Standardized Uptake Value Of Primary Tumor Research Articles

A New Perspective on the Effectiveness of FDG PET/CT in Predicting KRAS Mutation in Colon Cancer Cases.

Aim: The main aim of this study was to evaluate the effectiveness of 18F-fluorodeoxyglucose (18FDG) positron emission tomography/computerized tomography (PET/CT) parameters in predicting the Kristen rat sarcoma viral oncogene(KRAS) mutation status of patients with colon cancer. Materials and Methods: Between April 2013 and December 2020, 79 patients who were diagnosed with colon cancer by colonoscopy underwent staging 18FDG PET/CT with this diagnosis and met all the inclusion criteria were included in this study. Clinical and prognostic features and also imaging (18FDG PET/CT and magnetic resonance imaging) reports of the patients were collected and analyzed retrospectively. Results: KRAS mutation was seen in 32 of patients (40.5%). No significant difference was observed between KRAS mutant and wild-type patients in terms of clinical features (tumor location, findings regarding metastasis, T stage, and tumor differentiation grade in patients who underwent surgery) and overall survival. Progression-free survival was significantly shorter in KRAS mutant patients (p = 0.018). Primary tumor standardized uptake value (SUVmean) was significantly higher in KRAS mutant cases in the whole group (p = 0.024) and in patients in whom KRAS analysis was performed only in the primary lesion (p = 0.036). The cutoff value for predicting KRAS mutation status was 7.01 g/mL (area under the curve [AUC]: 0.650, confidence interval [CI] 95%, 0.56-0.74). Conclusions: When colon and rectal cancer cases were evaluated separately, the primary tumor SUVmean value was significantly higher in KRAS mutant colon cancer cases. However, its effectiveness in predicting KRAS mutation status was low, similar to other parameters in the literature.

The prognostic value of lymph node to primary tumor standardized uptake value ratio in cancer patients: a meta-analysis.

The lymph node to primary tumor standardized uptake value ratio (NTR) is an innovative parameter derived from positron emission tomography/computed tomography (PET/CT) scans that captures the intricate relationship between primary tumors and associated lymph nodes. This meta-analysis aimed to investigate the prognostic value of NTR in cancer patients. A systematic search of PubMed, Cochrane, and Embase databases was conducted to identify studies investigating the association between NTR and survival outcomes in cancer patients. The pooled adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were calculated using a random-effects model. Twelve studies comprising a total of 2037 patients were included in the meta-analysis. Elevated NTR was significantly associated with worse overall survival aHR (2.21, 95% CI 1.63 to 2.99), disease-free survival aHR (3.27, 95% CI 2.12 to 5.05), and distant metastasis-free survival aHR (2.07, 95% CI 1.55 to 2.78) in cancer patients. Subgroup analyses by cancer type showed consistent results across various malignancies, including head and neck squamous cell carcinoma, endometrial carcinoma, lung cancer, breast cancer, and nasopharyngeal carcinoma. This meta-analysis provides evidence for a significant association between elevated NTR and worse survival outcomes in cancer patients. Elevated NTR may serve as a useful prognostic biomarker for cancer patients and could potentially be used to guide treatment decisions and monitor disease progression. Future studies should aim to validate these findings in larger and more diverse patient populations and investigate the underlying mechanisms for the observed association between NTR and survival outcomes.

Prognostic Value of 18F-Fluorodeoxyglucose Uptake of Bone Marrow on PET/CT in Patients with Limited Disease Small Cell Lung Cancer

