The ratio between the whole-body and primary tumor burden, measured on (18)F-FDG PET/CT studies, as a prognostic indicator in advanced non-small cell lung cancer

OBJECTIVE: To determine whether the whole-body tumor burden, as quantified by (18)F-fluorodeoxyglucose positron-emission tomography/computed tomography ((18)F-FDG PET/CT), is a prognostic indicator in advanced (stage III or IV) non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: This was a prospective study in which we evaluated (18)F-FDG PET/CT staging parameters to quantify tumor burdens in patients with stage III or IV NSCLC. The following parameters were evaluated for the whole body (including the primary tumor) and for the primary tumor alone, respectively: maximum standardized uptake volume (wbSUV(max) and tuSUV(max)); metabolic tumor volume (wbMTV and tuMTV); and total lesion glycolysis (wbTLG and tuTLG). To determine whether the (18)F-FDG PET/CT parameters were associated with overall survival (OS) and progression-free survival (PFS), we evaluated the wbSUV(max)/tuSUV(max), wbMTV/tuMTV, and wbTLG/tuTLG ratios. RESULTS: (18)F-FDG PET/CT was performed for staging in 52 patients who were followed for a median of 11.0 months (mean, 11.7 months). The estimated median PFS and OS were 9.6 months and 11.6 months, respectively. In the univariate analysis, OS was found to correlate significantly with wbTLG (hazard ratio [HR] = 1.001; 95% confidence interval [95 CI]: 1.000-1.001; p = 0.0361) and with the wbTLG/tuTLG ratio (HR = 1.705; 95% CI: 1.232-2.362; p = 0.0013). In the multivariate analysis, only the wbTLG/tuTLG ratio was independently associated with OS (HR = 1.660; 95% CI: 1.193-2.310; p = 0.0027). CONCLUSION: The wbTLG/tuTLG ratio is an independent prognostic indicator of OS in advanced-stage NSCLC.