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FDG PET-CT in Non-small Cell Lung Cancer: Relationship between Primary Tumor FDG Uptake and Extensional or Metastatic Potential

  • Zhu, Shou-Hui (Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences) ;
  • Zhang, Yong (Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences) ;
  • Yu, Yong-Hua (Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences) ;
  • Fu, Zheng (Department of Positron Emission Tomography/Computed Tomography, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences) ;
  • Kong, Lei (Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences) ;
  • Han, Da-Li (Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences) ;
  • Fu, Lei (Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences) ;
  • Yu, Jin-Ming (Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences) ;
  • Li, Jia (Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences)
  • Published : 2013.05.30

Abstract

Objective: To explore the relationships between primary tumor $^{18}F$-FDG uptake measured as the SUVmax and local extension, and nodal or distant organ metastasis in patients with NSCLC on pretreatment PET-CT. Methods: 93 patients with NSCLC who underwent $^{18}F$-FDG PET-CT scans before the treatment were included in the study. Primary tumor SUVmax was calculated; clinical stages, presence of local extension, nodal and distant organ metastases were recorded. The patients with SUVmax${\geq}2.5$ were divided into low and high SUVmax groups by using the median SUVmax. The low SUVmax group consisted of 45 patients with SUVmax<10.5, the high SUVmax group consisted of 46 patients with SUVmax${\geq}10.5$. Their data were compared statistically. Results: 91 cases with SUVmax${\geq}2.5$ were included for analysis. The mean SUVmax in patients without any metastasis was $7.42{\pm}2.91$ and this was significantly lower than that ($12.18{\pm}4.94$) in patients with nodal and/or distant organ metastasis (P=0.000). In the low SUV group, 19 patients had local extension, 22 had nodal metastasis, and 9 had distant organ metastasis. In the high SUV group, 31 patients had local extension, 37 had nodal metastasis, and 18 had distant organ metastases. There was a significant difference in local extension (P =0.016), distant organ metastasis (P =0.046), and most significant difference in nodal metastasis rate (P =0.002) between the two groups. In addition, there was a moderate correlation between SUVmax and tumor size (r = 0.642, P<0.001), tumor stage (r = 0.546, P<0.001), node stage (r = 0.388, P<0.001), and overall stage (r = 0.445, P= 0.000). Conclusion: Higher primary tumor SUVmax predicts higher extensional or metastatic potential in patients with NSCLC. Patients with higher SUVmax may need a close follow-up and more reasonable individual treatment because of their higher extensional and metastatic potential.

