Prognostic Value Of Metabolic Parameters Research Articles

Prognostic value of metabolic parameters on baseline 18F-FDG PET/CT in small cell lung cancer.

Maximum standardized uptake value (SUV<inf>max</inf>) is the primary quantitave parameter given in 18F-FDG PET/CT reports. Calculations derived from three dimensional metabolic volumetric images have been proposed to be more successful than SUV<inf>max</inf> alone in prognostification with a lower interobserver variability in many cancers. We aimed to determine the prognostic value of metabolic parameters derived from 18F-FDG PET/CT studies in small cell lung cancer (SCLC) patient population with a long follow-up time. In this study, 38 consecutive SCLC patients (34M, 4F, age:65.76 ±8.18 years) who were referred to 18F-FDG PET/CT for staging between October 2006-January 2011 were included. SUV<inf>max</inf>, SUV<inf>mean</inf>, SUV<inf>peak</inf>, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were calculated. Overall survival (OS) was calculated from the date of the initial PET/CT to death from any cause. Survival tables were obtained and Kaplan Meier curves were reconstructed. Mantel-Cox regression analysis was performed in order to investigate if any of these parameters have an effect on survival along with other clinical risk factors. Median SUV<inf>max</inf>, SUV<inf>mean</inf>, SUV<inf>peak</inf>, MTV, TLG and LDH values were calculated as 13.9 g/dL, 6.4 g/dL,10.69 g/dL, 147 cm3, 1898.52 and 375U/L respectively. Median follow-up was 761.23±873.21 days (25.37 months, range:110-3338 days). Since basal 18F-FDG PET/CT scans, all patients were lost in the follow-up except for two patients. MTV was a significant prognostic factor in SCLC patients. Estimated mean survival times were 261.0±45.6 (95% CI: 171.6-350.3) days in patients with MTV value above the calculated median 147, and 577.0±124.0 (95% CI: 333.7-820.2) days in patients with MTV<147. The difference was statistically significant with a P=0.037. Baseline whole body MTV reflecting total tumor load is a prognostic index in SCLC. SUV is insufficient to predict prognosis.

Enhancing prognosis prediction using pre-treatment nodal SUVmax and HPV status in cervical squamous cell carcinoma

BackgroundThis study was to evaluate the prognostic value of metabolic parameters on F-18-FDG PET/CT and the status of human papillomavirus (HPV) infection and known prognostic variables for predicting tumor recurrence and investigating a prognostic model in patients with locally advanced cervical cancer treated with concurrent chemoradiotherapy (CCRT).MethodsA total of 129 patients with cervical squamous cell carcinoma who underwent initial CCRT were eligible for this study. Univariate and multivariate analyses were performed using traditional prognostic factors, metabolic parameters, and HPV infection. Classification and regression decision tree (CART) was used to establish new classification.ResultsAmong 129 patients, 29 patients (22.5%) had recurrence after a median follow-up of 60 months (range, 3–125 months). Tumor size, para-aortic lymph node metastasis, nodal SUVmax, and HPV infection status were identified as independent prognostic factors by multivariate analysis. The CART analysis classified the patients into three groups. The first node was nodal SUVmax, and HPV status was the second node for patients with nodal SUVmax ≤7.49; Group A (nodal SUVmax ≤7.49 and HPV positive, HR 1.0), Group B (nodal SUVmax ≤7.49 and HPV negative, HR 3.56), and Group C (nodal SUVmax > 7.49, HR 10.13). Disease-free survival was significantly different among the three groups (p < 0.001).ConclusionThe nodal SUVmax on F-18 FDG PET/CT and HPV infection status before CCRT are powerful independent prognostic factors for the prediction of disease-free survival in patients with cervical squamous cell carcinoma who underwent initial CCRT. We also suggest a simple prognosis prediction model using pre-treatment FDG PET/CT and HPV genotyping; however, it needs further validation in an independent dataset.