Merve AYIK TURK1, Berna KOMURCUOGLU2, Ahmet YANARTAS3, Ozgur BATUM2, Yunus TURK4, Mehmet Ufuk YILMAZ5 1Izmir Bozyaka Training and Research Hospital, Department of Pulmonology, İzmir 2Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Department of Pulmonology, İzmir 3Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Department of Nuclear Medicine, İzmir 4Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Department of Thoracic Surgery, İzmir 5Medicana Health Groups, Department of Pulmonology, İzmir Keywords: Small cell lung cancer, Prognostic factors, Limited stage, Bone marrow FDG uptake Small cell lung cancer (SCLC) is a malignancy from the neuroendocrine tumor family, which has a poor prognosis and presents with metastases at the time of the diagnosis. The present study investigated the relationship between bone marrow fluorodeoxy-D-glucose (FDG) uptake and survival to evaluate prognosis in limited-stage SCLC. This single-center retrospective study examined a total of 220 patients diagnosed with limited-stage SCLC between January 2010 and June 2019. Bone marrow FDG uptake, serum inflammatory markers, and other factors used to determine the prognosis, as well as overall survival (OS) and progression-free survival (PFS), were recorded and retrospectively analyzed. Within physiological limits, bone marrow standardized uptake value (SUV) mean of > 1.95 was identified as a good prognostic factor for PFS (p= 0.03). The multivariate analysis of OS and PFS revealed that the Eastern Cooperative Oncology Group (ECOG) performance scale (p= 0.001) was a common independent prognostic factor. Stages of the disease, albumin levels and bone marrow-to-liver ratio (BLR) [one of the positron emission tomography/computed tomography (PET/CT) parameters] of < 0.8 were prognostic factors for OS. The bone marrow SUV mean was positively correlated with the primary tumor SUV max and SUV mean. The bone marrow SUV mean is a parameter that can be used to predict PFS in limited-stage SCLC. For OS, in turn, the BLR was identified as an independent factor.

The Relationship between Preoperative FDG PET/CT Uptake and Survival in Patients with Lung Cancer

IntroductionDespite all advances in diagnosis and treatment, lung cancer is the leading cause of cancer death in both sexes worldwide. Because of the different survival rates in lung cancer, additional factors are needed to determine prognosis. In this study, we aimed to investigate the relationship between survival and clinical data of primary tumor SUV (Standardized Uptake Value) to evaluate the role of FDG-PET ([18F]-fluoro-2-deoxy-D-glucose Positron Emission Tomography) as a prognostic factor in lung cancer.Material and methodsThe data of patients who underwent anatomic resection and preoperative positron emission tomography/computed tomography (PET/CT) were performed retrospectively between February 2006 and October 2019 in the Department of Thoracic Surgery, Faculty of Medicine, Gaziantep University.ResultsAll cases were 666 patients, 64 of whom (9.6%) were females and 602 of them (90.4%) were males. The mean age of the patients was 61.91±9.6 years. Histologically, there were 369 (55.4%) epidermoid carcinomas, 233 (34.9%) adenocarcinomas. The overall mean survival was 68.2 months and the median survival was 63.6 months. The mean mass SUV values of the patients were 13.73 ± 6.65. The effect of histological type, TNM stage, metastasis and recurrence on survival was statistically significant (p < 0.05). According to the univariate analysis (Cox regression analysis), it was found that 1 unit increase in SUV value contributed to a statistically significant increase in mortality risk (p = 0.002, HR: 1.024, 95% CI: 1.009-1.040).ConclusionsIn our study on 666 patients, unlike literature, no statistically significant relationship was found between SUV value and survival.

The relationship between pre-treatment 18F-FDG PET/CT metabolic data and treatment response in patients with cervix uteri cancer.

To determine the risk group of patients with locally advanced squamous cell carcinoma of the uterine cervix that will resist to treatment before concomitant chemoradiotherapy and who will develop metastasis via fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) metabolic data. Fifty two patients with carcinoma of the uterine cervix who were treated in our clinic between 2015-2018 were evaluated. The presence of human papilloma virus (HPV) from the first paraffin blocks diagnosed in all patients has been tested withreal time polymerase chain reaction (PCR). All patients received brachytherapy after concomittant chemotherapy with external radiotherapy. The first 18F-FDG PET/CT and magnetic resonance images (MRI) images obtained for pretreatment staging and MRI after external radiotherapy were retrospectively reviewed. The patients who resisted concomittant chemoradiotherapy were tried and determined with pre-treatment 18F-FDG PET/CT metabolic data. The follow-up period of our patients with an average age of 53 years (42.5-60.75) was 53.5 months (42.5-60.75). Radiotherapy with a total median dose of 85 EqD2 (84-86) was delivered to all patients. The heterogeneity factor(HF) was found to be statistically significantly lower in patients in whom complete response was obtained after external radiotherapy in MRI (P=0.049). Any statistically significant difference was not found between groups of patients who did, and did not develop metastases as for primary tumor standardized uptake value (SUVmax, SUVmean), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) values. In patients without metastasis, heterogeneity factor (HF) was found to be statistically significantly lower than those who developed metastasis (P=0.026). It is possible to predict poor prognostic patients with the help of HF, although we could not predict the resistant patients to treatment of primary tumor.

