Value Of Metabolic Tumor Volume Research Articles

Prognostic Value of Metabolic Tumor Volume and Total Lesion Glycolysis on Preoperative 18F-FDG PET/CT in Patients with Pancreatic Cancer

In this study, we aimed to assess the prognostic value of metabolic tumor volume (MTV) and total lesion glycolysis (TLG) measured on (18)F-FDG PET/CT in pancreatic cancer patients who underwent resection with curative intent. Eighty-seven patients with pancreatic ductal adenocarcinoma who underwent (18)F-FDG PET/CT and subsequent surgical resection with curative intent with (30 patients) or without (57 patients) neoadjuvant therapy were retrospectively enrolled. The maximum standardized uptake value (SUVmax), MTV, and TLG were measured on (18)F-FDG PET/CT in all patients. The prognostic significances of PET/CT parameters and tumor factors for recurrence-free survival (RFS) and overall survival (OS) were evaluated by univariate and multivariate analyses. Of the 87 patients, 57 (64%) experienced recurrence during the follow-up period. The tumor size, pathologic T (pT) stage, SUVmax, MTV, and TLG were significant prognostic factors for both RFS and OS (P < 0.05) on univariate analyses, and the presence of lymph node metastasis showed significance only for predicting RFS (P < 0.05). On multivariate analyses, the tumor size, MTV, and TLG were independent prognostic factors for RFS, and pT stage, MTV, and TLG were independent prognostic factors for OS. For the 57 patients who did not undergo neoadjuvant treatment, MTV and TLG remained significant predictive factors for tumor recurrence, along with tumor size and SUVmax. MTV and TLG are independent prognostic factors for predicting RFS and OS in patients with pancreatic cancer. Thus, (18)F-FDG PET/CT can provide useful prognostic information for patients undergoing resection of pancreatic cancer with curative intent irrespective of neoadjuvant treatment.

Prognostic Value of Metabolic Tumor Volume Measured by 18F-FDG PET/CT in Esophageal Cancer Patients

Objective: In this study, we aimed to explore prognostic importance of definition of preoperative metabolic tumor volume in esophageal cancer patients.Methods: 22 patients who have histologically proven stage IIA-III esophageal cancer and underwent 18F-FDG PET/CT for preoperative staging of disease were included to the study. After 18F-FDG PET/CT, all the patients underwent surgery within 4 weeks period. Patients have been followed up until death or Sept 15th, 2012. Dates of death were recorded for survival analysis. During evaluation of 18F-FDG PET/CT images, metabolic tumor volumes were calculated by drawing the isocontour region of interests from all visually positive FGD uptake lesions.Results: 22 patients (15M, 7F; mean age: 65.1±8.4, min-max:48-80) underwent 18F-FDG PET/CT for preoperative staging of esophageal cancer. Preoperative diagnosis was squamous cell and adeno cancer in 17 (%77) and 5 (%23) patients, respectively. Location of primary tumor is distal, proximal and mid-esophagus in 13 (%59), 6 (%27) and 3 (%13) patients, respectively. Primary tumor of all the patients were FDG avid (mean SUVmax: 18.85±7.0; range: 5.5-35.1). Additionally, 18F-FDG uptake was seen in mediastinal lymph nodes in 13 patients (5.45±8.15; range: 2.6-29.9). Mean metabolic tumor volumes of primary esophageal lesions were calculated as 8.77±8.46cm3 (range: 2.3-34.2). Mean MTV of lymph nodes was 2.44±1.01cm3 (range: 0.4-3.6). Mean total metabolic tumor volume was calculated as 9.99±8.58cm3 (range: 2.3-27.3). 10 patients died during 447±121 days follow-up period. Mean survival time was 11.9±1.5 months (95%CI: 8.99-14.74) for entire patient group. Total metabolic tumor volume had a significant effect on survival (p=0.045) according to Cox proportional hazards regression analysis. One unit increase in MTV caused 1.1 (95%CI:1.003-1.196) fold increase in hazard, at any time.Conclusion: Definition of preoperative metabolic tumor volume has a prognostic value in the prediction of postoperative survival times. Patients who have higher preoperative metabolic tumor volumes could be good candidates for more aggressive chemo-radiation therapy regiments.Conflict of interest:None declared.