Additional prognostic value of metabolic parameters measured by dual time point pretreatment F-18 FDG PET/CT in patients with intrahepatic cholangiocarcinoma.

e15598 Background: The aim of this retrospective study was to determine whether delayed glucose metabolism assessed by dual time point F-18 FDG PET/CT provides additional prognostic information independent of established prognostic factors in patients with intrahepatic cholangiocarcinoma (IHCC). Methods: We reviewed retrospectively the medical records of 96 patients (men 57, women 39, mean age 66 ± 10 years) with pathologically proven IHCC. They underwent dual time point F-18 FDG PET/CT as part of a pretreatment workup from July 2012 to December 2017. For the analysis, patients were classified by age, sex, stage, serum CA19-9, early SUVmax (eSUV), delayed SUVmax (dSUV), delta SUVmax (ΔSUV, difference between early and delayed SUVmax) and histopathology (pCEA, p53, Ki-67 index). The relationship between FDG uptake and survival was analyzed using the Kaplan-Meier with log-Rank test and Cox’s proportional-hazard regression methods. Results: Median survival for all 96 study subjects was 303 days and median SUVmax was 7.2 (range: 2.5 – 21.7). The survival was found to be significantly related to eSUV ( p &lt; 0.0001), age ( p = 0.017), LN metastasis ( p = 0.03) and p53 index ( p = 0.04) and multivariate analysis study revealed that the patients with a higher SUVmax ( p = 0.0001, 95%CI = 1.80 to 5.89, HR = 3.26), prescence of LN metastasis ( p = 0.031), higher age ( p = 0.044) and a higher p53 index ( p = 0.007) showed worse overall survival. In addition, we carried out a subgroup analysis targeting the 55 patients with delayed SUVmax to evaluate a prognostic value of delayed image parameter. In univariate analysis, dSUV (cut-offvalue 7.3, p = 0.0006) and ΔSUV (cut-off value 3.2, p = 0.035), age ( p &lt; 0.0001) and sCA19-9 ( p = 0.018) showed significant correlation and dSUV was an independent factor of overall survival in multivariate analysis. ( p = 0.014, 95%CI = 1.30 to 10.7, HR = 3.74) And then, we analyzed combinations of eSUV, dSUV and ΔSUV each other to evaluate additional prognostic information. The result revealed that higher dSUV ( p = 0.0001, AUC = 0.68) and ΔSUV ( p = 0.0002, AUC = 0.71) showed a poorer overall survival although the eSUV of IHCC was low. Conclusions: Higher delayed SUVmax and ΔSUVmax on pretreatment dual time point F-18 FDG PET/CT can predict poorer survival and additional information of risk stratification in patients with IHCC.

Metabolic parameters of sequential 18F-FDG PET/CT predict overall survival of esophageal cancer patients treated with (chemo-) radiation

BackgroundTo evaluate the prognostic value of metabolic parameters of pre-treatment and interim 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) for overall survival (OS) of esophageal cancer(EC) patients undergoing (chemo-) radiotherapy.MethodsA retrospective analysis of 134 patients with pathology confirmed squamous cell EC treated between July 2009 and October 2013 in our hospital was performed. Inclusion criteria for this study were curative intended radiotherapy and availability of pre-treatment and interim 18F-FDG PET. 18F-FDG PET/CT scans were acquired before treatment and after 40 Gray (Gy) of radiotherapy. Maximum standard uptake value (SUVmax), metabolic tumor volume(MTV), total lesion glycolysis (TLG), and the percentual changes during both PET scans were recorded. The parameters were named as SUVmax1,MTV1,TLG1,SUVmax2,MTV2,TLG2,△SUVmax,△MTV and △TLG. The receiver operating characteristic curve (ROC) was used to analyze the relationship between metabolic parameters and OS, survival analysis was carried out by Kaplan-Meier and Cox regression analysis.ResultsUnivariate survival analysis showed that SUVmax2、MTV1、△MTV、TLG1、TLG2 and △TLG were associated with OS. Based on the largest Youden index of ROC curves, patients with SUVmax2 < 7.8, MTV1 < 10.5, △MTV < 0.075, TLG1 < 59.8, TLG2 < 44.3 and △TLG < 0.27 tended to live longer. Stratified for these parameters, the estimated median survival time were 27.9 months (m) vs 9.8 m, 36.9 m vs 11.3 m, 41.6 m vs 12 m, 48.9 m vs 14.3 m, 32.6 m vs 13.2 m, and 41.6 m vs 14.5 m. Cox multi-factor regression analyses revealed SUVmax2 as an independent prognostic factor for OS complementary to TNM staging and the length of primary tumor.ConclusionsSequential 18F-FDG PET/CT metabolic parameters bear important prognostic value for OS of EC patients. 18F-FDG PET/CT scan before treatment and during chemoradiotherapy seems helpful to evaluate the effect of chemoradiotherapy, guide clinical decisions and provide patients with personalized treatment.