Prognostic value of lymph node to primary tumor standardized uptake value ratio in unresectable esophageal cancer

BackgroundUnresectable esophageal cancer harbors high mortality despite chemoradiotherapy. Better patient selection for more personalized management may result in better treatment outcomes. We presume the ratio of maximum standardized uptake value (SUV) of metastatic lymph nodes to primary tumor (NTR) in 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography (FDG PET/CT) may provide prognostic information and further stratification of these patients.MethodsThe patients with non-metastatic and unresectable esophageal squamous cell carcinoma (SCC) receiving FDG PET/CT staging and treated by chemoradiotherapy were retrospectively reviewed. Receiver operating characteristic (ROC) analysis was performed to determine the optimal cut-off value for NTR. Kaplan-Meier method and Cox regression model were used for survival analyses and multivariable analyses, respectively.ResultsFrom 2010 to 2016, 96 eligible patients were analyzed. The median follow-up time was 10.2 months (range 1.6 to 83.6 months). Using ROC analysis, the best NTR cut-off value was 0.46 for prediction of distant metastasis. The median distant metastasis-free survival (DMFS) was significantly lower in the high-NTR group (9.5 vs. 22.2 months, p = 0.002) and median overall survival (OS) (9.5 vs. 11.6 months, p = 0.013) was also significantly worse. Multivariable analysis revealed that NTR was an independent prognostic factor for DMFS (hazard ratio [HR] 1.81, p = 0.023) and OS (HR 1.77, p = 0.014).ConclusionsHigh pretreatment NTR predicts worse treatment outcomes and could be an easy-to-use and helpful prognostic factor to provide more personalized treatment for patients with non-metastatic and unresectable esophageal SCC.

Primary tumor standardized uptake value (SUVmax) measured on 18F-FDG PET/CT and mixed NSCLC components predict survival in surgical-resected combined small-cell lung cancer

PurposeThe combined small-cell lung cancer (c-SCLC) is rare and has unique clinicopathological futures. The aim of this study is to investigate 18F-FDG PET/CT parameters and clinicopathological factors that influence the prognosis of c-SCLC.MethodsBetween November 2005 and October 2014, surgical-resected tumor samples from c-SCLC patients who received preoperative 18F-FDG PET/CT examination were retrospectively reviewed. The maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were used to evaluate metabolic parameters in primary tumors. The survivals were evaluated with the Kaplan–Meier method. Univariate and multivariate analyses were used to evaluate potential prognostic factors.ResultsThirty-one patients were enrolled, with a median age of 62 (range: 35 − 79) years. The most common mixed component was squamous cell carcinoma (SCC, n = 12), followed by large-cell carcinoma (LCC, n = 7), adenocarcinoma (AC, n = 6), spindle cell carcinoma (n = 4), adenosquamous carcinoma (n = 1) and atypical carcinoid (n = 1). The median follow-up period was 53.0 (11.0–142.0) months; the 5-year overall survival (OS) and progression-free survival(PFS) rate were 48.4% and 35.5%, respectively. Univariate survival analysis showed that gender, smoking history, tumor location were associated with PFS (P = 0.036, P = 0.043, P = 0.048), SUVmax and TNM stage were closely related to PFS in both Mixed SCC and non-SCC component groups (P = 0.007, P = 0.048). SUVmax, smoking history, tumor size and mixed SCC component were influencing factors of OS in patients (P = 0.040, P = 0.041, P = 0.046, P = 0.029). Multivariate survival analysis confirmed that TNM stage (HR = 2.885, 95%CI: 1.323–6.289, P = 0.008) was the most significantly influential factor for PFS. High SUVmax value (HR = 9.338, 95%CI: 2.426–35.938, P = 0.001) and mixed SCC component (HR = 0.155, 95%CI: 0.045–0.530, P = 0.003) were poor predictors for OS.ConclusionSurgical-resected c-SCLCs have a relatively good prognosis. TNM stage is the most significant factor influencing disease progression in surgical-resected c-SCLCs. SUVmax and mixed NSCLC components within c-SCLCs had a considerable influence on the survival. Both high SUVmax and mixed SCC component are poor predictors for patients with c-SCLCs.

