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Overestimation of the Prognostic Significance of SUV Measurement by Positron Emission Tomography for Non–Small-Cell Lung Cancer

South Shore Hematology-Oncology Associates, Rockville Centre, NY

To the Editor:

Sasaki et al.¹ report a significant association between standardized uptake value (SUV) obtained by positron emission tomography (PET) and clinical outcome in non–small-cell lung cancer. They note that previous authors have investigated the prognostic importance of SUV determined by PET using various cutoff points. However, the authors chose to determine their own optimal cutoff point from their data. This has been shown to overestimate statistical significance due to the failure to account for the effects of multiple testing.² Altman et al provide a formula to estimate the corrected P value in this setting.² Application of this formula results in a corrected P value of .27 for the relationship between overall survival and SUV from the data of Sasaki et al, which is clearly not a statistically significant result.

I agree with the authors that an independent study with a larger data set is necessary to determine more clearly whether SUV is related to outcome in non–small-cell lung cancer. If such a study is undertaken, a cutoff point for low versus high SUV should be chosen before examination of the data in order to avoid overestimation of statistical significance.

Author's Disclosures of Potential Conflicts of Interest

The author indicated no potential conflicts of interest.

REFERENCES

1. Sasaki R, Komaki R, Macapinlac H, et al: [¹⁸F]Fluorodeoxyglucose uptake by positron emission tomography predicts outcome of non–small-cell lung cancer. J Clin Oncol 23:1136-1143, 2005[Abstract/Free Full Text]

2. Altman DG, Lausen B, Sauerbrei W, et al: Dangers of using "optimal" cutpoints in the evaluation of prognostic factors. J Natl Cancer Inst 86:829-835, 1994[Free Full Text]

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Related Reply

• In Reply:
  Ritsuko Komaki, Ryohei Sasaki, and Pamela K. Allen
  JCO 2005 23: 6800 [Full Text]

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