Prognostic value of baseline metabolic tumor volume measured on 18F-fluorodeoxyglucose positron emission tomography/computed tomography in melanoma patients treated with ipilimumab therapy.

Ipilimumab induces durable remission in about 15-20% of patients with metastatic melanoma. However, reliable predictors of response to ipilimumab are currently lacking. Whole-body metabolic tumor volume (wMTV) has been shown to be a strong prognostic factor in a variety of malignancies treated with chemotherapy, but few results have been reported for patients treated with immunotherapy. The purpose of this study was to investigate the prognostic value of wMTV and other metabolic parameters from baseline 18F-FDG PET/CT scans in patients with melanoma being treated with ipilimumab. The prognostic impact of wMTV, as well as mean standardized uptake values and total lesion glycolysis, was evaluated in 142 consecutive patients with melanoma treated with single-agent ipilimumab therapy. Metabolic parameters were dichotomized by their respective medians and correlated with overall survival (OS). In addition, the prognostic value of metabolic parameters combined with known clinical prognostic factors was evaluated in multivariate analyses. The median OS time in all patients was 14.7months (95% CI 10.45-18.93months). wMTV was a strong independent prognostic factor for OS (p = 0.001). The median survival in patients with a metabolic volume above the median was 10.8months (95% CI 5.88-15.81months) as compared with 26.0months (95% CI 3.02-49.15months) in patients with an MTV below the median. A multivariate model including wMTV and known clinical prognostic factors, such as age and the presence of brain metastases, further improved the identification of patient subgroups with different OS times. wMTV appears to be a strong independent prognostic factor in melanoma patients treated with ipilimumab, and can be determined semiautomatically from routine 18F- FDG PET/CT scans. wMTV, combined with clinical prognostic factors, could be used to personalize immunotherapy and in future clinical studies.

Metabolic positron emission tomography parameters predict failure patterns in early non-small-cell lung cancer treated with stereotactic body radiation therapy: a single institution experience.

The prognostic value of metabolic parameters using 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) has not been established for early non-small cell lung cancer (NSCLC). Accordingly, the authors investigated the prognostic value of metabolic parameters in terms of failure patterns in patients with early NSCLC who underwent stereotactic body radiation therapy (SBRT). Data from 35 patients with Stage I NSCLC who underwent SBRT using CyberKnife and received pretreatment FDG PET/CT between 2008 and 2016 were retrospectively reviewed. Maximum standardized uptake value (SUVmax), metabolic tumor volume, and total lesion glycolysis were measured. The significance of these parameters with regard to failure patterns was assessed. The median follow-up was 23 months for all patients and 34 months for living patients. Ten patients experienced recurrence: three local failures, five regional failures (RF), and eight distant failures (DF). Three-year local, regional and distant control rates were 96.7%, 86.4% and 71.1%, respectively. High SUVmax (<9 vs. ≥9) was an independent predictive factor associated with increased RF (P = 0.027) and DF (P = 0.008). Furthermore, SUVmax was indicative of both progression-free (P = 0.015) and overall (P = 0.034) survival. High SUVmax was a significant metabolic parameter associated with increased RF and DF in patients with early NSCLC who received SBRT, having a high propensity for dissemination. These results suggest that adjuvant treatment in conjunction with SBRT may be considered in patients with early NSCLC and high SUVmax.

Angiographic severity of coronary artery disease and cardiovascular risk in acute coronary syndrome in patients with metabolic syndrome.