18F-fluorodeoxyglucose positron emission tomography/computed tomography in predicting overall survival of oral cavity squamous cell carcinoma: Ongoing controversy.

We aimed to retrospectively determine if initial staging 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/ CT) can predict overall survival (OS) in oral cavity squamous cell carcinoma (OCSCC), which is currently a source of ongoing controversy in the literature. Forty-six consecutive patients with nonmetastatic (Stage M0) OCSCC had 18F-FDG PET/CT prior to definitive surgical treatment followed by observation or adjuvant treatment at our institution between 2006 and 2012. The median follow-up time was 18 months (range 0.1–76 months). Univariate and multivariate analysis were used to determine the ability of imaging, pathologic, and demographic factors to predict OS. 18F-FDG PET/CT parameters were standardized uptake value (SUV) maximum and mean, metabolic tumor volume, and total lesional glycolysis (TLG) of primary tumor and regional nodes. Significant predictors of OS in the multivariate analysis were primary tumor SUV mean, nodal TLG, and age. Two-year OS of patients with primary tumor SUV mean below and above the median of 6.26 was 68% and estimated 28%, respectively. Two-year OS of patients with nodal TLG below and above median of 7.9 was 69% and 34%, respectively. Two-year OS of patients younger and older than median age of 57 was 60% and 43%, respectively. Our results suggest that 18F-FDG PET/CT may be a valuable addition to multifactorial models predicting outcome for OCSCC. Thus, continued research aiming to incorporate 18F-FDG PET/CT parameters in risk-stratification algorithms for OCSCC is warranted and should be conducted using more standardized prognostic models driven by a specific clinical question.

Prognostic Value of Lymph Node to Primary Tumor Standardized Uptake Value Ratio in Esophageal Cancer

Esophageal cancer harbors high mortality rate despite current standard concurrent chemoradiotherapy followed by operation. Thus, further stratification of the patients may offer better therapeutic outcome to those having a favorable nature of disease. We presume the lymph node to primary tumor standardized uptake value (SUVmax) ratio (NTR) in 18F-FDG PET/CT may provide further prognostic information. The patients with non-metastatic and unresectable esophageal cancer receiving 18F-FDG PET/CT staging and treated by chemoradiotherapy were retrospectively reviewed. The SUVmax of the metastatic lymph nodes and the primary tumor were collected and NTR was calculated. Receiver operating characteristic (ROC) analysis was performed to determine the optimal cut-off value for NTR. Kaplan-Meier method and Cox proportional hazard model were used for overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS) analysis. From 2009 to 2016, 96 eligible patients were collected and analyzed. The median follow-up time was 9.72 months (1.6 to 82.6 months). The median OS was significantly higher (18.3 vs. 9.2 months, p = 0.009) in the group with NTR lower than 0.64. A significantly better median PFS (9.2 vs. 5.9 months, p = 0.022) and DMFS (31.2 vs. 9.5 months, p = 0.002) were also found in the groups with lower NTR (using 0.42 and 0.46 as cut-off values respectively). Multivariable analysis revealed that NTR was an independent prognostic factor for OS (hazard ratio [HR] 2.24, p = 0.039) and DMFS (HR 2.84, p = 0.009). High pretreatment NTR predicts worse treatment outcomes for patients with non-metastatic and unresectable esophageal cancer.