Pre-treatment Metabolic Tumor Volume and Total Lesion Glycolysis are Useful Prognostic Factors for Esophageal Squamous Cell Cancer Patients

To study application of the maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) with 18F-FDG PET/CT for predicting prognosis of esophageal squamous cell cancer (ESC) patients. Eighty-six patients with ESC staged from I to IV were prospectively enrolled. Cisplatin-based chemoradiotherapy (CCRT) or palliative chemoradiotherapy were the main treatment methods and none received surgery. 18F-FDG PET/CT scans were performed before the treatment. SUVmax, MTV, and TLG were measured for the primary esophageal lesion and regional lymph nodes. Receiver operating characteristic curves (ROCs) were generated to calculate the P value of the predictive ability and the optimal threshold. MTV and TLG proved to be good indexes in the prediction of outcome for the ESC patients. An MTV value of 15.6 ml and a TLG value of 183.5 were optimal threshold to predict the overall survival (OS). The areas under the curve (AUC) for MTV and TLG were 0.74 and 0.70, respectively. Kaplan-Meier analysis showed an MTV less than 15.6 ml and a TLG less than 183.5 to indicate good media survival time (p value <0.05). In the stage III-IV patient group, MTV could better predict the OS (P < 0.001), with a sensitivity and specificity of 0.80 and 0.67, respectively. Pre-treatment MTV and TLG are useful prognostic factors in non- surgical ESC.

Prognostic value of metabolic tumor volume and total lesion glycolysis on preoperative 18F-FDG PET/CT in patients with pancreatic cancer.

190 Background: In this study, we aimed to assess the prognostic value of metabolic tumor volume (MTV) and total lesion glycolysis (TLG) measured on 18F-fluorodeoxyglucose (18F-FDG) PET/CT in pancreatic cancer patients who underwent resection with curative intent. Methods: Eighty-seven patients with pancreatic ductal adenocarcinoma who underwent 18F-FDG PET/CT and subsequent surgical resection with curative intent with (30 patients) or without (57 patients) neoadjuvant therapy were retrospectively enrolled in this study. The maximum standardized uptake value (SUVmax), MTV, and TLG were measured on 18F-FDG PET/CT in all patients. The prognostic significance of SUVmax, MTV, TLG, and tumor factors for predicting recurrence-free survival was evaluated by univariate and multivariate analyses. Results: Of the 87 patients enrolled, 57 (64%) experienced recurrence during the follow-up period, and the 1-year recurrence-free survival rate was 52%. Among the variables determined to be significant on univariate analysis including tumor size, pT stage, the presence of lymph node metastasis, SUVmax, MTV, and TLG, only tumor size, MTV, and TLG were significant prognostic factors on multivariate analysis (p &lt; 0.05). Patients with low MTV (71%) or TLG (74%) had significantly higher 1-year recurrence-free survival rates than those with high MTV (42%) or TLG (38%; p &lt; 0.05). In the 57 patients who did not undergo neoadjuvant treatment, MTV and TLG remained significant predictive factors for tumor recurrence, along with tumor size and SUVmax. Conclusions: MTV and TLG are independent prognostic factors for predicting recurrence in patients with pancreatic cancer. Thus, 18F-FDG PET/CT can provide useful prognostic information for patients undergoing resection of pancreatic cancer with curative intent irrespective of neoadjuvant treatment.

Metabolic tumour volume and total lesion glycolysis, measured using preoperative 18F–FDG PET/CT, predict the recurrence of endometrial cancer

To investigate the prognostic value of metabolic tumour volume (MTV) and total lesion glycolysis (TLG), measured by preoperative positron emission tomography and computerised tomography (PET/CT), in women with endometrial cancer. Retrospective cohort study. A tertiary referral centre. Women with endometrial cancer who underwent preoperative (18)F-FDG PET/CT in the period 2004-2009. Clinicopathological data for 84 women with endometrial cancer were reviewed from medical records. Cox proportional hazards modelling identified recurrence predictors. The receiver operating characteristic (ROC) curve was used to determine the cut-off value for predicting recurrence. Disease-free survival (DFS). The number of patients with International Federation of Gynecology and Obstetrics (FIGO) stages were: I (58); II (11); III (13); and IV (2). The median DFS was 48 (1-85) months. By univariate analysis, DFS was significantly associated with FIGO stage, histology, peritoneal cytology, myometrial invasion, nodal metastasis, serum CA-125, MTV, and TLG. Using multivariate analysis, the MTV (P = 0.010; hazard ratio, HR = 1.010; 95% confidence interval, 95% CI = 1.002-1.018) and TLG (P = 0.024; HR = 1.001; 95% CI = 1.000-1.002) were associated with DFS. The area under the ROC curve was 0.679 (95% CI = 0.505-0.836) after discriminating for recurrence using an MTV cut-off value of 17.15 ml. Regarding TLG, the cut-off value was 56.43 g and the area under the ROC plot was 0.661 (95% CI = 0.501-0.827). Kaplan-Meier survival graphs demonstrated a significant difference in DFS between groups categorised using the cut-off values for MTV and TLG (P < 0.022 for MTV and P < 0.047 for TLG, by log-rank test). Preoperative MTV and TLG could be independent prognostic factors predicting the recurrence of endometrial cancer.

Prognostic significance and predictive performance of volume-based parameters of F-18 FDG PET/CT in squamous cell head and neck cancers.

