Prognostic stratification using F-18 FDG PET/CT in patients with advanced stage (Stage III and IV) non-small cell lung cancer

Abstract

F-18 FDG PET could provide prognostic information in patients with advanced resectable NSCLC. In the current study, we investigated the prognostic implication of F-18 FDG PET after chemotherapy in patients with advanced stage III and IV NSCLC. A retrospective review identified 19 patients with advanced stage (stage III and IV) NSCLC who received F-18 FDG PET/CT at diagnosis of cancer and after chemotherapy. The visual response and changes of SUV max before and after treatment on survival was investigated using Kaplan-Meier and Cox proportional hazard regression analyses. The median follow-up time was overall 24.8 month (range, 9.4-59.8 month), for surviving patients 41 month (range, 34.1-59.8 month), and for deceased patients 16.6 month (range, 9.4-29.4 month). Overall survival after baseline F-18 FDG PET/CT at 1 year was 73.7% and at 2 year was 47.4%. Comparing patients with and without F-18 FDG PET/CT response, there was statistically significant difference in overall survival between the 2 groups (median survival time, responder, 29.4 month; non-responder, 14.2 month, Chi(2)=3.91, p=0.048). Also, using the %DeltaSUV(max) for the comparison, significant difference was existed in overall survival between 2 groups (Chi(2)=12.6, p=0.0004). When the tumor reveals more than 17.85% reduction of %DeltaSUV(max), the survival could be predicted (AUC, 0857; standard error, 0.0866; 95% confidence interval, 0.622-0.971; sensitivity, 75%; specificity, 100%; p=0.0001). With Cox proportional hazard model, %DeltaSUV(max) was determined to be a potent prognostic factor for survival (Chi(2), 12.09; p=0.0005). In conclusion, using the visual and quantitative analyses of F-18 FDG PET/CT, the responder to chemotherapy in advanced stage NSCLC patients had a better prognosis. Moreover, the potent predictor of prognosis in advanced stage NSCLC patients was %DeltaSUV(max).