Evaluation of Lung Cancer and Neuroendocrine Neoplasm in a Single Scan by Targeting Both Somatostatin Receptor and Integrin αvβ3

This pilot study aimed to prove the complementary value of a novel Gallium-labeled heterodimeric peptide, Ga-NOTA-3P-TATE-RGD, in detection and evaluation of tumors with somatostatin receptor subtype 2 or integrin αvβ3 overexpression, including non-small cell lung cancer (NSCLC), small-cell lung cancer (SCLC), neuroendocrine tumor (NET), and neuroendocrine carcinoma (NEC). With institute review board approval and written informed consent, 32 patients with pathologically diagnosed lung cancer (18 NSCLC, 14 SCLC) and 12 patients with neuroendocrine neoplasm (8 NET, 4 NEC) patients were recruited to undergo Ga-NOTA-3P-TATE-RGD PET/CT. For comparison, the NSCLC patients also underwent Ga-NOTA-TATE PET/CT, the SCLC patients underwent Ga-NOTA-RGD PET/CT, and the neuroendocrine neoplasm patients underwent F-FDG PET/CT within 3 days. The maximum standardized uptake value (SUV) of the primary tumor (T) and mean SUV of the blood pool (B) were measured, and the T/B ratios were calculated for comparison. In the primary tumors of NSCLC, the T/B ratios of Ga-NOTA-3P-TATE-RGD were significantly higher than those of Ga-NOTA-TATE (4.54 ± 3.00 versus 4.10 ± 2.83, P = 0.0058). In SCLC, the T/B ratios of Ga-NOTA-3P-TATE-RGD were significantly higher than those of Ga-NOTA-RGD (6.06 ± 6.09 versus 2.65 ± 1.19, P = 0.0344). In NET, the T/B ratios of Ga-NOTA-3P-TATE-RGD were 36.13 ± 33.84, significantly higher than those of F-FDG (2.91 ± 1.71, P = 0.0234). In NEC, there were no significant difference between the T/B ratios of Ga-NOTA-3P-TATE-RGD (4.80 ± 0.85) and those of F-FDG (3.56 ± 0.74, P = 0.1833). This proof-of-concept study preliminarily demonstrates the efficacy of the dual targeting Ga-NOTA-3P-TATE-RGD PET/CT in the evaluation of lung cancer and neuroendocrine neoplasm in a single scan.

Prediction of overall survival in patients with stage III and IV small cell lung cancer utilizing Primary tumor standardized uptake value on 18F-FDG PET/CT

Abstract Objective: To evаluаte 18FDG PET-CT for the prediction of overаll survivаl in pаtients with smаll cell lung cаncer аfter concurrent

A Predictive Model for Lymph Node Involvement with Malignancy on PET/CT in Non–Small-Cell Lung Cancer

Accurate assessment of lymph node (LN) involvement with malignancy is critical to staging and management of non-small-cell lung cancer. The goal of this retrospective study was to determine the tumor and imaging characteristics independently associated with malignant involvement of LNs visualized on positron emission tomography/computed tomography (PET/CT). From 2002 to 2011, 172 patients with newly diagnosed non-small-cell lung cancer underwent PET/CT within 31 days before LN biopsy. Among these patients, 504 anatomically defined, pathology-confirmed LNs were visualized on PET/CT. Logistic regression analysis was used to determine the associations between nodal involvement with malignancy and several clinical and imaging variables, including tumor histology, tumor grade, LN risk category in relation to the primary tumor location, pathologic findings from additional biopsied LNs, interval between PET/CT and biopsy, primary tumor largest dimension, primary tumor standardized uptake value (SUVmax), LN short-axis dimension, and LN SUVmax. On univariate analysis, adenocarcinoma histology (p = 0.010), high LN risk category (p < 0.001), larger LN short-axis dimension (p < 0.001), and higher LN SUVmax (p < 0.001) all correlated with nodal involvement. On multivariate analysis, adenocarcinoma histology (p = 0.003), high LN risk category (p = 0.005), and higher LN SUVmax (p < 0.001) correlated with nodal involvement, whereas LN short-axis dimension was no longer statistically significant (p = 0.180). A nomogram developed for clinical application based on this analysis had excellent concordance between predicted and observed results (concordance index, 0.95). Adenocarcinoma histology, higher LN SUVmax, and higher LN risk category independently correlate with nodal involvement with malignancy and may be used in a model to accurately predict the risk of a node's involvement with malignancy.

Anal cancer FDG-PET standard uptake value: correlation with tumor characteristics, treatment response and survival.