It has been previously reported that metabolic tumor volume on positron emission tomography-computed tomography predicts disease recurrence and death in head-and-neck cancer. In this study, we assessed the prognostic value of metabolic tumor volume measured using F18-Fluorodeoxyglucose PET/CT in patients with head and neck squamous cell carcinoma. We analyzed the imaging findings of 74 patients (age 57±16) retrospectively, with head and neck cancer who underwent PET/CT scan for staging and after treatment. Forty-tree patients had nasopharynx, 15 patients had hypopharynx, 9 patients had larynx, and 7 patients had oropharynx cancer. The MTVs of primary sites with or without lymph nodes were measured, and outcomes were assessed using the treatment response evaluation by the Response Evaluation Criteria in Solid Tumors and recurrence events during follow-up. A total of 48 patients had complete response or no recurrence was detected as of in the last follow-up. Of the first PET/CT scan, the median primary tumor SUVmax was 18.8 and the median nodal SUVmax was 13.4. The median primary tumor MTV% 50s ranged from 11.12 cm3 to 16.28 cm3, and the MTV after the therapy ranged from 1.18 cm3 to 3.51 cm3. Metabolic tumor volume (MTV) represents tumor burden, which shows F18-Fluorodeoxyglucose uptake and has a potential value in predicting short-term outcome and disease-free survival in patients with head and neck cancer.

Metabolic tumour volume as a prognostic factor for oral cavity squamous cell carcinoma treated with primary surgery.

BackgroundMetabolic tumour volume (MTV) obtained from pre-treatment 18 F-fluorodeoxydeglucose positron emission tomography with computed tomography (PET-CT) has been validated as an independent predictive factor of outcomes in head and neck cancer patients (HNC) treated with primary chemoradiotherapy (CRT). However its role in patients treated with primary surgery has not yet been studied.ObjectiveTo evaluate the prognostic value of MTV in patients treated with primary surgery for oral cavity squamous cell carcinoma (OCSCC).MethodDemographic and survival data was obtained from patients diagnosed with OCSCC from 2008–2012 in Alberta, Canada. All patients included in the study had PET-CT scan before curative surgical resection. MTV and maximum standardized uptake value (SUVmax) value was delineated from pre-treatment PET-CT scans using Segami Oasis software (Columbus, OH). MTV and SUVmax were divided into intertertile thirds before statistical analysis to allow for in-group comparison of survival.ResultsA total of 80 patients were analyzed using SPSS ver. 20.0 (SPSS Inc, Chicago, IL). Five-year overall, and disease-free survival using Kaplan-Meier curves were 70% and 73% respectively. When the combined SUVmax (tumour primary and locoregional metastasis) was evaluated, it failed to predict overall (HR = 1.0, p = 0.99) or disease-free survival (HR = 1.0, p = 0.227).Conversely an increase in MTV of 17.5 mL (difference between the highest and lowest MTV tertile) was associated with a 12.4 fold increase in risk of disease recurrence (p < 0.001) and an 11.2 fold increase in the risk of death (p < 0.05).ConclusionsThis study shows that MTV is an independent adverse prognostic factor for death and disease recurrence in OCSCC treated with primary surgery.

Pretreatment F-18 FDG PET/CT Parameters to Evaluate Progression-Free Survival in Gastric Cancer.

We performed this study to evaluate the predictive value of pretreatment F-18 FDG PET/CT for progression-free survival (PFS) in patients with gastric cancer. Of 321 patients with a diagnosis of gastric cancer, we retrospectively enrolled 97 patients (men:women = 61:36, age 59.8 ± 13.2years), who underwent pretreatment F-18 fluoro-2-deoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) from January 2009 to December 2009. Maximum standardized uptake value (SUVmax) was measured for each case with detectable primary lesions. In the remaining non-detectable cases, SUVmax was measured from the corresponding site seen on gastroduodenoscopy for analysis. In subgroup analysis, metabolic tumor volume (MTV) was measured in 50 patients with clearly distinguishable primary lesions. SUVmax, stage, depth of tumor invasion and presence of lymph node metastasis were analyzed in terms of PFS. Receiver operating characteristic (ROC) curves were used to find optimal cutoff values of SUVmax and MTV for disease progression. The relationship between SUVmax, MTV and PFS was analyzed using the Kaplan-Meier with log-rank test and Cox's proportional hazard regression methods. Of 97 patients, 15 (15.5%) had disease progression. The mean follow-up duration was 29.6 ± 10.2months. The mean PFS of low SUVmax group (≤5.74) was significantly longer than that of the high SUVmax group (>5.74) (30.9 ± 8.0 vs 24.3 ± 13.6months, p = 0.008). In univariate analysis, stage (I vs II, III, IV), depth of tumor invasion (T1 vs T2, T3, T4), presence of lymph node metastasis and SUVmax (>5.74 vs ≤5.74) were significantly associated with recurrence. In multivariate analysis, high SUVmax (>5.74) was the only poor prognostic factor for PFS (p = 0.002, HR 11.03, 95% CI 2.48-49.05). Subgroup multivariate analysis revealed that high MTV (>16.42) was the only poor prognostic factor for PFS (p = 0.034, HR 3.59, 95% CI 1.10-11.71). In gastric cancer, SUVmax measured by pretreatment F-18 FDG PET/CT has a significant predictive value for PFS. In addition, if MTV is measurable, high MTV is an independent factor for disease progression.

