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The Role of 18F-FDG PET/CT on Staging and Prognosis in Patients with Small Cell Lung Cancer

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Abstract

Background

We evaluated 18F-FDG PET/CT in small cell lung cancer (SCLC) staging and assessed metabolic (SUVmax, MTV and TLG) and morphologic (CTvol) variables as predictors for overall survival (OS) and progression-free survival (PFS).

Methods

Patients with newly diagnosed, histopathology-confirmed SCLC, who underwent 18F-FDG PET/CT were evaluated. A Cox proportional hazard model was used to determine the association between the primary tumour SUVmax, MTV, TLG and CTvol with OS and PFS. Similar evaluations were performed when hilar/mediastinal lymphadenopathy was included [total SUVmax (TSUVmax), total MTV (TMTV) and total TLG (TTLG)].

Results

55 patients were included. 18F-FDG PET/CT changed staging in 6/55 (10.9%) patients who were upstaged to extensive disease. TTLG (>443.8) was a significant variable for OS with HR=2.1 (CI 1.14–3.871, p=0.017). Patients with TTLG>443.8 had a median OS of 13.4 months compared to 25.7 months in patients with TTLG<443.8 (p=0.018). TMTV (>72.4) was significant for PFS with HR=2.3 (CI 1.11-4.8, p=0.025). A median PFS of 12.1 and 26.2 months was found with TMTV greater and less than 72.4, respectively (p=0.005).

Conclusions

18F-FDG PET/CT improved staging of patients with SCLC, and TTLG and TMTV can be used as prognostic variables for OS and PFS, respectively.

Key Points

• Identifying variables that predict the prognosis of patients with SCLC is important.

• 18F-FDG PET/CT influences staging of patients with SCLC.

• Metabolic parameters could be used as predictors for PFS and OS.

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Abbreviations

CTvol:

Computed tomography volume

MTV:

Metabolic tumour volume

NSCLC:

Non-small cell lung cancer

SCLC:

Small cell lung cancer

SUVmax:

Maximum standardized uptake value

TLG:

Total lesion glycolisis

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Acknowledgments

The scientific guarantor of this publication is Dr Hanna Bernstine. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Methodology: retrospective, observational, performed at one institution.

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Authors and Affiliations

  1. Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel

    A. Zer, D. Flex, A. M. Allen & S. M. Stemmer

  2. Department of Nuclear Medicine, Rabin Medical Center, Petah Tikva, Israel

    L. Domachevsky, M. Nidam, D. Groshar & H. Bernstine

  3. Department of Radiology, Rabin Medical Center, Petah Tikva, Israel

    Y. Rapson

  4. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    D. Groshar & H. Bernstine

  5. Beilinson Hospital, 39 Jabotinski St., Petah Tikva, 4941492, Israel

    L. Domachevsky

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  1. A. Zer
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  2. L. Domachevsky
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  4. M. Nidam
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  5. D. Flex
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  6. A. M. Allen
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  8. D. Groshar
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  9. H. Bernstine
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Corresponding author

Correspondence to L. Domachevsky.

Additional information

Liran Domachevsky and Alona Zer contributed equally to this work.

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Zer, A., Domachevsky, L., Rapson, Y. et al. The Role of 18F-FDG PET/CT on Staging and Prognosis in Patients with Small Cell Lung Cancer. Eur Radiol 26, 3155–3161 (2016). https://doi.org/10.1007/s00330-015-4132-2

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  • DOI: https://doi.org/10.1007/s00330-015-4132-2

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