Keywords

Non-small cell lung cancer;FDG-PET;SUV;clinical staging;metastasis

References

  1. Agarwal M, Brahmanday G, Bajaj SK, et al (2010). Revisiting the prognostic value of preoperative (18) F-fluoro-2-deoxyglucose ((18)F-FDG) positron emission tomography (PET) in early-stage (I & II) non-small cell lung cancers (NSCLC). Eur J Nucl Med Mol Imaging, 37, 691-8. https://doi.org/10.1007/s00259-009-1291-x
  2. Birim O, Kappetein AP, van Klaveren RJ, et al (2006). Prognostic factors in non-small cell lung cancer surgery. Eur J Surg Oncol, 32, 12-23. https://doi.org/10.1016/j.ejso.2005.10.001
  3. Chao F, Zhang H (2012). PET/CT in the staging of the nonsmall-cell lung cancer. J Biomed Biotechnol, 2012, 783739.
  4. Cuaron J, Dunphy M, Rimner A (2012). Role of FDG-PET scans in staging, response assessment, and follow-up care for non small cell lung cancer. Front Oncol, 2, 208.
  5. Detterbeck FC, Boffa DJ, Tanoue LT (2009). The new lung cancer staging system. Chest, 136, 260-71. https://doi.org/10.1378/chest.08-0978
  6. De Wever W, Ceyssens S, Mortelmans L, et al (2007). Additional value of PET-CT in the staging of lung cancer: comparison with CT alone, PET alone and visual correlation of PET and CT. Eur Radiol, 17, 23-32. https://doi.org/10.1007/s00330-006-0284-4
  7. De Wever W, Coolen J, Verschakelen JA (2009). Integrated PET/CT and cancer imaging. JBR-BTR, 92, 13-9.
  8. Felip E, Stahel RA, Pavlidis N, et al (2005). ESMO Minimum Clinical Recommendations for diagnosis, treatment and follow-up of non-small-cell lung cancer (NSCLC). Ann Oncol, 16, i28-9.
  9. Fischer BM, Mortensen J (2006). The future in diagnosis and staging of lung cancer: positron emission tomography. Respiration, 73, 267-76. https://doi.org/10.1159/000092080
  10. Gambhir SS (2002). Molecular imaging of cancer with positron emission tomography. Nat Rev Cancer, 2, 683-93. https://doi.org/10.1038/nrc882
  11. Gibbs AR, Thunnissen FB (2001). Histological typing of lung and pleural tumours: third edition. J Clin Pathol, 54, 498-9. https://doi.org/10.1136/jcp.54.7.498
  12. Goldstraw P, Crowley J, Chansky K, et al (2007). The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours. J Thorac Oncol, 2, 706-14. https://doi.org/10.1097/JTO.0b013e31812f3c1a
  13. Hellwig D, Graeter TP, Ukena D, et al (2007). 18F-FDG PET for mediastinal staging of lung cancer: which SUV threshold makes sense? J Nucl Med, 48, 1761-6. https://doi.org/10.2967/jnumed.107.044362
  14. Higashi K, Ito K, Hiramatsu Y, et al (2005). $^{18}F$-FDG uptake by primary tumor as a predictor of intratumoral lymphatic vessel invasion and lymph node involvement in non-small cell lung cancer: analysis of a multicenter study. J Nucl Med, 46, 267-73.
  15. Huang W, Zhou T, Ma L, et al (2011). Standard uptake value and metabolic tumor volume of $^{18}F$-FDG PET/CT predict shortterm outcome early in the course of chemoradiotherapy in advanced non-small cell lung cancer. Eur J Nucl Med Mol Imaging, 38, 1628-35. https://doi.org/10.1007/s00259-011-1838-5
  16. Ikushima H, Dong L, Erasmus J, et al (2010). Predictive value of 18F-fluorodeoxyglucose uptake by positron emission tomography for non-small cell lung cancer patients treated with radical radiotherapy. J Radiat Res, 51, 465-71. https://doi.org/10.1269/jrr.10024
  17. Iskender I, Kadioglu SZ, Cosgun T, et al (2012). False-positivity of mediastinal lymph nodes has negative effect on survival in potentially resectable non-small cell lung cancer. Eur J Cardiothorac Surg, 41, 874-9. https://doi.org/10.1093/ejcts/ezr054
  18. Ioachim HL, Medeiros LJ (2009). Ioachim's Lymph Node Pathology. Philadelphia: Lippincott Williams & Wilkins, pp 589-8.
  19. Jemal A, Center MM, DeSantis C, et al (2010). Global patterns of cancer incidence and mortality rates and trends. Cancer Epidemiol Biomarkers Prev, 19, 1893-1907. https://doi.org/10.1158/1055-9965.EPI-10-0437
  20. Jemal A, Siegel R, Xu J, Ward E (2010). Cancer statistics, 2010. CA Cancer J Clin, 60, 277-300. https://doi.org/10.3322/caac.20073
  21. Ladanyi M, Pao W (2008). Lung adenocarcinoma: guiding EGFR-targeted therapy and beyond. Mod Pathol, 21, S16-22. https://doi.org/10.1038/modpathol.3801018
