Prognostic value of node-to-primary tumor maximum standardized uptake value ratio in T1-4N1-3M0 non-small cell lung cancer patients treated with concurrent chemo-radiotherapy

BACKGROUND: This study aimed to identify whether NTR is the independent risk factor for progression-free survival (PFS) and overall survival (OS) in patients treated with concurrent chemo-radiotherapy (cCRT). METHODS: We retrospectively studied 106 T1-4N1-3M0 non-small cell lung cancer patients treated with cCRT. The maximum standardized uptake value (SUVTumor) of the primary tumor and the metastatic lymph nodes (SUVLN) were measured. The prognostic significance of NTR for predicting PFS and OS was assessed. A multi-adjusted spline regression model was conducted to provide more precise estimates and examine the shape of the associations between NTR and the risk of progression. RESULTS: From 2012 to 2017, 106 eligible patients were analyzed. The median follow-up time was 15.3 months (3.5–44.6 months). We determined the maximizing area under the time-dependent receiver operating characteristic curve was at an NTR of 0.73 for predicting PFS. The two-year PFS was significantly lower in the high-NTR group (35.7% vs. 55.4%, P = 0.02) and two-year OS (43.4% vs. 61.1%, P = 0.03 was also significantly worse. Multivariable analysis revealed that only NTR was an independent prognostic factor for PFS (hazard ratio [HR]: 10.04, P < 0.001) and OS (HR: 4.19, P = 0.03). The restricted cubic spline regression model showed that NTR had a non-linear relationship with log relative risk for progression. CONCLUSION: NTR was an independent risk factor for predicting PFS and OS in T1-4N1-3M0 non-small cell lung cancer patients treated with cCRT.