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Prognostic value of total lesion glycolysis and metabolic tumor volume in Non-small cell lung cancer Karolien Vanhove1,2, Liesbet Mesotten1,3, Micheline Heylen1, Ruben Derwael1, Michiel Thomeer1,3, Peter Adriaensens1,4, Evelyne Louis1 and Ronald Boellaard5 1Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium, 2Algemeen Ziekenhuis Vesalius, Tongeren, Belgium, 3Ziekenhuis Oost-Limburg, Genk, Belgium, 4Institute of Materials Research, Hasselt University, Diepenbeek, Belgium, 5VU Medical Center, Amsterdam, The Netherlands Table 2. Univariate analysis and Cox Regression model for overall survival INTRODUCTION • Lung cancer is the most common cancer worldwide and the most important cause of cancer related death worldwide in both men and woman. • At present prognosis in non-small cell lung cancer (NSCLC) primarily depends on tumor-nodemetastatis stage (TNM). • The staging system does not provide a satisfactory explanation of relapse and survival within a subgroup of the TNM system. • Accumulating evidence shows that the metabolism of cancer cells differs from that of normal cells. Increased glucose uptake and glycolytic activity is a hallmark of cancer and the altered glucose metabolism can be assessed by Positron Emission Tomography (PET). • Maximum standardized uptake value (SUVmax), SUV index, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) have been found to be correlated with survival in patients with stage I to IV NSCLC. OBJECTIVE This study aims to examine whether SUVmax, SUVindex, TLG50 and MTV are correlated with overall survival (OS) or progression free survival (PFS) in stage I to IV NSCLC. Furthermore we want to prove that further stratification of patients with the same TNM stage based on TLG may improve outcome. Table 3. Univariate analysis and Cox Regression model for progression free survival Figure 1. Measurement of MTV from FDG PET/CT images by an SUV-based semi-automatic delineation tool SUBJECTS AND METHODS RESULTS Study population 148 Patients with stage I to IV stage NSCLC who did not received any treatment before undergoing PET CT study at The Limburg PET Center were enrolled in the study between February 2011 and August 2012. Only patients with a biopsy proven adenocarcinoma or squamous carcinoma were included to obtain a more homogeneous study group. Patient characteristics are summarized in table 1. Table 1. Subject characteristics Positron Emission Tomography / Computed Tomography •All patients were fasted for at least 6 hours before FDG-PET/CT study. •Baseline serum glucose was measured prior to scanning, •Patients were scanned after administration of 3,75 MBQ/kg and an uptake time of 1 hour •On PET images SUVmax, SUVmean and MTV of the primary tumors were measured by a semi-automatic delineation tool. •PET parameters were corrected for lean body mass and glycaemia •TLG was defined as SUVmean × MTV •TLG50 was calculated by using a threshold of 50 % of the corrected SUVmax. •SUV index was calculated by the ratio of tumor SUVmax to liver SUVmean to improve reproducibility and to lower the influence of patient and scanner related factors CONCLUSION Our study indicates that TLG of the primary tumor is an independent prognostic factor in patients with NSCLC for both OS and PFS. Further stratification of patients with the same TNM stage based on TLG may improve outcome. Prospective studies and validation are needed for determination of the optimal cutoff before transferring results into clinical practice.