The extent of angiographic lesions, size of infarct, and in-hospital and long-term prognosis in patients with metabolic syndrome (MS) have not been clearly determined. The aim of the study was to investigate the effect of MS on the severity of coronary artery disease (CAD) and cardio-vascular risk evaluated using the GRACE 2.0 risk score and left ventricular ejection fraction (LVEF) in patients with first acute coronary syndrome (ACS) treated with coronary angioplasty. The study was conducted in a group of 160 consecutive patients hospitalised for their first ACS. Coronary angiogra-phy was assessed and an echocardiographic evaluation of LVEF was performed. MS was diagnosed according to the National Cholesterol Education Programme-Adult Treatment Panel III criteria. Cardiovascular risk was evaluated using the GRACE 2.0 score. Statistical analysis was performed using the STATISTICA software version 12.0. Diagnostic criteria for MS were met by 53.5% of the patients. Patients with and without MS did not differ in angio-graphic severity of CAD and cardiovascular risk as evaluated with the GRACE 2.0 score. LVEF was significantly elevated in patients with MS. In the examined group the angiographic severity of CAD correlated positively with age, body mass index (BMI) and the homeostatic model assessment for insulin resistance (HOMA-IR) index. The cardiovascular risk correlated positively with age, BMI, fasting insulin levels, and HOMA-IR, and inversely with blood pressure and triglyceride levels. The multivariable regression model for predicting the LVEF value indicated that the strongest prognostic factor was the type of ACS. The associations between the angiographic severity of CAD and age, BMI, and insulin resistance (IR) confirm the involvement of these parameters in coronary atherosclerosis. The correlations between the estimated cardiovascular risk and IR indicate the prognostic value of metabolic parameters in patients after first ACS. The type of ACS is the strongest predictor of LVEF at discharge in this population.

Prognostic value of FDG PET-CT metabolic parameters before radiotherapy in patients with esophageal cancer receiving radiotherapy

Objective To investigate the prognostic value of metabolic parameters of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET-CT) before radiotherapy in patients with esophageal cancer receiving radiotherapy. Methods We retrospectively analyzed the clinical data of 37 patients with stage Ⅱ-Ⅲ esophageal squamous cell carcinoma admitted to Anhui Provincial Hospital from 2010 to 2015, who underwent PET-CT scans within 4 weeks before radiotherapy. The following information was collected: age, sex, the location of primary lesion, clinical stage, and treatment regimen. The maximum standard uptake value (SUVmax), mean standard uptake value (SUVmean), metabolic tumor volume (MTV), PET tumor length (PTL), and total lesion glycolysis (TLG) were calculated. The optimal cut-off values of SUVmax, SUVmean, MTV, PTL, and TLG were determined by the receiver operating characteristic (ROC) curve. The Kaplan-Meier method was used to calculate survival rates, and the log-rank test was used for survival comparison and univariate prognostic analysis; the Cox model was used for multivariate prognostic analysis of significant variables. Results The area under the ROC curve suggested that MTV>TLG>PTL=0.713>0.679>0.670. The Kaplan-Meier survival analysis showed that patients had better survival time when MTV was less than 27.44 cm3, TLG was less than 166.2 g, and PTL was less than 36.74 mm (P<0.05). The Cox multivariate regression analysis showed that only MTV was an independent prognostic factor for radiotherapy in patients with esophageal cancer (P=0.000). Conclusions MTV, TLG and PTL have certain values in predicting the prognosis of patients with esophageal cancer before radiotherapy, and are helpful for selecting and adjust the clinical treatment regimen and improving the survival rate and prognosis. Key words: Tomography, X-ray computed, Positron-emission; Deoxyglucose; Esophageal neoplasms/radiotherapy; Prognosis

Prognostic value of metabolic indices and bone marrow uptake pattern on preoperative 18F–FDG PET/CT in pediatric patients with neuroblastoma

