-rank test). Median OS in the low, intermediate and high-risk subgroups was 40 (95% CI: 11-69), 23 (95% CI: 15-31) and 14 (95% CI: 13-14) months (P=0.0001, log-rank test). In the multivariate analysis, SUV, B-line and PET/CT score were significantly associated with EFS [harard ratio (HR) 2.12 (95% CI: 1.27-3.55) and intermediate risk HR 2.01 (95% CI: 1.13-3.59), P=0.003] and OS [high-risk HR 2.79 (95% CI: 1.16-4.55) and intermediate risk HR 2.30 (95% CI: 1.58-4.94), P=0.001].

Conclusions: A PET/CT score was developed for inoperable stage III NSCLC patients treated with CRT and was an independent predictor of patient outcome in the single-center cohort.

Keywords: Chemoradiotherapy (CRT); combined modality therapy; positron emission tomography computed tomography (PET-CT); survival rate.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tlcr.2020.04.04). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Definition of A- and B-line.
Figure 2
Figure 2
OS according to PET/CT staging score (P<0.001, log-rank test). PET, positron emission tomography; CT, computed tomography.
Figure 3
Figure 3
EFS according to PET/CT staging score (P=0.002, log-rank test). EFS, event-free survival; PET, positron emission tomography; CT, computed tomography.
See this image and copyright information in PMC

References

    1. Antonia SJ, Villegas A, Daniel D, et al. Overall survival with durvalumab after chemoradiotherapy in stage III NSCLC. N Engl J Med 2018;379:2342-50. 10.1056/NEJMoa1809697 - DOI - PubMed
    1. Käsmann L, Taugner J, Eze C, et al. Performance status and its changes predict outcome for patients with inoperable stage III NSCLC undergoing multimodal treatment. Anticancer Res 2019;39:5077-81. 10.21873/anticanres.13701 - DOI - PubMed
    1. Prelaj A, Ferrara R, Rebuzzi SE, et al. EPSILoN: A prognostic score for immunotherapy in advanced non-small-cell lung cancer: a validation cohort. Cancers (Basel) 2019. doi: .10.3390/cancers11121954 - DOI - PMC - PubMed
    1. Gong J, Xu L, Li Z, et al. A Clinical prognostic score to predict survival of advanced or metastatic non-small cell lung cancer (NSCLC) patients receiving first-line chemotherapy: a retrospective analysis. Med Sci Monit 2018;24:8264-71. 10.12659/MSM.911026 - DOI - PMC - PubMed
    1. Taugner J, Käsmann L, Eze C, et al. Survival score to characterize prognosis in inoperable stage III NSCLC after chemoradiotherapy. Transl Lung Cancer Res 2019;8:593-604. 10.21037/tlcr.2019.09.19 - DOI - PMC - PubMed