Prognostic Value of 18F–FDG–PET Parameters in Patients with Small Cell Lung Cancer: A Meta-Analysis and Review of Current Literature

Tine Nøhr Christensen,Barbara Malene Bjerregaard Fischer,Per Kragh Andersen,Seppo W Langer

doi:10.3390/diagnostics11020174

Tine Nøhr Christensen, Barbara Malene Bjerregaard Fischer + Show 2 more

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https://doi.org/10.3390/diagnostics11020174

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Abstract

Many studies have suggested a prognostic value of one or several positron emission tomography (PET) parameters in patients with small cell lung cancer (SCLC). However, studies are often small, and there is a considerable interstudy disagreement about which PET parameters have a prognostic value. The objective of this study was to perform a review and meta-analysis to identify the most promising PET parameter for prognostication. PubMed®, Cochrane, and Embase® were searched for papers addressing the prognostic value of any PET parameter at any treatment phase with any endpoint in patients with SCLC. Pooled hazard ratios (HRs) were calculated by a random effects model for the prognostic value of the baseline maximum standardized uptake value (SUVmax) and metabolic tumor volume (MTV). The qualitative analysis included 38 studies, of these, 19 studies were included in the meta-analyses. The pooled results showed that high baseline MTV was prognostic for overall survival (OS) (HR: 2.83 (95% confidence interval [CI]: 2.00–4.01) and progression-free survival (PFS) (HR: 3.11 (95% CI: 1.99–4.90)). The prognostic value of SUVmax was less pronounced (OS: HR: 1.50 (95% CI: 1.17–1.91); PFS: HR: 1.24 (95% CI: 0.94–1.63)). Baseline MTV is a strong prognosticator for OS and PFS in patients with SCLC. MTV has a prognostic value superior to those of other PET parameters, but whether MTV is superior to other prognosticators of tumor burden needs further investigation.

Highlights

Small cell lung cancer (SCLC) is an aggressive cancer, and most patients present at an advanced stage [1]
Four studies had a partial overlap of patient cohorts with one other study each [12,13,14,15]
Baseline SUV Baseline SUVmax was addressed in 28 studies, but only seven studies showed a significant prognostic value of SUVmax for overall survival (OS) and/or PFS [18,19,20,21,22,23,24]

Summary

Introduction

Small cell lung cancer (SCLC) is an aggressive cancer, and most patients present at an advanced stage [1]. Patients with limited disease (LD) are treated with concomitant thoracic radiotherapy and platin-based chemoradiotherapy. Patients presenting at an advanced stage (extensive disease; ED) are treated with palliative platin-based chemotherapy. Up to 40% of patients do not achieve objective response to first-line therapy [2], but even when objective response is achieved, it is often followed by a quick and fatal relapse, and overall survival (OS) is poor [2]. The introduction of immunotherapy for first-line treatment and for treatment of relapse gives hope for an improved clinical outcome [3,4,5]

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