To evaluate the prognostic value of metabolic parameters and bone marrow uptake (BMU) patterns on pretherapeutic 18-F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in pediatric patients with neuroblastoma (NB). Forty-seven pediatric patients with newly diagnosed neuroblastoma who underwent 18F-FDG PET/CT were retrospectively reviewed. Clinicopathological factors and metabolic parameters including maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG) and bone marrow uptake patterns on PET/CT were compared to predict recurrence-free survival (RFS) and overall survival (OS) by univariate and multivariate analysis. During the follow-up period, 27 (57.4%) patients experienced recurrence. MTV (P=0.001), TLG (P=0.004) and BMU patterns (P=0.025) remained significant predictive factors for tumor recurrence, along with tumor size, histology, stage, lactate dehydrogenase (LDH) and other distant metastasis (except bone metastasis). Univariate analysis showed that histology, stage, tumor size (>37.25cm), other distant metastasis, MTV (>88.10cm3) and TLG (>1045.2g) and BMU patterns correlated with both RFS and OS (P<0.05). On multivariate analysis, TLG remained the only independent prognostic factor for RFS (P=0.016) and OS (P=0.012), and BMU patterns and MTV were statistically significant for OS (P=0.024 and P=0.038, respectively). Pretherapeutic 18F-FDG PET/CT can provide reliable prognostic information for neuroblastoma pediatric patients, and patients with high MTV, TLG and focal bone marrow (unifocal and multifocal) uptake on PET/CT may have inferior outcomes during subsequent treatment.

Prognostic Value of Metabolic Parameters by 18F-FDG PET/CT in Nasopharyngeal Cancer (NPC) in Non-Endemic Area

Prognostic Value of Metabolic Parameters by 18F-FDG PET/CT in Nasopharyngeal Cancer (NPC) in Non-Endemic Area

Identification of Metabolic Biomarkers Using Serial 18F–FDG PET/CT for Prediction of Recurrence in Advanced Epithelial Ovarian Cancer

PURPOSE. To evaluate the prognostic value of metabolic parameters derived from serial 18F fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in patients with advanced epithelial ovarian cancer (EOC). METHODS. Thirteen patients with advanced EOC who received surgical staging and adjuvant platinum-based combination chemotherapy were prospectively enrolled. 18F–FDG PET/CT was performed before and after the surgical staging, and after third cycle of chemotherapy. Tumor glucose metabolism at baseline and its change after operation and third cycle of chemotherapy such as changes of maximum standardized uptake values (ΔSUVmax) via 18F–FDG PET/CT were measured, and assessed regarding their ability to predict recurrence. RESULTS. Median duration of progression-free survival (PFS) was 25 months (range, 13–34), and although optimal debulking was performed in 10 patients, 5 (38.5%) patients experienced recurrence. Univariate analyses showed significant associations between recurrence and low ΔSUVmax after surgical staging, and low SUVmax change after third cycle of chemotherapy. Multivariate analysis identified low ΔSUVmax after third cycle of chemotherapy as an independent risk factor for recurrence (P=.047, hazard ratio (HR) 16.375, 95% CI 1.041–257.536). Kaplan–Meier survival curves showed that PFS significantly differed in groups categorized based on ΔSUVmax after chemotherapy (P=.001, log-rank test). CONCLUSIONS. 18F–FDG PET/CT allows for prediction of treatment response by the level of FDG uptake in terms of SUV at baseline and after chemotherapy. The metabolic response measured as ΔSUVmax after third cycle of chemotherapy appears to be promising predictor of recurrence in patients with advanced EOC.

Prognostic value of metabolic parameters determined by preoperative ¹⁸F-FDG PET/CT in patients with uterine carcinosarcoma.

ObjectiveTo evaluate the prognostic value of metabolic parameters measured by preoperative 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) in patients with uterine carcinosarcoma (UCS).MethodsData of 55 eligible patients with UCS who underwent preoperative 18F-FDG PET/CT and surgical staging were analyzed retrospectively. Maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV2.5), and total lesion glycolysis (TLG2.5) of the primary tumors were measured using a SUV threshold of 2.5. The optimal cutoff value of each parameter was determined by time-dependent receiver operating characteristic curve, and its impact on progression-free survival and overall survival was evaluated by Cox proportional hazards model.ResultsDuring a median follow-up period of 29 (range, 1.5–109.4) months, 47.3% (26/55) of the patients experienced disease progression, and the disease-associated mortality rate was 43.6% (24/55). Univariate analysis determined that hazard ratios (HRs) for disease progression for SUVmax (≥8.33), MTV2.5 (≥63.92 mL), and TLG2.5 (≥396.16) were 1.930 (95% confidence interval [CI]=0.793–4.701), 3.264 (95% CI=1.466–7.268), and 2.692 (95% CI=1.224–5.924), respectively. And, HRs for death were 1.979 (95% CI=0.774–5.060), 2.764 (95% CI=1.217–6.274), and 2.721 (95% CI=1.198–6.182), respectively. While peritoneal cytology, histology, and tumor diameter were independent prognostic factors in multivariate analysis, MTV and TLG were not.ConclusionThough MTV and TLG of primary UCS were not independent predictors compared to surgically obtained data, MTV and TLG of primary UCS may provide useful information on prognosis especially in patients who are not able to undergo surgical staging.

