Prognostic and Predictive Values of F-18 FDG PET/CT Volumetric Parameters in Small Cell Lung Cancer

Abstract

Introduction: Volumetric parameters of the 18F-FDG PET/CT can contribute to the treatment decision in high risk patients. In the present study, we aimed to examine the predictive, prognostic, and clinical value of PET/CT by using the two volumetric parameters: metabolic tumor volume (MTV) and total lesion glycolysis (TLG), SUVmax to concurrently evaluate survival data in patients diagnosed with small cell lung cancer (SCLC). Methods: 244 patients with SCLC, who underwent 18F-FDG PET/CT imaging for staging purpose were enrolled. Primary tumor SUVmax, MTV (40-70%) and TLG (40-70%) obtained from PET/CT were documented. Results: All lesions (n=244) showed 18F-FDG uptake, mean SUVmax of 19.74±8.71 [range (min – max) = 3.80 - 58.80]. SUVmax was significantly higher in tumors with diameters > 2 cm compared to those with diameters ≤ 2 cm (p=0.000). The mean survival time was significantly shorter in patients with tumor diameter greater than 2 cm, locoregional LN involvement, distant nodal metastasis, or distant organ metastasis (p=0.019, p<0.001, p<0.001 and p<0.001, respectively). Primary tumor SUVmax showed statistically significant positive correlation with tumor size, TLG40/70, and SUVmean40/70. Also, high MTV40 and TLG40 showed statistically significant association with increased tumor diameter and distant organ metastasis. Conclusion: In our study, volumetric parameters of 18F-FDG PET/CT showed remarkable superiority specifically over metabolic parameters in the detection of distant organ metastasis. Patients with high FDG uptake in primary tumors should be carefully evaluated for poor prognostic and metastatic potential; optimal treatment should be planned accordingly.

Keywords

• Volumetric parameters
• 18F-FDG PET/CT
• Small Cell lung cancer

References

1. Barta, J. A., Powell, C. A., & Wisnivesky, J. P. (2019). Global Epidemiology of Lung Cancer. Annals of global health, 85(1), 8. https://doi.org/10.5334/aogh.2419
2. Caballero Vázquez, A., Garcia Flores, P., Romero Ortiz, A., García Del Moral, R., & Alcázar-Navarrete, B. (2020). Small cell lung cancer: Recent changes in clinical presentation and prognosis. The clinical respiratory journal, 14(3), 222–227. https://doi.org/10.1111/crj.13119
3. Arslan, E., Çermik, T. F., Trabulus, F. D. C., Talu, E. C. K., & Başaran, Ş. (2018). Role of 18F-FDG PET/CT in evaluating molecular subtypes and clinicopathological features of primary breast cancer. Nuclear medicine communications, 39(7), 680–690. https://doi.org/10.1097/MNM.0000000000000856
4. Mantziari, S., Pomoni, A., Prior, J. O., Winiker, M., Allemann, P., Demartines, N., & Schäfer, M. (2020). 18F- FDG PET/CT-derived parameters predict clinical stage and prognosis of esophageal cancer. BMC medical imaging, 20(1), 7. https://doi.org/10.1186/s12880-019-0401-x
5. Turgeon, G. A., Iravani, A., Akhurst, T., Beaulieu, A., Callahan, J. W., Bressel, M., Cole, A. J., Everitt, S. J., Siva, S., Hicks, R. J., Ball, D. L., & Mac Manus, M. P. (2019). What 18F-FDG PET Response-Assessment Method Best Predicts Survival After Curative-Intent Chemoradiation in Non-Small Cell Lung Cancer: EORTC, PERCIST, Peter Mac Criteria, or Deauville Criteria?. Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 60(3), 328–334. https://doi.org/10.2967/jnumed.118.214148
6. Lin X, Fan W, Liang P, Yingying HU, Zhang X. Value of 18F-FDG PET/CT with Volume Metabolic Parameters for Prognosis Evaluation in Limited-Disease Small Cell Lung Cancer. Journal of Sun Yat-sen University (Medical Sciences). 2017;38(5):765-73.
7. Chen, M. Y., Chou, H. H., Liu, F. Y., Chen, C. Y., Lin, G., Yang, L. Y., Pan, Y. B., Jung, S. M., Wu, R. C., Huang, Y. T., Tsai, J. C., Yen, T. C., Lai, C. H., & Chang, T. C. (2016). (18)F-FDG PET in small-cell cervical cancer: a prospective study with long-term follow-up. European journal of nuclear medicine and molecular imaging, 43(4), 663–674. https://doi.org/10.1007/s00259-015-3229-9
8. Zheng Y, Huo L, Jiantao BA, Ren C, Fang LI. Value of 18 F-FDG PET/CT for prognosis evaluation in patients with small cell lung cancer. Chinese Journal of Nuclear Medicine and Molecular Imaging. 2015:(6):442-5.