Comparison of F-18-FDG PET/CT findings between pancreatic solid pseudopapillary tumor and pancreatic ductal adenocarcinoma

ObjectivePancreatic solid pseudopapillary tumor (SPT) is a rare benign tumor. Little data are available on positron emission tomographic/computed tomographic (PET/CT) characteristics of this tumor. Therefore, we analyzed the metabolic characteristics of SPT using F-18-FDG PET/CT and compared the results with those of pancreatic ductal adenocarcinoma. MethodsWe retrospectively reviewed the records of 11 SPT patients and 46 patients with ductal adenocarcinoma. Ten SPT patients had primary tumors and 1 patient had metastatic SPT. Maximum standardized uptake value (max SUV), mean SUV, metabolic tumor volume (MTV), total lesion glycolysis (TLG), and tumor-to-background ratio (TBR) were evaluated. Mann–Whitney U test between pancreatic SPT and ductal adenocarcinoma was performed. In addition, age, gender and tumor size-adjusted analysis of covariance (ANCOVA) was done between pancreatic SPT and ductal adenocarcinoma. ResultsCompared with pancreatic ductal adenocarcinomas, SPTs had significantly higher tumor size-adjusted MTV and TLG. MTV and TLG values were significantly correlated with T-stage of the SPTs. In 1 SPT patient, metastases in the liver and mesentery were revealed by intense uptake of FDG on F-18-FDG PET/CT, and after PET/CT had suggested the presence of pancreatic SPT. ConclusionWe recommend that SPT be considered when a solid pancreatic mass with increased FDG metabolism is encountered on PET/CT. F-18-FDG PET/CT may be useful in detecting subtle metastases of SPT.

Prognostic value of volumetric parameters measured by 18F-FDG PET/CT in patients with head and neck squamous cell carcinoma

The objective of this study was to investigate the value of metabolic tumour volume (MTV) assessed with (18)F-FDG PET/CT in predicting event-free survival (EFS) and overall survival (OS) in patients with head and neck squamous cell carcinoma (HNSCC), and particularly to compare it with more conventional parameters such as maximum standardized uptake value (SUVmax). Patients referred to our department for (18)F-FDG PET/CT for staging of HNSCC were prospectively included between February 2009 and March 2011. Each patient was scanned using a Philips Gemini PET/CT system at 1 h after injection. The MTV was calculated semiautomatically for the primary site using methods based on SUV with various thresholds: 3-D contour around voxels equal to or greater than 2.0, 2.5, 3.0, 3.5, 4.0, 4.5, 5.0, 5.5, 6.0, 6.5 and 7.0 times SUV, or more than 30%, 40% and 50% of SUVmax. ROC analysis was used to test the statistical significance of the differences among the calculated MTVs. EFS and OS were determined using the Kaplan-Meier method and compared with MTV in univariate and multivariate analyses, including the usual prognostic factors: age, sex, primary site, treatment, SCC histologic grade, AJCC stage, TNM classification, tumour SUVmax and SUVpeak. The study included 80 consecutive patients (70 men, 10 women; mean age 62.4 ± 9.0 years). ROC analysis revealed that pretreatment MTV using a threshold of 5.0 times SUV (MTV5.0) was the best parameter to predict recurrence and death after treatment. In univariate analysis, MTV5.0 >4.9 ml was predictive of poor EFS (p < 0.0001) and poor OS (p < 0.0001). In multivariate, MTV5.0 persisted as an independent predictive factor for EFS (p = 0.011) and OS (p = 0.010), while SUVmax became nonsignificant (p = 0.277 for EFS, p = 0.975 for OS). Our results suggest that MTV measured by (18)F-FDG PET/CT has independent prognostic value of in patients with HNSCC, stronger than SUVmax.

