Rationale and Objectives
To explore the correlation between the tumor dissemination characteristic at 18F-fluoro-deoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) images and the outcome of first-line systemic therapy for stage IV non-small
cell lung cancer (NSCLC).
Materials and Methods
The current retrospective study included 101 NSCLC patients receiving first-line systemic
therapy with baseline 18F-FDG PET/CT images available. The distance between the two lesions that were the
farthest apart was defined as Dmax to calculate the tumor dissemination. The tumor metabolic volume (MTV) of the primary
tumor and the MTV of the whole-body tumor lesions (MTVwb) were calculated using 18F-FDG PET/CT imaging. The Kaplan–Meier survival analyses and Cox predictive model
were performed to assess the relationship between the parameters and survival.
Results
Dmax and MTVwb were independent prognostic factors for overall survival (OS) (p = 0.019 and p = 0.011, respectively) and progression-free survival (PFS) (p = 0.043 and p = 0.009, respectively). Poor PFS and OS were associated with high MTVwb (>54.0 cm3) and high Dmax (>48.5 cm) (p = 0.006 and p = 0.008, respectively). When MTVwb and Dmax were combined, three risk groups were stratified with no (score 0), one (score 1),
or two (score 2) factors (p < 0.001 for PFS, p < 0.001 for OS). The group with a score of 0 had a considerably longer PFS and OS
than those who received a score of 1 or 2 (PFS: 61.1%, 43.5%, and 21.1%, respectively,
OS: 77.8%, 54.3%, and 36.8%, respectively).
Conclusion
The combination of tumor dissemination characteristic (Dmax) and tumor burden (MTVwb) can further improve the prognosis stratification of NSCLC.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Academic RadiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Cancer statistics, 2022.CA Cancer J Clin. 2022; 72: 7-33
- Chemotherapy-induced immunomodulation in non-small-cell lung cancer: a rationale for combination chemoimmunotherapy.Immunotherapy. 2017; 9: 913-927
- Chemotherapy remains a cornerstone in the treatment of nonsmall cell lung cancer.Curr Opin Oncol. 2020; 32: 63-67
- 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. 2007; 2: 706-714
- Lung cancer staging and prognosis.Cancer Treat Res. 2016; 170: 47-75
- Treatment patterns and overall survival associated with first-line systemic therapy for patients with advanced non-small cell lung cancer.J Manag Care Spec Pharm. 2017; 23: 195-205
- NCCN guidelines insights: non-small cell lung cancer, version 2.2021.J Natl Compr Canc Netw. 2021; 19: 254-266
- Role of FDG PET/CT in the eighth edition of TNM staging of non-small cell lung cancer.Radiographics. 2018; 38: 2134-2149
- Prognostic and predictive values of metabolic parameters of (18)F-FDG PET/CT in patients with non-small cell lung cancer treated with chemotherapy.Mol Imaging. 2019; 181536012119846025
- Role of various metabolic parameters derived from baseline 18F-FDG PET/CT as prognostic markers in non-small cell lung cancer patients undergoing platinum-based chemotherapy.Clin Nucl Med. 2018; 43: e8-e17
- CT-based radiomics signatures can predict the tumor response of non-small cell lung cancer patients treated with first-line chemotherapy and targeted therapy.Eur Radiol. 2022; 32: 1538-1547
- Radiomics features as predictive and prognostic biomarkers in NSCLC.Expert Rev Anticancer Ther. 2021; 21: 257-266
- (18)F-FDG PET dissemination features in diffuse large B-cell lymphoma are predictive of outcome.J Nucl Med. 2020; 61: 40-45
- Risk stratification in diffuse large B-cell lymphoma using lesion dissemination and metabolic tumor burden calculated from baseline PET/CT.Ann Oncol. 2021; 32: 404-411
- LIFEx: a freeware for radiomic feature calculation in multimodality imaging to accelerate advances in the characterization of tumor heterogeneity.Cancer Res. 2018; 78: 4786-4789
- Paget's "Seed and Soil" theory of cancer metastasis: an idea whose time has come.Adv Anat Pathol. 2019; 26: 69-74
- Tumor metastasis: mechanistic insights and clinical challenges.Nat Med. 2006; 12: 895-904
- Mechanism of the mesenchymal-epithelial transition and its relationship with metastatic tumor formation.Mol Cancer Res. 2011; 9: 1608-1620
- The role of EMT and MET in cancer dissemination.Connect Tissue Res. 2015; 56: 403-413
- EMT-associated heterogeneity in circulating tumor cells: sticky friends on the road to metastasis.Cancers. 2020; 12: 1632
- Single-cell transcriptome analysis demonstrates inter-patient and intra-tumor heterogeneity in primary and metastatic lung adenocarcinoma.Aging. 2020; 12: 21559-21581
- Comprehensive analysis of EMT-related genes and lncRNAs in the prognosis, immunity, and drug treatment of colorectal cancer.J Transl Med. 2021; 19: 391
- Epitranscriptomics and epiproteomics in cancer drug resistance: therapeutic implications.Signal Transduct Target Ther. 2020; 5: 193
- Epithelial-to-mesenchymal transition is dispensable for metastasis but induces chemoresistance in pancreatic cancer.Nature. 2015; 527: 525-530
- Radiogenomic analysis demonstrates associations between (18)F-fluoro-2-deoxyglucose PET, prognosis, and epithelial-mesenchymal transition in non-small cell lung cancer.Radiology. 2016; 280: 261-270
- Diagnosis of recurrence and assessment of post-recurrence survival in patients with extracranial non-small cell lung cancer evaluated by 18F-FDG PET/CT.Lung Cancer. 2013; 81: 71-76
- Impact of initial PET/CT staging in terms of clinical stage, management plan, and prognosis in 592 patients with non-small-cell lung cancer.Eur J Nucl Med Mol Imaging. 2014; 41: 906-914
- 18F-FDG PET early response evaluation of locally advanced non-small cell lung cancer treated with concomitant chemoradiotherapy.J Nucl Med. 2013; 54: 1528-1534
- Prognostic value of the quantitative metabolic volumetric measurement on 18F-FDG PET/CT in stage IV nonsurgical small-cell lung cancer.Acad Radiol. 2012; 19: 69-77
- Metabolic response evaluated by 18F-FDG PET/CT as a potential screening tool in identifying a subgroup of patients with advanced non-small cell lung cancer for immediate maintenance therapy after first-line chemotherapy.Eur J Nucl Med Mol Imaging. 2013; 40: 1005-1013
- Metabolic tumor volume measured by F-18 FDG PET/CT can further stratify the prognosis of patients with stage IV non-small cell lung cancer.Nucl Med Mol Imaging. 2012; 46: 286-293
- Prognostic value of volumetric parameters on staging and posttreatment FDG PET/CT in patients with stage IV non-small cell lung cancer.Clin Nucl Med. 2016; 41: 347-353
- Analysis of ERCC1, BRCA1, RRM1 and TUBB3 as predictors of prognosis in patients with non-small cell lung cancer who received cisplatin-based adjuvant chemotherapy: a prospective study.Oncol Lett. 2016; 11: 299-305
- 18F-fludrodeoxyglucose maximal standardized uptake value and metabolic tumor burden are associated with major chemotherapy-related tumor markers in NSCLC patients.Onco Targets Ther. 2016; 9: 6315-6324
Article info
Publication history
Published online: May 16, 2023
Accepted:
March 20,
2023
Received in revised form:
March 19,
2023
Received:
January 12,
2023
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved All rights reserved.