The present work studies the correlation of (18) F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) standardized uptake value (SUV) with tumor characteristics, clinical response and prognosis in a series of anal canal cancer patients treated with chemo-radiotherapy. Fifty-five patients were included in the present analysis. PET maximum SUV (SUVmax) of primary tumor was calculated for each patient. The correlation with clinical parameters, tumor response and survival data were analyzed. SUVmax significantly correlated with T-stage (p = 0.01) and histology (p = 0.03). Median SUVmax was higher for lesions with partial response (PR, 21/55, 38%) than for lesions with complete response (CR, 34/55, 62%) but without statistical significance (p = 0.17). The actuarial disease-free survival (DFS) and overall survival (OS) rates were 53.0 and 77.8% at 2 years and 41.3 and 58.6% at 5 years, respectively. Median SUVmax did not statistically correlate with clinical response or survival. CR and T1-T2 stage were statistically significant prognostic factors for disease-free survival (p < 0.0001 and p = 0.02, respectively) and CR was significant also for overall survival (p < 0.0001). Our data suggest that pre-treatment FDG-PET/CT SUVmax cannot directly predict tumor response and survival, but it is strongly associated with tumor characteristics such as primary tumor stage and histology, being the first one of the most important and validated prognostic factors for anal cancer.

Ratio of Lymph Node to Primary Tumor SUV on PET/CT Accurately Predicts Nodal Malignancy in Non–Small-Cell Lung Cancer

Introduction/BackgroundAmong non–small-cell lung cancers with appreciable functional activity, positron emission tomography/computed tomography (PET/CT) is the most accurate imaging modality for clinical staging. However, lymph nodes (LN) with marginally elevated standardized uptake value (SUV) present a diagnostic challenge. In this retrospective study, we hypothesized that normalizing the LN SUV by using the ratio of the LN to primary tumor SUVmax (SUVN/T) may be a better predictor of nodal malignancy than using SUVmax alone for nodes with low to intermediate SUV. Patients and MethodsWe identified 172 patients with newly diagnosed non–small-cell lung cancer who underwent pathologic LN staging and PET/CT within 31 days before biopsy. Receiver operating characteristic curves with area under the curve (AUC) calculations were used to evaluate SUVmax and SUVN/T for their ability to predict nodal malignancy for both the entire cohort of 504 LNs and a subset of 132 LNs from 85 patients who had both primary tumor SUVmax > 2.5 and LN SUVmax 2.0 to 6.0. ResultsIn patients with primary tumor SUVmax > 2.5 and LN SUVmax 2.0 to 6.0, SUVN/T was significantly more accurate in predicting nodal malignancy (AUC, 0.846; 95% confidence interval, 0.775-0.917) than SUVmax (AUC, 0.653; 95% confidence interval, 0.548-0.759). The optimal cutoff value of SUVN/T to predict nodal malignancy was 0.28 (90% sensitivity, 68% specificity). Sensitivity was > 95% for SUVN/T < 0.21, whereas specificity was > 95% for SUVN/T > 0.50. ConclusionThe ratio of LN SUV to primary tumor SUV on PET/CT is more accurate than SUVmax when assessing nodes of low to intermediate SUV.

18FDG SUV in the primary tumor and lymph node metastases is not predictive for development of distant metastases in high risk head and neck cancer patients

Pretreatment screening on distant metastases is particularly useful in head and neck squamous cell carcinoma (HNSCC) patients with high risk factors. In a retrospective study of 88 patients with previously identified clinical high risk factors the predictive value of standardized uptake value (SUV) of 18F-fluorodeoxyglucose (FDG) in the primary tumor and in the lymph node metastases for the development of distant metastases was examined. Different SUVs corrected for plasma glucose levels and body mass index were calculated and analysed in different patient groups: all patients (n=88), patients with a follow up >6months (n=73), not previously treated patients (n=51) and not previously treated patients with a follow up >6months (n=40). Twenty-four of the 88 (27%) high risk HNSCC patients were diagnosed with distant metastases during screening and follow up. No correlation was found between different SUVs of the primary tumor and lymph nodes metastases and the development of distant metastases. SUVs of primary tumor and lymph node on FDG-PET are not predictive for distant metastases in a (selected) group of patients with already high risk factors for distant metastases.

