Journal of Clinical Oncology, Vol 17, Issue 10
(October), 1999: 3201-3206
© 1999 American Society for Clinical Oncology
Prognostic Importance of the Standardized Uptake Value on 18F-Fluoro-2-Deoxy-Glucose–Positron Emission Tomography Scan in Non–Small-Cell Lung Cancer: An Analysis of 125 Cases
Johan F. Vansteenkiste,
Sigrid G. Stroobants,
Patrick J. Dupont,
Paul R. De Leyn,
Erik K. Verbeken,
Georges J. Deneffe,
Luc A. Mortelmans,
Maurits G. Demedts,
and the Leuven Lung Cancer Group
From the Department of Pulmonology, Respiratory Oncology Unit and Departments of Nuclear Medicine, Thoracic Surgery, and Pathology, University Hospital Gasthuisberg, Catholic University, Leuven, Belgium.
Address reprint requests to J. Vansteenkiste, MD, PhD, Respiratory Oncology Unit, Department of Pulmonology, University Hospital Gasthuisberg, Catholic University, Herestraat, B-3000 Leuven, Belgium; email johan.vansteenkiste{at}uz.kuleuven.ac.be
PURPOSE: The amount of radio-labeled 18F-fluoro-2-deoxy-glucose (FDG) uptake, a measurement of the increased glucose metabolism of non–small-cell lung cancer (NSCLC) cells, has recently been correlated with proliferation capacity. The Standardized Uptake Value (SUV), a semi-quantitative measurement of FDG uptake on positron emission tomography (PET) scan, could thus be of prognostic significance.
PATIENTS AND METHODS: We analyzed the follow-up of 125 potentially operable NSCLC patients, previously included in three of our prospective PET protocols. Performance status, maximal tumor diameter, tumor-cell type, SUV, and final staging were analyzed for their possible association with survival.
RESULTS: Sixty-five patients had stage I or II NSCLC, 37 had stage IIIA, and 23 had stage IIIB. Treatment was complete resection in 91 cases. In a univariate analysis, performance status (P = .002), stage (P = .001), tumor diameter (P = .06), tumor-cell type (P = .03), and SUV greater than 7 (P = .001) were correlated with survival. For SUV, group dichotomy with a cut-off SUV of 7 had the best discriminative value for prognosis, both in the total and surgical cohort. A multivariate Cox analysis identified performance status (P = .02), stage (P = .01), and SUV (P = .007) as important for the prognosis. In the surgical group, patients with a resected tumor less than 3 cm had an expected 2-year survival of 86%, if the SUV was below 7, and 60%, if above 7. Nearly all resected tumors larger than 3 cm had SUV's greater than 7 and an expected 2-year survival of 43%.
CONCLUSION: We conclude that the FDG uptake in primary NSCLC on PET has an important prognostic value and could be complementary to other well-known factors in the decision on adjuvant treatment protocols.
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E. Salminen and M. Mac Manus
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K. H. Kernstine, K. A. McLaughlin, Y. Menda, N. P. Rossi, D. J. Kahn, D. L. Bushnell, M. M. Graham, C. K. Brown, and M. T. Madsen
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