Volume-Based Assessment With F-18-FDG PET/CT Improves Outcome Prediction for Patients With Stage IIIA-N2 Non-Small Cell Lung Cancer
- Authors
- Hyun, Seung Hyup; Ahn, Hee Kyung; Ahn, Myung-Ju; Ahn, Yong Chan; Kim, Jhingook; Shim, Young Mog; Choi, Joon Young
- Issue Date
- Sep-2015
- Publisher
- AMER ROENTGEN RAY SOC
- Keywords
- F-18-FDG PET/CT; metabolic tumor volume; neoadjuvant concurrent chemoradiotherapy; non-small cell lung cancer; standardized uptake value
- Citation
- AMERICAN JOURNAL OF ROENTGENOLOGY, v.205, no.3, pp.623 - 628
- Journal Title
- AMERICAN JOURNAL OF ROENTGENOLOGY
- Volume
- 205
- Number
- 3
- Start Page
- 623
- End Page
- 628
- URI
- https://scholarworks.bwise.kr/gachon/handle/2020.sw.gachon/10204
- DOI
- 10.2214/AJR.14.13847
- ISSN
- 0361-803X
- Abstract
- OBJECTIVE. We evaluated the prognostic impact of volume-based assessment by pretreatment F-18-FDG PET/CT in patients who had clinical stage IIIA-N2 non-small cell lung cancer (NSCLC) treated with neoadjuvant concurrent chemoradiotherapy (CCRT) followed by surgical resection. MATERIALS AND METHODS. We reviewed 161 consecutive patients who had stage IIIA-N2 NSCLC treated with neoadjuvant CCRT followed by surgery. In all cases, N2 disease was pathologically confirmed by mediastinoscopic biopsy, endobronchial ultrasound-guided transbronchial needle aspiration, or video-assisted thoracoscopic surgery. We measured the total metabolic tumor volume (total MTV) and the maximum standardized uptake value (SUVmax), including a primary tumor and metastatic nodes on the pretreatment scan. Overall survival (OS) and disease-free survival (DFS) were assessed using the Kaplan-Meier method. The association of PET parameters with OS and DFS was determined by univariable and multivariable analyses performed using the Cox regression model. RESULTS. A higher total MTV was significantly associated with poor DFS (hazard ratio [HR], 1.82; p = 0.036) and OS (HR = 2.97; p = 0.012) in the multivariable analysis. In contrast, a higher SUVmax was not significantly associated with poor DFS and OS. Patients with a high total MTV (> 22 cm(3)) had a median survival time that was significantly shorter than that of patients with a low total MTV (median DFS, 11.3 vs 42.0 months, respectively [p < 0.001]; median OS, 38.3 months vs not reached [p < 0.001]). Kaplan-Meier curves showed significant differences on the basis of total MTV in patients with or without mediastinal downstaging after CCRT. Patients with a high total MTV had significantly worse DFS when they had post-neoadjuvant pathologic (yp) stage 0-II disease (p = 0.020) or yp stage III disease (p = 0.036). Higher total MTV was also associated with worse OS in patients with yp stage 0-II disease (p = 0.013) or yp stage III disease (p = 0.007). CONCLUSION. A higher pretreatment total MTV is associated with worse outcome, independent of yp stage, in patients with stage IIIA-N2 NSCLC treated with neoadjuvant CCRT followed by surgery.
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