Prognostic value of metabolic parameters on preoperative 18F-fluorodeoxyglucose positron emission tomography/ computed tomography in patients with stage III gastric cancer.

This study investigated the prognostic value of metabolic parameters determined by 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in patients with stage III gastric cancer. Patients with pre-operative PET/CT and confirmed stage III after curative surgical resection were retrospectively enrolled. Parameters evaluated from pre-operative PET/CTwere maximum standardized uptake value (SUVmax) and peak SUV (SUVpeak) of primary tumor, SUVmax or SUVpeak of tumor to liver ratio (TLRmax and TLRpeak). Volumetric parameters, metabolic tumor volume (MTV) and total lesion glycolysis (TLG), were also evaluated. These PET/CT parameters were compared with the overall survival (OS) and recurrence-free survival (RFS). From total of 133 consecutive patients, tumor recurrence was found in 54 patients (40.6%) and 53 died during the follow-up period (median, 43 mo; range 5-62). In univariate analysis, SUVmax, SUVpeak, TLRmax and TLRpeak were significantly associated with the OS and RFS. In multivariate analysis, high TLRmax and TLRpeak were significantly unfavorable prognostic factors for RFS (both P<0.05) even after adjusting for age, depth of tumor invasion, lymph node metastasis, and chemotherapy. MTV and TLG showed no statistically significant correlation with outcome. In conclusion, glucose metabolism of primary tumor measured by pre-operative PET/CT provides prognostic information, especially for recurrence, in stage III gastric cancer.

Prognostic value of post-treatment metabolic tumor volume from 11C-methionine PET/CT in recurrent malignant glioma

We investigated the diagnostic and prognostic significance of metabolic parameters from 11C-methionine (MET) positron emission tomography (PET) in patients with malignant glioma. The MET-PET was examined in 42 patients who had been previously treated with adjuvant treatment for malignant glioma. Both ratios of maximal MET uptake of the tumors to those of the contralateral normal gray matter (T/N ratio) and metabolic tumor volume (MTV) were estimated in each lesion. The diagnostic performance for recurrence was investigated in all enrolled patients. A definitive diagnosis was done with pathologic confirmation or clinical follow-up. Among recurrent patients, we evaluated the prognostic value of metabolic parameters (T/N ratio and MTV) as well as clinical factors. Among 42 patients, 35 patients were revealed with recurrence. Both T/N ratios (p = 0.009) and MTV (p = 0.001) exhibited statistical significance to differentiate between recurrence and post-treatment radiation effect. A T/N ratio of 1.43 provided the best sensitivity and specificity for recurrence (91.4 and 100%, respectively), and a MTV of 6.72cm3 provided the best sensitivity and specificity (77.1% and 100%, respectively). To evaluate the prognostic impact, different cutoffs of MTV were examined in patients with recurrent tumor and a threshold of 60cm3 was determined as a best cutoff value to separate the patients in two prognostic groups. Univariate analysis revealed improved overall survival (OS) for patients with Karnofsky performance scale (KPS) score ≥70 (p < 0.001) or MTV <60cm3 (p = 0.049). Multivariate analysis showed that patients with KPS score ≥70 (p < 0.001; hazard ratio = 0.104; 95% CI, 0.029-0.371) or MTV < 60cm3 (p = 0.031; hazard ratio = 0.288; 95% CI, 0.093-0.895) were significantly associated with a longer OS. However, T/N ratio was not correlated with patients' outcome. Metabolic parameters had the diagnostic value to differentiate recurrence from post-treatment radiation effect. Compared with T/N ratio, MTV was an independent significant prognostic factor with KPS score in patients with recurrent tumor. Our study had a potential to manage these patients according to prognostic information using MET-PET.