Primary Tumor Standardized Uptake Value Predicts Survival in Head and Neck Squamous Cell Carcinoma

Background: The purpose of this study was to determine whether the pretreatment primary tumor standardized uptake value (SUV), as measured by positron emission tomography (PET), can add prognostic information for predicting survival in patients with head and neck squamous cell carcinoma (HNSCC). Materials and Methods: 7 articles were identified by searching electronic databases. Statistical analysis was performed with RevMan 4.2.2. SUV measurement and SUV threshold for defining high SUV were studied dependently. For each publication, we first obtained an estimate of the relative risk (RR) for comparing patients with a low or a high SUV. Subsequently, we aggregated the individual RRs into a combined RR, using a fixed-effect model. Publication bias was assessed using a funnel plot. Results: The study included 7 clinical trials dedicated to HNSCC, involving 674 patients who underwent fluoro-2-deoxy-<smlcap>D</smlcap>-glucose-PET scanning before treatment. The combined RR from the 7 reports for the survival was 0.53 (95% confidence interval: 0.46-0.62). The funnel plot showed symmetrical distribution, indicating no evidence of any substantial publication bias. Conclusion: Our meta-analysis indicates that patients with HNSCC who have a primary tumor with a high SUV have poor survival; this should be further confirmed in a meta-analysis based on individual patient data.

Pretreatment tumor standardized uptake value as a prognostic factor in primary head and neck squamous cell carcinoma.

Our objective was to conduct a systematic review and meta-analysis of studies assessing the diagnostic performance of primary tumor standardized uptake value (SUV) in head and neck squamous cell carcinoma (HNSCC), as measured by positron emission tomography. A systematic search of the indexed medical literature was conducted using appropriate keywords to identify relevant studies. Six articles were identified by searching electronic databases. A statistical analysis was performed with RevMan 4.2.2 software. SUV measurement and the SUV threshold for defining high SUV were studied dependently. For each publication, we first obtained an estimate of the relative risk (RR) for comparing patients with a low and those with a high SUV. Subsequently, we aggregated the individual RRs into a combined RR using the fixed-effects model to yield weighted mean pooled estimates with 95% confidence intervals (CIs). Publication bias was assessed with a funnel plot. A total of 6 clinical trials involving 453 patients were included in the meta-analysis. The combined RR from the 6 reports for local control was 0.72 (95% CI: 0.63-0.81). The funnel plot revealed symmetrical distribution, indicating no evidence of significant publication bias. The increase in the SUV of the primary tumor was found to be a poor prognostic marker for patients with HNSCC in the meta-analysis, which requires further confirmation in a meta-analysis based on individual patient data.

Primary Tumor Standardized Uptake Value Measured on F18-Fluorodeoxyglucose Positron Emission Tomography Is of Prediction Value for Survival and Local Control in Non–Small-Cell Lung Cancer Receiving Radiotherapy: Meta-Analysis

Introduction:The 2-[18F]-Fluorodeoxyglucose (FDG) positron emission tomography (PET/CT) has become an imaging tool for clinical assessment of tumor, node, metastasis in non–small-cell lung cancer (NSCLC). Primary tumor maximum standardized uptake value (SUVmax) on 18F-FDG PET/CT before and after radiation therapy (RT) has been studied as a potential prognostic factor for NSCLC patients receiving radiotherapy. However, the sample sizes of most studies were small, and the results of the prediction value of SUVmax remained undetermined, which lead us to perform a meta-analysis to improve the precision in estimating its effect.Methods:We performed a meta-analysis of published literature for primary tumor SUVmax-based biomarkers of the outcome of NSCLC receiving radiotherapy. The required data for estimation of individual hazard ratios (HRs) to compare patients with a low and a high SUVmax were extracted from each publication. A combined HR was calculated by Stata statistical software (Version 11). All of the results were verified by two persons to ensure its accuracy.Results:Thirteen studies were finally included into this meta-analysis; data are available in 13 studies for pre-RT primary tumor SUVmax and in five studies for post-RT. For overall survival, the combined HR estimate was 1.05 (95% confidence interval [CI], 1.02–1.08) and 1.32 (95% CI, 1.15–1.51) for pre-RT SUVmax and post-RT SUVmax, respectively; 1.26 (95% CI, 1.05–1.52) and 2.01 (95% CI, 1.16–3.46) for local control (LC). In stereotactic body radiotherapy (SBRT) group, HR for LC was 1.11 (95% CI, 1.06–1.18) and 2.19 (95% CI, 1.34–3.60) for pre-SBRT SUVmax and post-SBRT SUVmax, respectively.Conclusion:Both pre-RT and post-RT primary tumor SUVmax can predict the outcome of patients with NSCLC treated with radiotherapy. Patients with high levels of pre-RT SUVmax seemed to have poorer overall survival and LC.

