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¹⁸F-FMT Uptake Seen Within Primary Cancer on PET Helps Predict Outcome of Non–Small Cell Lung Cancer

¹ Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Showa-machi, Maebashi, Gunma, Japan; ² Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Showa-machi, Maebashi, Gunma, Japan; ³ Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Showa-machi, Maebashi, Gunma, Japan; ⁴ Department of Molecular Imaging, Gunma University Graduate School of Medicine, Showa-machi, Maebashi, Gunma, Japan; and ⁵ Division of Bio-system Pharmacology, Department of Pharmacology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan

Correspondence: For correspondence or reprints contact: Kyoichi Kaira, Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Showa-machi, Maebashi, Gunma 371-8511, Japan. E-mail: kkaira1970{at}yahoo.co.jp

L-[3-¹⁸F]--methyl tyrosine (¹⁸F-FMT) is an amino-acid tracer for PET imaging. We evaluated the prognostic significance of ¹⁸F-FMT PET in patients with non–small cell lung cancer. Methods: Ninety-eight patients (80 men and 18 women; age range, 42–82 y; median age, 69 y) with stage I–IV non–small cell lung cancer were enrolled in this study. They included 57 with adenocarcinoma, 31 with squamous cell carcinoma, 5 with large cell carcinoma, and 5 with other conditions. The median follow-up duration was 17.0 mo. A pair of PET studies with ¹⁸F-FMT and ¹⁸F-FDG was performed, and tracer uptake by the primary tumor was evaluated using the maximal standardized uptake value (SUV_max). Overall survival and disease-free survival were calculated by the Kaplan–Meier method. The prognostic significance was assessed by univariate and multivariate analyses. Results: The best discriminative SUV_max cutoffs for ¹⁸F-FMT and ¹⁸F-FDG in the primary tumors were 1.6 and 11, respectively. In the univariate analysis, a high SUV_max was significant in predicting poor overall survival for ¹⁸F-FMT (P = 0.0129) and ¹⁸F-FDG PET (P = 0.0481). According to histologic types, ¹⁸F-FMT and ¹⁸F-FDG uptake were a stronger prognostic predictor in adenocarcinoma than in nonadenocarcinomatous disease. Patients with a high SUV_max for ¹⁸F-FMT showed significantly worse disease-free survival rates than those with a low SUV_max, and multivariate analysis confirmed that a high SUV_max for ¹⁸F-FMT was an independent and significant factor in predicting a poor prognosis in patients with adenocarcinoma (P = 0.0191). Conclusion: Uptake of ¹⁸F-FMT in primary tumors was an independent prognostic factor in patients with pulmonary adenocarcinoma.

Key Words: ¹⁸F--methyltyrosine • positron emission tomography • ¹⁸F-fluorodeoxyglucose • lung cancer • prognostic factor

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