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Research ArticleBRIEF COMMUNICATION

SUVmax Above 20 in 18F-FDG PET/CT at Initial Diagnostic Workup Associates with Favorable Survival in Patients with Cancer of Unknown Primary

Gregor Zaun, Manuel Weber, Martin Metzenmacher, Marcel Wiesweg, Thomas Hilser, Yasmin Zaun, Sven Liffers, Michael Pogorzelski, Isabel Virchow, Wilfried Eberhardt, Sarah Theurer, Tanja Abu Sabbah, Timm M. Reissig, Martin Stuschke, Cornelius Kürten, Timon Hussain, Stephan Lang, Stefan Kasper, Wolfgang P. Fendler, Ken Herrmann and Martin Schuler
Journal of Nuclear Medicine August 2023, 64 (8) 1191-1194; DOI: https://doi.org/10.2967/jnumed.122.265161
Gregor Zaun
1Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany;
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Manuel Weber
2Department of Nuclear Medicine, University Hospital Essen, Essen, Germany;
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Martin Metzenmacher
1Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany;
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Marcel Wiesweg
1Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany;
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Thomas Hilser
1Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany;
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Yasmin Zaun
1Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany;
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Sven Liffers
3German Cancer Consortium, Partner Site University Hospital Essen, Essen, Germany;
4Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Hospital Essen, Essen, Germany;
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Michael Pogorzelski
1Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany;
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Isabel Virchow
1Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany;
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Wilfried Eberhardt
1Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany;
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Sarah Theurer
5Institute of Pathology, West German Cancer Center, University Hospital Essen, Essen, Germany;
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Tanja Abu Sabbah
1Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany;
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Timm M. Reissig
1Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany;
4Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Hospital Essen, Essen, Germany;
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Martin Stuschke
6Department of Radiation Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany; and
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Cornelius Kürten
7Department of Otorhinolaryngology, West German Cancer Center, University Hospital Essen, Essen, Germany
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Timon Hussain
7Department of Otorhinolaryngology, West German Cancer Center, University Hospital Essen, Essen, Germany
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Stephan Lang
7Department of Otorhinolaryngology, West German Cancer Center, University Hospital Essen, Essen, Germany
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Stefan Kasper
1Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany;
3German Cancer Consortium, Partner Site University Hospital Essen, Essen, Germany;
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Wolfgang P. Fendler
2Department of Nuclear Medicine, University Hospital Essen, Essen, Germany;
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Ken Herrmann
2Department of Nuclear Medicine, University Hospital Essen, Essen, Germany;
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Martin Schuler
1Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany;
3German Cancer Consortium, Partner Site University Hospital Essen, Essen, Germany;
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  • FIGURE 1.
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    FIGURE 1.

    CONSORT (Consolidated Standards of Reporting Trials) flow diagram for patient inclusion in data analysis.

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    FIGURE 2.

    Median OS of full analysis set and patient subsets. (A) OS of full analysis set (n = 154) was 20.0 mo (95% CI, 10.0–30.0). (B) At 36.0 mo (95% CI, 21.3–50.7), OS of PET/CT set (18F-FDG PET/CT at initial diagnostic workup, n = 76) was significantly higher than OS of comparator set (without 18F-FDG PET/CT at initial diagnostic workup, n = 78), at 12.0 mo (95% CI, 8.7–15.3; P < 0.001).

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    FIGURE 3.

    Multivariate analysis for prognostic parameters for PET/CT set (n = 76): hazard ratio with 95% CI and P value. *P < 0.05. **P < 0.01. HR = hazard ratio; NEC = neuroendocrine carcinoma).

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    FIGURE 4.

    Median OS in relation to SUVmax in PET/CT set. In subset with initial 18F-FDG PET/CT, patients with SUVmax above 20 (n = 22) had significantly higher OS (not reached) than patients with SUVmax of 20 or less (n = 54) (32.0 mo; 95% CI, 23.2–40.8; P = 0.022).

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    TABLE 1.

    Baseline Characteristics

    Full analysis set (n = 154)PET/CT set (n = 76)Comparator set (n = 78)
    ParameterCharacteristicn%n%n%
    SexMale8253.254153.954152.56
    Female7246.753546.053747.44
    Age>60 y8454.553951.324557.69
    ≤60 y7045.453748.683342.31
    MetastasisSolitary6139.614052.632126.92
    Diffuse9360.393647.375773.08
    HistologyAdenocarcinoma6642.862532.894152.56
    Undifferentiated carcinoma106.4967.8945.13
    Squamous cell carcinoma5334.424052.631316.67
    Neuroendocrine carcinoma2516.2356.582025.64
    Secondary malignancyYes3220.781418.421823.08
    No12279.226281.586076.92
    Pulmonary artery embolism or thrombosisYes2818.181317.111519.23
    No12681.826382.896380.77
    Affected organ systems18353.904761.843646.15
    24126.622026.322126.92
    ≥33019.48911.842126.92
    SUVmax>202228.95
    ≤205471.05
    • Median age was 62 y (range, 20–85 y). Median SUVmax was 13.9 (range, 3.5–30.8).

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Journal of Nuclear Medicine: 64 (8)
Journal of Nuclear Medicine
Vol. 64, Issue 8
August 1, 2023
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SUVmax Above 20 in 18F-FDG PET/CT at Initial Diagnostic Workup Associates with Favorable Survival in Patients with Cancer of Unknown Primary
Gregor Zaun, Manuel Weber, Martin Metzenmacher, Marcel Wiesweg, Thomas Hilser, Yasmin Zaun, Sven Liffers, Michael Pogorzelski, Isabel Virchow, Wilfried Eberhardt, Sarah Theurer, Tanja Abu Sabbah, Timm M. Reissig, Martin Stuschke, Cornelius Kürten, Timon Hussain, Stephan Lang, Stefan Kasper, Wolfgang P. Fendler, Ken Herrmann, Martin Schuler
Journal of Nuclear Medicine Aug 2023, 64 (8) 1191-1194; DOI: 10.2967/jnumed.122.265161

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SUVmax Above 20 in 18F-FDG PET/CT at Initial Diagnostic Workup Associates with Favorable Survival in Patients with Cancer of Unknown Primary
Gregor Zaun, Manuel Weber, Martin Metzenmacher, Marcel Wiesweg, Thomas Hilser, Yasmin Zaun, Sven Liffers, Michael Pogorzelski, Isabel Virchow, Wilfried Eberhardt, Sarah Theurer, Tanja Abu Sabbah, Timm M. Reissig, Martin Stuschke, Cornelius Kürten, Timon Hussain, Stephan Lang, Stefan Kasper, Wolfgang P. Fendler, Ken Herrmann, Martin Schuler
Journal of Nuclear Medicine Aug 2023, 64 (8) 1191-1194; DOI: 10.2967/jnumed.122.265161
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