Prognostic value of FDG PET-CT metabolic parameters before treatment in patients with esophageal cancer receiving radiotherapy

Objective To investigate the prognostic value of metabolic parameters, maximum standard uptake value (SUVmax), metabolic tumour volume (MTV), total lesion glycolysis (TLG), and PET tumor length(PTL), in primary lesions of esophageal cancer on FDG PET-CT imaging in patients receiving radiotherapy or combined radiotherapy. Methods A total of 55 patients with stage Ⅰ-IV esophageal cancer who received PET-CT radiotherapy localization in our hospital from 2006 to 2012 were enrolled. The association of sex, age, primary lesion, TNM stage, SUVmax, MTV, TLG, PTL, and therapeutic methods with the patient's prognosis was analyzed. The receiver operating characteristic curve was used to determine the cut-off values of SUVmax, MTV, TLG, and PTL, and the patients were divided into higher-value group and lower-value group. The Kaplan-Meier method was used to calculate survival rates, and the log-rank test was used for survival difference analysis. Results The median overall survival (OS) time for all patients was 19.1 months (95% CI 8.1-30.1), and the 1-, 2-, 3-, and 4-year OS rates were 59%, 45%, 35%, and 26%, respectively. The group with lower values of SUVmax(<11.4), MTV (<8.27 cm3), TLG (<35.21), and PTL (<5.8 cm) had better prognosis than those with higher values (P=0.002, 0.021, 0.044, and 0.000). Conclusions SUVmax, MTV, TLG, and PTL before treatment have certain values in predicting the prognosis of patients with esophageal cancer. Risk stratification can be performed for these patients before radiotherapy according to these parameters, in order to develop individualized treatment regimens and improve prognosis. Key words: Tomography, positron-emission; Fluorodeoxyglucose; Tomography, X-ray computed; Esophageal neoplasms/radiotherapy; Prognosis

18F-FDG PET-CT performed before and during radiation therapy of head and neck squamous cell carcinoma: Are they independent or complementary to each other?

The aims of this study are to evaluate the prognostic value of metabolic parameters derived from (18) F-FDG PET-CT performed before definitive radiation therapy (RT) (prePET) in patients with mucosal primary head and neck squamous cell carcinoma (MPHNSCC) and to assess the additive prognostic values of FDG PET-CT performed during RT (iPET). One hundred patients with MPHNSCC treated with radical RT underwent staging prePET and iPET performed during the third week of treatment. The maximum standardized uptake value (SUVmax ), metabolic tumour volume (MTV) and total lesional glycolysis (TLG) of primary tumour were analysed for both prePET and iPET, and results were correlated with loco-regional recurrence-free survival (LRFS), disease-free survival (DFS), metastatic failure-free survival (MFFS) and overall survival (OS), using Kaplan-Meier analysis. Optimal cut-offs (OC) for prePET and iPET were derived from Receiver Operating Characteristic curves. Patients with metabolic parameters above/below the individual OC of prePET as well as iPET (i.e. combined prePET and iPET (comPET)) were evaluated against their outcomes. Median age was 61years (range 39-81), median follow-up of 20months (range 4-70, mean 27), and AJCC 7th Edition clinical stage II, III and IV were 8, 24 and 68 patients respectively. Metabolic values below individual OC in comPET were found to be associated with statistically significant improvements (P<0.05) in DFS, LRFS and OS. In addition, patients with SUVmax above the OC in comPET were associated with worse MFFS (P=0.011) and confirmed on both univariate (P=0.019) and multivariate analyses (P=0.04). Addition of iPET significantly improves the prognostic values of all three metabolic parameters and can potentially be used in future adaptive local and systemic therapy trials.

Metabolic burden measured by (18)f-fluorodeoxyglucose positron emission tomography/computed tomography is a prognostic factor in patients with small cell lung cancer.

