Download Prognostic value of total lesion glycolysis and metabolic tumor

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.