Elsevier

European Journal of Radiology

Volume 81, Issue 12, December 2012, Pages 4179-4184
European Journal of Radiology

Prognostic significance of total lesion glycolysis in patients with advanced non-small cell lung cancer receiving chemotherapy

https://doi.org/10.1016/j.ejrad.2012.07.009Get rights and content

Abstract

Background

[18F]fluorodeoxyglucose positron emission tomography (FDG-PET) imaging has been employed as a non-invasive diagnostic tool for malignant tumors. Total lesion glycolysis (TLG) on FDG-PET is calculated by multiplying the mean standardized uptake value (SUVmean) by the tumor volume. Unlike the maximum standardized uptake value (SUVmax), which represents the point of greatest metabolic activity within tumors, TLG has been suggested to reflect global metabolic activity in whole tumors.

Methods

We retrospectively examined whether or not FDG-PET measurements, including SUVmean, SUVmax, and TLG, could predict progression-free survival (PFS) or overall survival (OS) in patients with non-small cell lung cancer (NSCLC) receiving chemotherapy.

Results

This study involved 81 consecutive patients with NSCLC who received chemotherapy. All of the patients underwent FDG-PET examination before treatment. SUVmean, SUVmax, and TLG on FDG-PET were significantly associated with gender, smoking status, and tumor histology. With adjustment for several other variables, Cox regression analysis showed that TLG was significantly prognostic for both PFS [hazard ratio = 2.34; 95% confidence interval, 1.18–4.64; P = 0.015] and OS (hazard ratio = 2.80; 95% confidence interval, 1.12–6.96; P = 0.003), whereas SUVmean and SUVmax had no significant association with PFS (P = 0.693 and P = 0.322, respectively) or OS (P = 0.587 and P = 0.214, respectively).

Conclusions

Our findings suggest that TLG may be more useful than SUVmean and SUVmax for predicting PFS and OS in NSCLC patients receiving chemotherapy. The TLG measurement on FDG-PET imaging could be routinely recommended to advanced NSCLC patients.

Introduction

Lung cancer continues to be the leading cause of cancer death worldwide. Non-small cell lung cancer (NSCLC) is the most common lung cancer type, accounting for approximately 80% of all cases, and includes several different types of tumor histology, including adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. More than half of all NSCLC patients have metastases at the time of diagnosis, and chemotherapy is reported to be the most effective treatment for those with advanced disease [1]. Recently, the clinical use of [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) has emerged as a non-invasive diagnostic tool for malignant tumors and become widespread. FDG-PET, which reflects increased glucose uptake, provides information on metabolic activity within tumors [2], [3], [4], and has been reported to be useful for disease staging. For example, previous studies have shown that the standardized uptake value (SUV), which has been used to quantitatively evaluate FDG uptake on FDG-PET, is associated with the outcome of patients with NSCLC [5], [6], [7]. In addition, recent studies have demonstrated that a low SUV is associated with favorable outcome in patients with advanced NSCLC receiving chemotherapy or gefitinib [7], [8], [9].

Among the parameters of FDG-PET, that most frequently studied has been the mean standardized uptake value (SUVmean) and/or maximum standardized uptake value (SUVmax), which cannot reflect metabolic activity in the whole tumor. Total lesion glycolysis (TLG) has recently been introduced by Larson et al. as another FDG-PET parameter, combining the FDG-defined metabolic activity with the lesion volume [10]. Although SUVmax represents only the point of greatest metabolic activity within a tumor, TLG, which is calculated by multiplying the SUVmean value by the tumor metabolic volume, has been suggested to better reflect global metabolic activity in whole tumors. For example, TLG has been reported to be a promising prognostic marker in several different malignancies, such as breast cancer, malignant pleural mesothelioma, gastric cancer, colorectal cancer, and osteosarcoma [10], [11], [12], [13], [14]. However, it remains to be determined whether TLG is prognostically useful in patients with advanced NSCLC receiving chemotherapy. In the present study, we retrospectively analyzed the relationships between FDG-PET parameters, including SUVmean, SUVmax, and TLG, and other clinical factors, and examined whether or not these parameters would be capable of predicting progression-free survival (PFS) or overall survival (OS) in patients with NSCLC receiving chemotherapy.

Section snippets

Patients and treatment

This retrospective study involved 81 consecutive NSCLC patients treated at a single institution (Kurume University Hospital, Kurume, Japan). All of the patients received chemotherapy between April 2004 and September 2011. Details of the patients’ clinical characteristics, including age, gender, histology, smoking status, performance status (PS), stage, and treatment modality, were obtained from chart reviews by an independent reviewer unaware of the results of FDG-PET measurements (Table 1). Of

Relationships between SUVmean, SUVmax, or TLG and various clinical characteristics

Significant correlations were observed between TLG and SUVmean (correlation coefficient = 0.786, P < 0.001) or SUVmax (correlation coefficient = 0.677, P < 0.001) by Spearman's rank correlation test. Table 2 shows the relationships between SUVmean, SUVmax, or TLG and various clinical characteristics, including gender, age, smoking status, tumor histology, stage, and PS. Significant associations were observed between SUVmean, SUVmax, and TLG and gender (P = 0.016, P = 0.004, and P < 0.001, respectively).

Discussion

In the present study, we examined which of the FDG-PET parameters, including SUVmean, SUVmax, and TLG, could be useful for predicting PFS or OS in NSCLC patients receiving chemotherapy. Previously, we have demonstrated that lower SUVmax may be associated with better prognosis in non-surgical NSCLC patients. In addition, it has been shown that lower SUVmax is correlated with favorable outcomes in patients with advanced NSCLC receiving gefitinib or platinum-based chemotherapy [7], [8]. SUVmax is

Conflict of interest statement

None declared.

Acknowledgments

None.

References (21)

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