FDG PET/CT metabolic tumor volume and total lesion glycolysis predict prognosis in patients with advanced lung adenocarcinoma

We investigated fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT)-assessed metabolic tumor volume (MTV) and total lesion glycolysis (TLG) as prognostic factors in lung adenocarcinoma patients. This retrospective study included 106 patients (19 stage I/II and 87 stage III/IV lung adenocarcinoma) who underwent FDG PET/CT before treatment. Standardized uptake value (SUV), MTV, and TLG (MTV×mean SUV) of each malignant lesion were measured. Whole MTV and whole TLG were the summation of all the MTV and TLG values in each patient. Survival analysis and FDG PET/CT parameters regarding epidermal growth factor receptor (EGFR) gene mutation status were evaluated. Univariate survival analysis of stage III/IV patients identified high whole MTV (≥90), high whole TLG (≥600), and stage IV as significant predictors of poor progression-free survival. For overall survival, high whole MTV (≥90), high whole TLG (≥600), EGFR mutation-negative, and stage IV were significant poor prognostic predictors. After multivariate survival analysis, high whole MTV (P=0.001), high whole TLG (P=0.027), and stage IV (P=0.006) were independent predictors of poor progression-free survival. High whole MTV (P<0.001), high whole TLG (P=0.001), and EGFR mutation-negative (P=0.001) were independent prognostic predictors for poor overall survival. In a survival analysis of stage I/II patients, none was an independent prognostic predictor. No significant differences were found in FDG PET/CT parameters for EGFR mutation-negative and EGFR mutation-positive patients. Assessment of MTV and TLG by FDG PET/CT in advanced lung adenocarcinoma patients provides useful information regarding prognosis.

Prognostic value of metabolic tumor volume and total lesion glycolysis from 18F-FDG PET/CT in patients undergoing stereotactic body radiation therapy for stage I non-small-cell lung cancer

The aim of this study was to evaluate the prognostic value of pretreatment F-fluorodeoxyglucose PET/computed tomography (CT), particularly in the assessment of metabolic tumor burden markers such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG), with respect to clinical outcomes in stage I non-small-cell lung cancer (NSCLC) patients undergoing stereotactic body radiation therapy (SBRT). This retrospective study evaluated 50 patients who underwent SBRT for stage I NSCLC from May 2007 to December 2012. The maximum standardized uptake value (SUVmax), average SUV (SUVavg), MTV, and TLG were measured from the PET/CT scan. The study population was dichotomized at the median into high and low groups. Kaplan-Meier log-rank tests were then used to compare high with low PET/CT parameter groups, and univariate Cox proportional hazards regression analysis was carried out to identify predictors of overall survival. The 2-year local control rate was 93.7%. After a median follow-up of 25.1 months, the 2-year overall survival was 79.3%. Eight patients (16%) had disease recurrence. There were three local failures (6%), three mediastinal failures (6%), and six cases of distant metastases (12%). Both Kaplan-Meier actuarial analysis and Cox proportional hazards regression found no correlation between SUVmax, SUVavg, MTV, and TLG and overall survival. Standard PET/CT measures, such as SUVmax, as well as newer measures of metabolic tumor burden, such as MTV and TLG, were not correlated with overall survival in our study population of stage I NSCLC patients undergoing SBRT. Larger studies with longer follow-up periods are needed to confirm these results.

Intratumoral Metabolic Heterogeneity for Prediction of Disease Progression After Concurrent Chemoradiotherapy in Patients with Inoperable Stage III Non-Small-Cell Lung Cancer.

We evaluated the value of variable (18)F-FDG PET/CT parameters for the prediction of disease progression after concurrent chemoradiotherapy (CCRT) in patients with inoperable stage III non-small-cell lung cancer (NSCLC). One hundred sixteen pretreatment FDG PET/CT scans of inoperable stage III NSCLC were retrospectively reviewed (stage IIIA: 51; stage IIIB: 65). The volume of interest was automatically drawn for each primary lung tumor, and PET parameters were assessed as follows: maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) using the boundaries presenting SUV intensity exceeding 3.0, and the area under the curve of the cumulative SUV-volume histograms (AUC-CSH), which is known to reflect the tumor heterogeneity. Progression-free survival (PFS), locoregional recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were compared with each PET and clinical parameters by univariate and multivariate survival analysis. In the ROC analysis, the optimal cutoff values of SUVmax, MTV (cm(3)), and AUC-CSH for prediction of PFS were determined as 21.5, 27.7, and 4,800, respectively. In univariate analysis, PFS was statistically significantly reduced in those with AUC-CSH < 4,800 (p = 0.004). In multivariate analysis, AUC-CSH and SUVmax were statistically significant independent prognostic factors (HR 3.35, 95% CI 1.79-6.28, p < 0.001; HR 0.25, 95% CI 0.09-0.70, p = 0.008, respectively). Multivariate analysis showed that AUC-CSH was the most significant independent prognostic factor for LRFS and DMFS (HR 3.27, 95% CI 1.54-6.94, p = 0.002; HR 2.79, 95% CI 1.42-5.50, p = 0.003). Intratumoral metabolic heterogeneity of primary lung tumor in (18)F-FDG PET/CT can predict disease progression after CCRT in inoperable stage III NSCLC.

