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. 2021 Sep-Oct;54(5):289-294.
doi: 10.1590/0100-3984.2020.0054.

The ratio between the whole-body and primary tumor burden, measured on 18F-FDG PET/CT studies, as a prognostic indicator in advanced non-small cell lung cancer

Felipe Renê Alves Oliveira  1 , Allan de Oliveira Santos  1 , Mariana da Cunha Lopes de Lima  1 , Ivan Felizardo Contrera Toro  1 , Thiago Ferreira de Souza  1 , Bárbara Juarez Amorim  1 , Aristoteles Souza Barbeiro  1 , Elba Etchebehere  1
Affiliations

The ratio between the whole-body and primary tumor burden, measured on 18F-FDG PET/CT studies, as a prognostic indicator in advanced non-small cell lung cancer

Felipe Renê Alves Oliveira et al. Radiol Bras. 2021 Sep-Oct.

Abstract
in English, Portuguese

Objective: To determine whether the whole-body tumor burden, as quantified by 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG PET/CT), is a prognostic indicator in advanced (stage III or IV) non-small cell lung cancer (NSCLC).

Materials and methods: This was a prospective study in which we evaluated 18F-FDG PET/CT staging parameters to quantify tumor burdens in patients with stage III or IV NSCLC. The following parameters were evaluated for the whole body (including the primary tumor) and for the primary tumor alone, respectively: maximum standardized uptake volume (wbSUVmax and tuSUVmax); metabolic tumor volume (wbMTV and tuMTV); and total lesion glycolysis (wbTLG and tuTLG). To determine whether the 18F-FDG PET/CT parameters were associated with overall survival (OS) and progression-free survival (PFS), we evaluated the wbSUVmax/tuSUVmax, wbMTV/tuMTV, and wbTLG/tuTLG ratios.

Results: 18F-FDG PET/CT was performed for staging in 52 patients who were followed for a median of 11.0 months (mean, 11.7 months). The estimated median PFS and OS were 9.6 months and 11.6 months, respectively. In the univariate analysis, OS was found to correlate significantly with wbTLG (hazard ratio [HR] = 1.001; 95% confidence interval [95 CI]: 1.000-1.001; p = 0.0361) and with the wbTLG/tuTLG ratio (HR = 1.705; 95% CI: 1.232-2.362; p = 0.0013). In the multivariate analysis, only the wbTLG/tuTLG ratio was independently associated with OS (HR = 1.660; 95% CI: 1.193-2.310; p = 0.0027).

Conclusion: The wbTLG/tuTLG ratio is an independent prognostic indicator of OS in advanced-stage NSCLC.

Objetivo: Avaliar se a carga metabólica tumoral do corpo inteiro medida na tomografia por emissão de pósitrons/tomografia computadorizada com 18F-fluordesoxiglicose (18F-FDG PET/CT) é um indicador prognóstico em pacientes com câncer de pulmão de células não pequenas (CPCNP) em estágio avançado (estágio III ou IV).

Materiais e métodos: Avaliamos, prospectivamente, a carga tumoral na 18F-FDG-PET/CT de estadiamento em pacientes com CPCNP avançado. Os parâmetros avaliados do tumor primário (tu) e do corpo inteiro (wb) (incluindo o primário) foram: SUV máximo (wbSUVmax e tuSUVmax), volume metabólico tumoral (wbMTV e tuMTV), glicólise total da(s) lesão(ões) (wbTLG e tuTLG), além das seguintes razões: wbSUVmax/tuSUVmax, wbMTV/tuMTV e wbTLG/tuTLG. Os parâmetros medidos na 18F-FDG-PET/CT, variáveis clínicas e patológicas foram correlacionados com a sobrevida global (SG) e a sobrevida livre de progressão (SLP).

Resultados: 18F-FDG-PET/CT foi realizada em 52 pacientes (tempos mediano/médio de sobrevida = 11,0/11,7 meses). A SLP mediana foi de 9,6 meses e a SG foi de 11,6 meses. Houve correlação significativa da wbTLG (hazard ratio [HR] = 1,001; intervalo de confiança de 95% [IC 95%]: 1,000-1,001; p = 0,0361) e wbTLG/tuTLG (HR = 1,705; IC 95%: 1,232-2.362; p = 0,0013) com a SG. Na análise multivariada, a razão wbTLG/tuTLG associou-se independentemente com a SG (HR = 1,660; IC 95%: 1,193-2,310; p = 0,0027).

Conclusão: A razão wbTLG/tuTLG é um indicador prognóstico independente de SG em CPCNP avançado.

Keywords: Carcinoma, non-small-cell lung/diagnosis; Carcinoma, non-small-cell lung/mortality; Fluorodeoxyglucose F18; Positron-emission tomography/methods; Tomography, X-ray computed/methods; Tumor burden.

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Figures

Figure 1.
Figure 1.
18F-FDG PET/CT in a patient with advanced NSCLC, showing the VOIs for the tuTLG (upper) and wbTLG (lower).
Figure 2.
Figure 2.
Examples of the importance of the tumor burden, calculated from 18F-FDG PET/CT imaging, as a prognostic indicator. A: A patient with stage IIIB NSCLC. The primary tumor (arrow) shows intense uptake (SUV = 13.2), and the multiple mediastinal lymph node metastases have intense hypermetabolism. B: A patient with stage IV NSCLC. The primary tumor (arrow) shows intense uptake (SUV = 47.2), and the patient was classified as having stage IV disease due to a contralateral axillary lymph node metastasis (dotted arrow). According to the TNM staging, the estimated 5-year OS rate was 19% for the patient depicted in A and 6% for the patient depicted in B. The wbTLG/tuTLG ratio was 1.27 for the patient in A and 1.01 for the patient in B. The patient in A had a higher tumor burden and died 11.57 months after diagnosis, whereas the patient in B, despite having been classified as having stage IV disease, was alive 25.7 months after diagnosis. Therefore, the wbTLG/tuTLG ratio, which is an independent prognostic indicator, may be a more accurate tool for assessing OS, which is especially useful in oligometastatic NSCLC.
See this image and copyright information in PMC

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