9. Araz, M., Soydal, C., Özkan, E., Sen, E., Nak, D., Kucuk, O. N., Gönüllü, U., & Kir, K. M. (2022). Prognostic value of metabolic parameters on baseline 18F-FDG PET/CT in small cell lung cancer. The quarterly journal of nuclear medicine and molecular imaging : official publication of the Italian Association of Nuclear Medicine (AIMN) [and] the International Association of Radiopharmacology (IAR), [and] Section of the Society of..., 66(1), 61–66. https://doi.org/10.23736/S1824-4785.19.03169-8
10. Morgensztern, D., Ng, S. H., Gao, F., & Govindan, R. (2010). Trends in stage distribution for patients with non-small cell lung cancer: a National Cancer Database survey. Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 5(1), 29–33. https://doi.org/10.1097/JTO.0b013e3181c5920c
11. Zhu, D., Wang, Y., Wang, L., Chen, J., Byanju, S., Zhang, H., & Liao, M. (2018). Prognostic value of the maximum standardized uptake value of pre-treatment primary lesions in small-cell lung cancer on 18F-FDG PET/CT: a meta-analysis. Acta radiologica (Stockholm, Sweden : 1987), 59(9), 1082–1090. https://doi.org/10.1177/0284185117745907
12. Choi, E. K., Park, M., Im, J. J., Chung, Y. A., & Oh, J. K. (2020). Prognostic value of 18F-FDG PET/CT metabolic parameters in small cell lung cancer. The Journal of international medical research, 48(4), 300060519892419. https://doi.org/10.1177/0300060519892419
13. Tang B, Ding C. Value of 18F-FDG PET/CT in Clinical Correlation and Prognosis Evaluation with Limited-Stage Small Cell Lung Cancer. Biomed J Scient & Tech Res. 2019;17(2):12660-8.
14. Ding CY, Guo Z, Li YY, Li TR. Prognostic value of (18) F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) in extensive-stage small cell lung cancer. Zhonghua Zhong Liu Za Zhi [Chinese Journal of Oncology]. 2017;39(11):828-34.
15. Kim, S. J., & Chang, S. (2015). Limited Prognostic Value of SUV max Measured by F-18 FDG PET/CT in Newly Diagnosed Small Cell Lung Cancer Patients. Oncology research and treatment, 38(11), 577–585. https://doi.org/10.1159/000441289
16. Inal, A., Kucukoner, M., Kaplan, M. A., Urakci, Z., Nas, N., Guven, M., Dostbil, Z., Altindag, S., & Isikdogan, A. (2013). Is (18)F-FDG-PET/CT prognostic factor for survival in patients with small cell lung cancer? Single center experience. Revista portuguesa de pneumologia, 19(6), 260–265. https://doi.org/10.1016/j.rppneu.2013.03.007
17. Kwon, S. H., Hyun, S. H., Yoon, J. K., An, Y. S., Oh, Y. T., Choi, J. H., Park, K. J., & Lee, S. J. (2016). The Highest Metabolic Activity on FDG PET Is Associated With Overall Survival in Limited-Stage Small-Cell Lung Cancer. Medicine, 95(5), e2772. https://doi.org/10.1097/MD.0000000000002772
18. Nobashi, T., Koyasu, S., Nakamoto, Y., Kubo, T., Ishimori, T., Kim, Y. H., Yoshizawa, A., & Togashi, K. (2016). Prognostic value of fluorine-18 fludeoxyglucose positron emission tomography parameters differs according to primary tumour location in small-cell lung cancer. The British journal of radiology, 89(1059), 20150618. https://doi.org/10.1259/bjr.20150618
19. Zer, A., Domachevsky, L., Rapson, Y., Nidam, M., Flex, D., Allen, A. M., Stemmer, S. M., Groshar, D., & Bernstine, H. (2016). The Role of 18F-FDG PET/CT on Staging and Prognosis in Patients with Small Cell Lung Cancer. European radiology, 26(9), 3155–3161. https://doi.org/10.1007/s00330-015-4132-2
20. Oh, J. R., Seo, J. H., Chong, A., Min, J. J., Song, H. C., Kim, Y. C., & Bom, H. S. (2012). Whole-body metabolic tumour volume of 18F-FDG PET/CT improves the prediction of prognosis in small cell lung cancer. European journal of nuclear medicine and molecular imaging, 39(6), 925–935. https://doi.org/10.1007/s00259-011-2059-7