Diagnostic value of metabolic tumor volume assessed by 18F-FDG PET/CT added to SUVmax for characterization of thyroid 18F-FDG incidentaloma

The objective of the study was to investigate whether metabolic tumor volume (MTV) measured by fluorine-18 fluorodeoxyglucose (F-FDG) PET/computed tomography (PET/CT) after stratification of serum thyroid stimulating hormone (TSH) levels could predict malignancy in patients with thyroid F-FDG incidentaloma. A total 262 patients with focal thyroid F-FDG incidentaloma undergoing cancer evaluation for nonthyroid cancer or a health checkup were enrolled in this study. We retrospectively evaluated the relationship of the maximum standardized uptake value (SUVmax) and MTV in the prediction of malignant thyroid F-FDG incidentaloma. The prevalence of malignancy was 20.9% (37/177). Malignant thyroid incidentaloma had a statistically significant higher value of SUVmax (malignant: median 4.6, range 1.9-34.9; benign: median 4.1, range 0-28; P=0.030). The value of MTV4 in malignant thyroid incidentaloma was significantly higher than that of benign thyroid incidentaloma (malignant: median 0.16, range 0.02-1.19; benign: median 0.10, range 0-0.65; P=0.032). However, the values of MTV3.5, MTV3, and MTV2.5 did not differ significantly between the groups. After stratification of serum TSH levels (an SUVmax>5 was used as the cutoff point) the sensitivity and specificity for prediction of malignancy were found to be 61.1% [95% confidence interval (CI): 35.7-82.7%] and 68.7% (95% CI: 56.2-79.4%), respectively. The area under the curve (AUC) was 0.655 (95% CI: 0.545-0.755; P=0.0239). When MTV4 greater than 0.07 cm was used as the cutoff point, the sensitivity and specificity for prediction of malignancy were 81.2% (95% CI: 54.4-96.0%) and 50.0% (95% CI: 37.0-63.0%), respectively. The AUC was 0.650 (95% CI: 0.534-0.755; P=0.0451). On comparison receiver operating characteristic curve analysis, no significant difference was found between SUVmax and MTV4 in the prediction of thyroid carcinoma (P=0.4346). However, a combination of SUVmax and MTV4 resulted in an AUC of 0.669 (95% CI: 0.554-0.772; P=0.0183). The SUVmax and MTV4 measured by F-FDG PET/CT after stratification of serum TSH levels could predict thyroid cancer in patients with thyroid F-FDG incidentaloma. A combination of SUVmax and MTV4 may be more useful for the differentiation of malignant from benign thyroid incidentaloma.

Prognostic value of preoperative metabolic tumor volume measured by 18F-FDG PET/CT and MRI in patients with endometrial cancer

ObjectiveTumor metabolic activity is a significant prognostic factor for endometrial cancer; however, there are few reports on the clinical importance of metabolic tumor volume (MTV) in patients with endometrial cancer. Therefore, we evaluated the prognostic value of preoperative MTV measured by 18F-FDG PET/CT and MRI in a group of these patients. MethodsWe retrospectively reviewed patients with pathologically proven endometrial cancer who had undergone preoperative 18F-FDG PET/CT and MRI scans. The prognostic significance of PET/CT parameters and other clinicopathological variables was evaluated. ResultsA total of 76 consecutive patients were included in the study. The median follow-up duration was 27mo (range 3 to 96mo) after surgery. MTV was correlated with FIGO stage and SUVmax. Age and FIGO stage were independent prognostic factors for recurrence in the multivariate analysis. In the subgroup analysis for 62 patients with endometrioid endometrial cancer, age (hazard ratio 1.098, P=0.007, 95% confidence interval (CI) 1.026–1.175) and an MTV index of ≥876.4 (hazard ratio 5.795, P=0.032, 95% CI 1.160–28.958) were determined to be independent prognostic factors of recurrence, and there was a statistically significant difference in progression-free survival (PFS) between patients in the high MTV and low MTV groups (log-rank test, P=0.002). ConclusionPreoperative MTV of the primary tumor was an independent prognostic factor for PFS and was significantly associated with recurrence in patients with endometrioid endometrial cancer. MTV is a promising tool for the prediction of outcome in patients with endometrioid endometrial cancer.

Prognostic Value of Preoperative Metabolic Tumor Volume and Total Lesion Glycolysis Measured by 18F-FDG PET/CT in Salivary Gland Carcinomas

Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) from (18)F-FDG PET/CT are emerging prognostic biomarkers in various human cancers. This study examined the prognostic value of these metabolic tumor parameters measured by pretreatment (18)F-FDG PET/CT in patients with salivary gland carcinomas. Forty-nine patients with intermediate- or high-grade salivary gland carcinomas who underwent definitive surgery with or without radiotherapy or chemoradiotherapy were evaluated preoperatively by (18)F-FDG PET/CT. Maximum standardized uptake values (SUV max), MTV, and TLG were measured for each patient. Univariate and multivariate analyses were used to identify clinicopathologic and imaging variables associated with progression-free survival (PFS) and overall survival (OS). Univariate analyses included the following variables: age, sex, pT and pN classifications, overall pTNM stage, histologic grade, resection margin, tumor lymphovascular invasion and perineural invasion, postoperative adjuvant therapy, gross total volume, SUV max, MTV, and TLG. The 3-y PFS and OS rates for all study patients were 66.9% and 81.6%, respectively. The median SUV max, MTV, and TLG were 5.1 (range, 1.7-21.5), 16.2 mL (1.0-115.1 mL), and 24.4 g (2.1-224.4 g), respectively. Univariate analyses showed that there were significant correlations between pT classification, pN classification, MTV, and TLG and both PFS and OS (P < 0.05). However, SUV max was not associated with either PFS (P = 0.111) or OS (P = 0.316). Multivariate analyses revealed that MTV (P = 0.011; hazard ratio, 11.50; 95% confidence interval, 1.45-91.01) and TLG (P = 0.038; hazard ratio, 3.55; 95% confidence interval, 1.07-11.76) were independent variables for PFS. Pretreatment values of MTV and TLG are independent prognostic factors in patients with intermediate or high-grade salivary gland carcinomas.

Prognostic value of metabolic tumor volume measured by 18F-FDG PET/CT in advanced-stage squamous cell carcinoma of the larynx and hypopharynx

Metabolic tumor volume (MTV) of (18)F-FDG PET/CT is a volumetric measurement of tumor cells with increased 18F-FDG uptake. We evaluated the prognostic value of MTV in patients with locoregionally advanced laryngeal and hypopharyngeal cancer. We evaluated 81 patients with advanced-stage squamous cell carcinoma of the laryngohypopharynx who underwent 18F-FDG PET/CT between January 2004 and September 2009. Clinicopathologic factors and MTV were analyzed for their association with locoregional control (LRC) and overall survival (OS). The 3-year LRC and OS for all patients were 70.9 and 78.7%, respectively, with a median follow-up of 40.4 months (range 24.5-90.1). In univariate analyses, MTV, primary site, and primary treatment strategy were associated with both LRC and OS (P<0.05). On multivariate analysis, MTV was an independent prognostic factor for both LRC [P=0.018; HR=3.141, 95% confidence interval (CI)=1.175-8.399] and OS (P=0.008; HR=3.758, 95% CI=1.415-9.982). Primary site was also a significant prognostic factor for LRC (P=0.047). Pretreatment MTV is an independent prognostic factor in patients with locoregionally advanced squamous cell carcinoma of the larynx and hypopharynx.

Metabolic Tumor Volume Predicts Disease Progression and Survival in Patients with Squamous Cell Carcinoma of the Anal Canal

PET imaging has become a useful diagnostic tool in patients with anal cancer. We evaluated the prognostic value of metabolic tumor volume (MTV) in patients with anal cancer treated with definitive chemoradiotherapy. Patients with anal cancer who underwent PET imaging for pretreatment staging or radiation therapy planning from 2003 to 2011 were included. PET parameters included MTV and maximum standardized uptake value (SUVmax). Total MTV (MTV-T) was defined as the sum of the volumes above a standardized uptake value 50% of the SUVmax within the primary tumor and involved nodes. Kaplan-Meier and Cox regression models were used to test for associations between metabolic or clinical endpoints and overall survival (OS), progression-free survival (PFS), and event-free survival (EFS). Thirty-nine patients were included. Median follow-up for the cohort was 22 mo. Overall, 6 patients died and 9 patients had disease progression. The 2-y OS, PFS, and EFS for the entire cohort were 88%, 74%, and 69%, respectively. Higher MTV-T was associated with worse OS (P = 0.04), PFS (P = 0.004), and EFS (P = 0.002) on univariate analysis. Patients with an MTV greater than 26 cm(3) had worse PFS than did those with an MTV of 26 cm(3) or less (33% vs. 82%, P = 0.003). SUVmax was not prognostic for any outcome. Higher T classification (T3/T4 vs. T1/T2) was associated with worse PFS and EFS. When adjusting for T classification, MTV-T remained a significant predictor for PFS (P = 0.01) and EFS (P = 0.02). MTV-T yields prognostic information on PFS and EFS beyond that of established prognostic factors in patients with anal cancer.

FDG-PET/CT Metabolic Tumor Volume: A New Prognostic Marker in Hodgkin Lymphoma?

