Investigate The Role Of ¹⁸f-fdg Maximum Standardized Uptake Value In Predicting The Prognosis Of Surgically Treated Patients With Non-small Cell Lung Cancer

Background:Primary lung cancer is the leading cause of cancer death, and more than 87% of patients with lung cancer are diagnosed with non-small cell lung cancer(NSCLC). Surgery is the one of the most important means of treatment of NSCLC. During perioperative period, it is difficult to solve two problems:First, some patients would have a high risk if underwent radical surgery, whether it is worthwhile to carry out the operation; Second, should the patients have adjuvant chemotherapy after surgery. Both issues involve the prognosis of the patients with surgery.To date, TNM stage is the strongest prognostic factor for NSCLC. However, survival odds by stage clearly underscore that each pathologic stage is a heterogeneous population containing individuals at much higher risk of death than others in the same stage. Only 60% of patients with pathologic stage I are alive 5 years after resection.The facts show that to determine the prognosis of the resected NSCLC only with the morphology-based tumor TNM stage is no longer meet the requirements. How to effectively determine the postoperative prognosis of different individuals, thus giving the targeted individual therapy, has become an urgent problem.It has been reported that 18F-fluoro-2-deoxy-glucose (18F-FDG) uptake on PET is associated with tumor aggressiveness in NSCLC. The maximum standardized uptake value(SUVmax), a semi-quantitative measurement of FDG uptake on PET, could thus be of prognostic significance. In the present study, we focused on the role of 18F-FDG uptake in predicting the outcome of surgically treated patients with NSCLC.Methods:A retrospective analysis was performed on 77 cases of patients (Between July 2006 and December 2008) who received complete resection and preoperative 18F-FDG PET imaging. The maximum standardized uptake value(SUVmax), in addition with five clinicopathological factors those could possibly influence survival were compared for their possible association with patients survival, using the Log-rank test in univariate analysis and the Cox proportional hazards model in multivariate analysis. Association between SUVmax and other factors was also analyzed. Further study explored the relationship between SUV and survival in groups with different postoperative TNM staging or different patholoy. P<0.05 were considered to be statistically significant. Statistical analyses were performed using SPSS for Windows Release 17.0.Results:The median SUVmax was 6.2 for all subjects. Patients with SUV more than 6.2 had shorter overall survival than patients less than 6.2 in univariate analyses (P=0.028). Multivariate analyses demonstrated that SUVmax(threshold value equal to 6.2) was an independent predictor for survival, including TNM stage and adjuvant therapy. Other factors were independent predictors. Univariate analyses did not show any significant difference in survival by SUVmax when data were stratified according to pathological stageⅠ(P=0.445). Univariate analyses showed significant difference in survival by SUVmax when data were stratified according to pathological stageⅡandⅢ(P=0.048). Univariate analyses showed significant difference in survival by SUVmax when data were stratified according to adenocarcinoma (P=0.042), but squamous cancer were not (P=0.516). Multivariate analyses demonstrated that SUVmax (threshold value equal to 4.6) was an independent predictor for survival in adenocarcinoma, including adjuvant therapy.Conclusions:SUV based on the value of primary tumor size groups can effectively evaluate the prognosis of NSCLC patients. Further, in theⅡ～Ⅲof NSCLC patients, SUV value of the group can effectively assess the prognosis of NSCLC patients. For adenocarcinoma, SUV group helps screen high-risk patients with poor prognosis...