Independent prognostic value of whole-body metabolic tumor burden from FDG-PET in non-small cell lung cancer

Purpose To determine whether whole-body metabolic tumor burden, measured as either metabolic tumor volume (MTV WB ) or total lesion glycolysis (TLG WB ), using FDG-PET/CT is an independent prognostic marker in non-small cell lung cancer (NSCLC). Methods 328 patients with histologically proven NSCLC were identified for this retrospective analysis. This study was approved by our Institutional Review Board. All patients underwent baseline 18 F-FDG-PET/CT scan imaging before therapy. The MTV WB , TLG WB , maximum standardized uptake value (SUV maxWB ) and mean standardized uptake value (SUV meanWB ) of tumors throughout the whole body were measured from FDG-PET images with semi-automated 3D contouring software. Results In univariate analysis, there was a statistically significant association of overall survival (OS) with the MTV WB (hazard ratio (HR) = 1.62, p < 0.001), TLG WB (HR = 1.47, p < 0.001). The patients with a MTV WB ≤ median of 65.7 ml and TLG WB ≤ median of 205.11 SUV mean * ml had a median OS of 41.1 and 35.4 months compared with 9.5 and 9.7 months for those with a MTV WB > 65.7 ml and TLG WB > 205.11 SUV mean * ml, respectively. From a series of multivariate Cox regression models, the MTV WB and TLG WB were significantly better than SUV maxWB and SUV meanWB at prognostication and significantly associated with patients’ OS with HRs of 1.50 ( p < 0.001) and 1.42 ( p < 0.001), respectively, after adjustment for patient’s age, gender and treatment intent as well as the tumor SUV maxWB , histology and stage. Conclusions MTV WB and TLG WB as metabolic tumor burden measurements in 18 F-FDG-PET/CT are independent prognostic markers and are significantly better than SUV maxWB and SUV meanWB at prognostication.