AbstractAbstract 3632 Introduction:Although Hodgkin Lymphoma (HL) is highly curable, about 15% of patients (pts) are refractory or relapsed after first line treatment. Classic prognostic scores (e.g. IPS) are useful for identifying high risk pts, who need intensive treatment, and low risk pts, who beneficiate de-escalation to minimize side effects. However, they are not enough suitable to predict outcomes. Consequently, finding new complementary tools for detecting refractory or relapsing pts, remains a challenge. Fluorodeoxyglucose (FDG)-PET/CT involvement in initial staging has been widely studied. Although clinical or CT tumor volume is an important prognostic factor, metabolic tumor volume (MTV) is not enough explored. We performed a study to 1) determine whether MTV and maximum standardized uptake value (SUV) max could be new prognostic markers and 2) compare metabolic tissue heterogeneity with CD68 expression, a promising new prognostic factor linked with inflammatory microenvironment. Patients and methods:Among 456 histologically proven HL pts registered in the Regional Lymphoma database of Limousin (SRRLL, France) since 1990’s, 158 have an available sample for CD68 staining. Among the 106 pts who have undergone FDG-PET, 43 pts have available quantitative initial and early response (post-C2) SUV FDG-PET/CT data. The median follow-up was 21 months (6–72.5). Pts were classified following Ann Arbor stages I: 4 pts, II: 17 pts, III: 9 pts, IV: 13 pts. FDG-PET/CT exams were performed with a biograph6 Siemens® device and analyzed with Siemens MI® application. MTV was computed for all pts with a 2D delineation technique and using a thresholding method. The threshold (T) corresponds to mean liver SUV (+3 sd) calculated into 50 cm3 of normal liver. All the tumor voxels (3D pixels) equal or greater than the T belong to MTV. MTV per pathological area (MTVa) was also analyzed. Pts with spleen lesions have an increased volume compared to the others. To minimize spleen’s impact, MTV was calculated without spleen (MTVws). Quantitative FDG uptake is routinely measured by SUVmax. The mean SUVmax was also worked out into 1 cm3 around the tumor SUVmax. ROC curves were plotted for continuous variables such as age, erythrocyte sedimentation rate (ESR), MTV, SUVmax and mean SUVmax. CD68, tumor associated macrophage expression, was tested with a 25% threshold for positivity. Significant factors allowed dividing pts into favorable and unfavorable groups. Event free survival (EFS) studies were carried out for all binary variables using COX model. A univariate regression analysis was performed. Variables with a p<0.20 were included in multivariate analysis. Results:Median age and sex ratio (n=43) were respectively 29 y-o (16–77) and 0.87. ROC and univariate analysis showed that MTV, MTVa and MTVws were significant predictors for absence of complete remission (CR) at post-C2 and EFS. Cut-off values for prognosis (Cp) were 310 cm3 for MTV or MTVws and 53 cm3 for MTVa (p<0.001). Cut-off values for post-C2 were 244 cm3 for MTV or MTVws and 62 cm3 for MTVa (p<0.007). For pts with a large tumor volume (MTV, MTVws or MTVa > Cp), 1 and 2 years EFS were shorter (figure1). Two years EFS for MTV, MTVa and MTVws are respectively: 40%, 50% and 21% for large tumor volume and 87%, 86% and 89% for small tumor volume (p= 0.004, p=0.01 and p=0.0003). The mean SUVmax and heterogeneity were significant in univariate analysis (p=0.01 and p=0.04) but not in ROC analysis. Heterogeneity level was not correlated with CD68 expression. Each new parameter was compared, in multivariate analysis, to ESR, stages, B symptoms, bulky, age. MTV was an independent factor for predicting outcomes and post-C2 results (p<0.01) and better than mean SUV max. Similar results were found for MTVa and MTVws (p<0.02 and p<0.01). Discussion:In spite of limited number of pts and short follow-up, prognostic value of MTV is very significant. Those data are in accordance with the few results previously reported (Hutchings et al. Int J Radiat Oncol Biol Phys, 2005). Song et al. (Cancer Science, 2012) also highlighted that MTV was better predictor than SUVmax in DLBCL. Conclusion:Large MTV seems to be a potential predictive marker for adverse post-C2 results and EFS. These data need further studies to confirm, in larger cohort, these first promising results to establish a better initial risk stratification of pts, leading to optimal adaptive therapy strategy. [Display omitted] Disclosures:No relevant conflicts of interest to declare.

Predictive and prognostic value of metabolic tumour volume and total lesion glycolysis in solid tumours

Data available in patients suffering from squamous cell carcinoma of the head and neck, lung carcinoma, oesophageal carcinoma and gynaecological malignancies suggest that metabolic tumour volume and to a lesser extent total lesion glycolysis have the potential to become valuable in the imaging of human solid tumours as prognostic biomarkers for short- to intermediate-term survival outcomes, adding value to clinical staging, for assessment of response to treatment with neoadjuvant and concurrent chemotherapy, and for treatment optimization; for example, based on early treatment response assessment using changes in metabolic tumour volume over time, it might be possible to select patients who require a more aggressive treatment to improve their outcome. Prospective studies enrolling consecutive patients, adopting standardized protocols for FDG PET acquisition and processing, adjusting for potential confounders in the analysis (tumour size and origin) and determining the optimal methodology for determination of these novel markers are mandatory.