Prognostic Value of Primary Tumor FDG Uptake for Occult Mediastinal Lymph Node Involvement in Clinically N2/N3 Node-negative Non–Small Cell Lung Cancer

The objective of this study was to identify predictive factors of occult mediastinal nodal involvement on staging positron emission tomography with F-fluorodeoxyglucose in patients with non-small cell lung cancer. We performed a retrospective review of 665 patients with suspected non-small cell lung cancer who underwent staging positron emission tomography with F-fluorodeoxyglucose from January 1, 2000 through August 31, 2010 at the Hospital of the University of Pennsylvania with clinical stage I or II disease and no evidence of N2 or N3 involvement on staging positron emission tomography (PET). A total of 201 of these patients underwent invasive pathologic staging of the mediastinum at the Hospital of the University of Pennsylvania with pathology reports available at the time of review. A total of 63 of the 201 patients were found to have N2 disease at the time of pathologic staging. The mean standardized uptake value (SUV) of the primary tumor for patients with occult N2 metastases was significantly higher than the node-negative patients (SUV 9.31 vs. 7.24, P=0.04). Histology, tumor location (central vs. peripheral), sex, and age were not predictive for occult N2 disease. A multivariate analysis was performed and identified primary tumor SUV>6 was the only significant predictor (P=0.02). An analysis by quartile identified a primary tumor SUV>10 to have an odds ratio of 1.72 compared with an SUV<4 of occult N2 involvement. Increased primary tumor SUV predicted for increased risk of mediastinal nodal disease. Tumor location was not predictive of PET-occult mediastinal nodal involvement, in contrast to previous publications. Pathologic staging of the mediastinum should be strongly considered in these patients even with a negative mediastinum on PET.

Predicting complete response to neoadjuvant CRT for distal rectal cancer using sequential PET/CT imaging

Molecular imaging using positron emission tomography/computerized tomography (PET/CT) may add relevant incremental diagnostic information to standard structural cross-sectional imaging. Such information may allow identification of patients with rectal cancer that are more likely to develop complete tumor regression after neoadjuvant chemoradiation therapy (CRT). The objective of this report was to identify PET/CT features that are associated with a complete response after CRT. 99 cT2-4N0-2M0 distal rectal cancer patients (≤7 cm from anal verge) were included in this prospective single center trial (NCT 00254683). Patients underwent baseline PET/CT followed by 54 Gy and 5-fluorouracil-based neoadjuvant CRT. After completion of therapy, patients underwent 6- and 12-week PET/CT. Clinical assessment of tumor response was performed at 12 weeks and was blinded to radiological information. Patients were treated according to clinical assessment. There were seven patients with a complete pathological response (pCR) and 16 with a complete clinical response (cCR) (23 complete responders). Comparison of pCR exclusively and non-pCR revealed that only baseline primary tumor standard uptake value (SUV) was a significant predictor of response. Comparison of complete responders (pCR or cCR) and non-complete responders showed that depth of rectal wall uptake at baseline PET/CT (p = 0.002) and variation between baseline and 12-week maximum standard uptake value (SUVmax) of primary tumor (p = 0.001) were independent predictors for complete response at multivariate analysis. A decrease >67 % between baseline and 6-week or 76 % between baseline and 12-week SUVmax were associated with complete response (pCR or cCR; p = 0.02 and p < 0.001, respectively). Positron emission tomography/computerized tomography at baseline, 6 and 12 weeks, may provide information regarding patients with a higher likelihood of developing complete tumor regression following neoadjuvant CRT.