| ObjectiveThis study is to evaluate the prognostic value of maximum standardized uptake value(SUVmax)and its related parameters,metabolic tumor volume(MTV),tumor lesion glycometabolism(TLG)etc.by 18F-FDG PET/CT in patients with Stage IV non-small cell lung carcinoma(NSCLC)and to investigate the effects of parameters mentioned above on overall survival(OS).MethodsWe retrospectively analyzed 91 patients with pathologically proven Stage IV NSCLC who underwent pretreatment 18F-FDG PET/CT in The Second Affiliated Hospital of Zhejiang University from August 15,2013 to March 15,2017.Inclusive criteria were as follows:(a)The pathological type was NSCLC,and patients were in Stage IV;(b)No other malignancies were diagnosed before Stage IV NSCLC;(c)Patients received 18F-FDG PET/CT examination without any tumor correlated treatment;(d)Complete clinical data and follow-up data were needed.There were 91 cases containing 58 males and 33 females,with an average age of 61.2±11.3 years old(range from 35 to 87 years old).Follow-up methods mainly included outpatient follow-up and telephone follow-up.OS starting point was patients' acceptance of pretreatment 18F-FDG PET/CT examination,and the termination was the day of death or the last follow-up.For analysis of overall survival,the Kaplan-Meyer log-rank test and Cox proportional hazard modal were used for univariate analysis and multivariate analysis,respectively.ResultsThe average survival time of the 91 patients was 13.3±11.0 months(95%CI:11.0-15.6),and the overall survival rate was 42.9%in 1 year and 20.9%in 2 years.During the follow-up,52 cases(57.14%)died,and the median follow-up time of the group was 7.5 months(range from 1 to 37 months);39 cases(42.86%)were still alive or lost after the follow-up,and the median follow-up time for this group was 12 months(range from 1 to 45 months).In univariate analysis,age,pathological types,TKI targeted therapy,maximum diameter of primary tumor,T stage,metabolic tumor volume of primary tumor(PMTV),tumor lesion glycometabolism of primary tumor(PTLG),sum of SUVrmax of all lesions(sumSUVmax),sum of volume of all lesions(sumMTV)were significant predictors of OS(all P<0.05);However,other SUVmax related parameters,including SUVmax of primary tumor(Pmax),the ratio of Pmax to mean standardized uptake value(SUVmean)of mediastinal blood pool(Pmax/Mmean),SUVmax of total lesions(Tmax)and the ratio of Tmax to SUVmean of liver blood pool(Tmax/Lmean)were not significant predictors for OS in patients with Stage IV NSCLC(all P>0.05).In multivariate analysis,independent prognostic factors associated with OS were pathological types(HR=3.333,P = 0.003),whether TKI therapy was accepted(HR=2.513,P = 0.005)and sumMTV(HR=5.435,P<0.001).Conclusion(1)Compared with the SUV and its related parameters,PMTV and PTLG,sumMTV representing the whole body tumor metabolic volume could provide better predictive effects for survival.(2)Besides sumMTV,the pathological classification and whether TKI targeted therapy was accepted were also the independent risk factors for prognosis of patients with Stage IV NSCLC;When the pathological classification of the patient was squamous cell carcinoma,or patient did not accept TKI targeted therapy,or sumMTV of patient was greater than 62cm3,the risk of death was higher.(3)SUVmax and its related parameters(including Pmax,Pmax/Mmean,Tmax,Tmax/Lmean and sumSUVmax)were not able to perform a good prognostic evaluation for patients with Stage IV NSCLC. |
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