PurposeEvidence regarding the usefulness of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in predicting the prognosis of non-small cell lung cancer is increasing. However, data on small cell lung cancer (SCLC) are scarce. The aim of this study was to evaluate the prognostic value of metabolic parameters measured using 18F-FDG PET/CT in patients with SCLC.Materials and MethodsWe conducted a retrospective review of 114 patients with pathologically proven SCLC (26 cases of limited disease and 88 cases of extensive disease) who underwent pretreatment 18F-FDG PET/CT. The maximal SUV (SUVmax) was used quantitatively for determination of FDG PET activity. The SUVmax of the primary tumor (primary SUVmax), the sum of SUVmax values of malignant lesions (SUVsum), and the mean SUVmax of malignant lesions were calculated.ResultsThe patient population was subdivided using a median SUVsum value of 24.6. High SUVsum showed a significant association with known factors for poor prognosis, including higher neuron-specific enolase (p=0.010), CYFRA 21-1 (p=0.014), and extensive disease status (p=0.007). Patients with high SUVsum had significantly shorter median overall survival (6.6 months vs. 13.0 months, p<0.001) and progression-free survival (5.2 months vs. 8.0 months, p<0.001) than patients with low SUVsum. Results of multivariate analysis showed that SUVsum, chemotherapy cycles, and the response to first-line treatment were significant prognostic factors of survival. In contrast, mean SUVmax and primary SUVmax were not significant predictors of survival.ConclusionIn this study, metabolic burden represented by SUVsum from pretreatment 18F-FDG PET/CT was an independent prognostic factor in patients with SCLC.

Prognostic Value of Metabolic Parameters in Patients with Synchronous Colorectal Cancer Liver Metastasis Following Curative-Intent Colorectal and Hepatic Surgery

Synchronous colorectal cancer liver metastasis (SCLM) remains a clinical challenge, largely because of the limited availability of tools that use reliable prognostic indicators to guide treatment. This study assessed the prognostic ability of preoperative (18)F-FDG PET/CT in patients with SCLM who had undergone curative-intent colorectal and liver surgery. All included patients had undergone simultaneous colorectal and hepatic surgery to treat SCLM. Cox regression for survival analysis was undertaken using clinicopathologic variables and metabolic parameters (metabolic tumor volume [MTV], total lesion glycolysis [TLG], and peak standardized uptake value [SUVpeak]) as covariates, with tumor recurrence and death used as endpoints. One hundred twenty patients (82 men, 38 women; mean age ± SD, 59.9 ± 10.1 y) met the inclusion and exclusion criteria. Univariate analysis showed that MTV, TLG, and the size of hepatic metastases were significant indicators of both recurrence-free survival and overall survival, whereas those of primary colorectal tumors were not. Multivariate analysis revealed that the SUVpeak of primary tumors and hepatic metastases remained significant after adjusting for other clinicopathologic variables, whereas the MTV and TLG of hepatic metastases became insignificant after adjusting for differences in tumor size. The combination of a high SUVpeak of hepatic metastases and a low SUVpeak of primary tumors was related to poor prognosis under the multivariate model. In patients with SCLM who underwent curative-intent colorectal and liver surgery, metabolic parameters of hepatic metastases possess prognostic significance whereas those of primary colorectal tumors do not. For hepatic metastases, the SUVpeak is an independent prognostic factor, whereas MTV and TLG are surrogate measures of tumor size. Reduced recurrence-free survival rates are associated with higher SUVpeak for hepatic metastases and lower SUVpeak for primary tumors. Further studies are needed to elucidate the underlying mechanisms.

Prognostic value of 18F‐FDG PET/CT in patients with squamous cell carcinoma of the tonsil: Comparisons of volume‐based metabolic parameters

The prognostic significance of volume-based metabolic parameters measured by (18)F-fluorodeoxyglucose positron emission tomography/CT ((18) F-FDG PET/CT) is not established. We evaluated the prognostic value of metabolic parameters in patients with squamous cell carcinoma (SCC) of the tonsil. We enrolled a total of 69 patients with SCC of the tonsil who underwent pretreatment (18)F-FDG PET/CT. We measured maximum standardized uptake value (SUV(max)), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and asymmetry indices (of SUV(max), MTV, and TLG). The prognostic significance of these parameters and clinical variables was assessed by Cox proportional hazards regression analysis. Multivariate analyses with adjustments for age, sex, and American Joint Committee on Cancer stage showed that only TLG (hazard ratio = 1.020, 95% confidence interval 1.003-1.037, p = .023) was an independent predictive factor associated with decreased overall survival. TLG is a significant independent metabolic prognostic factor for overall survival in patients with SCC of the tonsil.