Metabolic Burden Measured by (18)F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Is a Prognostic Factor in Patients with Small Cell Lung Cancer

PURPOSE: Evidence regarding the usefulness of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-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 (18)F-FDG PET/CT in patients with SCLC. MATERIALS AND METHODS: We 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 (18)F-FDG PET/CT. The maximal SUV (SUV(max)) was used quantitatively for determination of FDG PET activity. The SUV(max) of the primary tumor (primary SUV(max)), the sum of SUV(max) values of malignant lesions (SUV(sum)), and the mean SUV(max) of malignant lesions were calculated. RESULTS: The patient population was subdivided using a median SUV(sum) value of 24.6. High SUV(sum) 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 SUV(sum) 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 SUV(sum). Results of multivariate analysis showed that SUV(sum), chemotherapy cycles, and the response to first-line treatment were significant prognostic factors of survival. In contrast, mean SUV(max) and primary SUV(max) were not significant predictors of survival. CONCLUSION: In this study, metabolic burden represented by SUV(sum) from pretreatment (18)F-FDG PET/CT was an independent prognostic factor in patients with SCLC.