  22. Lardinois D, Weder W, Hany TF, et al (2003). Staging of nonsmall-cell lung cancer with integrated positron-emission tomography and computed tomography. N Engl J Med, 348, 2500-7. https://doi.org/10.1056/NEJMoa022136
  23. Li X, Zhang H, Xing L, et al (2012). Mediastinal lymph nodes staging by $^{18}F$-FDG PET/CT for early stage non-small cell lung cancer: a multicenter study. Radiother Oncol, 102, 246-50. https://doi.org/10.1016/j.radonc.2011.10.016
  24. Li M, Liu N, Hu M, et al (2009). Relationship between primary tumor fluorodeoxyglucose uptake and nodal or distant metastases at presentation in T1 stage non-small cell lung cancer. Lung Cancer, 63, 383-6. https://doi.org/10.1016/j.lungcan.2008.06.004
  25. Ma BB, King A, Lo YM, et al (2006). Relationship between pretreatment level of plasma Epstein-Barr virus DNA, tumor burden, and metabolic activity in advanced nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys, 66, 714-20. https://doi.org/10.1016/j.ijrobp.2006.05.064
  26. Nambu A, Kato S, Sato Y, et al (2009). Relationship between maximum standardized uptake value (SUVmax) of lung cancer and lymph node metastasis on FDG-PET. Ann Nucl Med, 23, 269-275. https://doi.org/10.1007/s12149-009-0237-5
  27. Paesmans M, Berghmans T, Dusart M, et al (2010). Primary tumor standardized uptake value measured on fluorodeoxyglucose positron emission tomography is of prognostic value for survival in non-small cell lung cancer: update of a systematic review and meta-analysis by the European Lung Cancer Working Party for the International Association for the Study of Lung Cancer Staging Project. J Thorac Oncol, 5, 612-9.
  28. Park SG, Lee JH, Lee WA, et al (2012). Biologic correlation between glucose transporters, hexokinase-II, Ki-67 and FDG uptake in malignant melanoma. Nucl Med Biol, 39, 1167-72. https://doi.org/10.1016/j.nucmedbio.2012.07.003
  29. Pauls S, Buck AK, Hohl K, et al (2007). Improved non-invasive T-Staging in non-small cell lung cancer by integrated $^{18}F$-FDG PET/CT. Nuklearmedizin, 46, 9-14.
  30. Ramalingam SS, Owonikoko TK, Khuri FR (2011). Lung cancer: New biological insights and recent therapeutic advances. CA Cancer J Clin, 61, 91-112. https://doi.org/10.3322/caac.20102
  31. Sculier JP, Chansky K, Crowley JJ, et al (2008). The impact of additional prognostic factors on survival and their relationship with the anatomical extent of disease expressed by the 6th Edition of the TNM Classification of Malignant Tumors and the proposals for the 7th Edition. J Thorac Oncol, 3, 457-66. https://doi.org/10.1097/JTO.0b013e31816de2b8
  32. Takenaka T, Yano T, Ito K, et al (2009). Biological significance of the maximum standardized uptake values on positron emission tomography in non-small cell lung cancer. J Surg Oncol, 100, 688-92. https://doi.org/10.1002/jso.21386
  33. Taylor MD, Smith PW, Brix WK, et al (2009). Correlations between selected tumor markers and fluorodeoxyglucose maximal standardized uptake values in esophageal cancer. Eur J Cardiothorac Surg, 35, 699-705. https://doi.org/10.1016/j.ejcts.2008.11.029
  34. Ung YC, Maziak DE, Vanderveen JA, et al (2007). $^{18}Fluorodeoxyglucose$ positron emission tomography in the diagnosis and staging of lung cancer: a systematic review. J Natl Cancer Inst, 99, 1753-67. https://doi.org/10.1093/jnci/djm232
  35. Vesselle H, Freeman JD, Wiens L, et al (2007). Fluorodeoxyglucose uptake of primary non-small cell lung cancer at positron emission tomography: new contrary data on prognostic role. Clin Cancer Res, 13, 3255-63. https://doi.org/10.1158/1078-0432.CCR-06-1128
  36. Xu X, Yu J, Sun X, et al (2008). The prognostic value of 18F-fluorodeoxyglucose uptake by using serial positron emission tomography and computed tomography in patients with stage III nonsmall cell lung cancer. Am J Clin Oncol, 31, 470-5. https://doi.org/10.1097/COC.0b013e31816fc943
  37. Zhang HQ, Yu JM, Meng X, et al (2011). Prognostic value of serial [18F]fluorodeoxyglucose PET-CT uptake in stage III patients with non-small cell lung cancer treated by concurrent chemoradiotherapy. Eur J Radiol, 77, 92-6. https://doi.org/10.1016/j.ejrad.2009.07.023

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