Brose Alexander, Miederer Isabelle, König Jochem, Gkika Eleni, Sahlmann Jörg, Schimek-Jasch Tanja, Schreckenberger Mathias, Nestle Ursula, Kappes Jutta, Miederer Matthias
Department of Translational Imaging in Oncology, National Center for Tumor Diseases (NCT/UCC) Dresden, Medical Faculty and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, Dresden, 01307, Germany.
German Cancer Research Center (DKFZ), Heidelberg, Germany.
Cancer Imaging. 2024 Dec 21;24(1):171. doi: 10.1186/s40644-024-00811-7.
Staging of non-small cell lung cancer (NSCLC) is commonly based on [F]FDG PET/CT, in particular to exclude distant metastases and guide local therapy approaches like resection and radiotherapy. Although it is hoped that PET/CT will increase the value of primary staging compared to conventional imaging, it is generally limited to the characterization of TNM. The first aim of this study was to evaluate the PET parameter metabolic tumor volume (MTV) above liver background uptake as a prognostic marker in lung cancer. The second aim was to investigate the possibility of incorporating MTV into the TNM classification system for disease prognosis in locally advanced NSCLC treated with chemoradiotherapy.
Retrospective evaluation of 235 patients with histologically proven, locally advanced NSCLC from the multi-centre randomized clinical PETPLAN trial and a clinical cohort from a hospital registry. The PET parameters SUVmax, SULpeak, MTV and TLG above liver background uptake were determined. Kaplan-Meier curves and stratified Cox proportional hazard regression models were used to investigate the prognostic value of PET parameters and TNM along with clinical variables. Subgroup analyses were performed to compare hazard ratios according to TNM, MTV, and the two variables combined.
In the multivariable Cox regression analysis, MTV was associated with significantly worse overall survival independent of stage and other prognostic variables. In locally advanced disease stages treated with chemoradiotherapy, higher MTV was significantly associated with worse survival (median 17 vs. 32 months). Using simple cut-off values (45 ml for stage IIIa, 48 ml for stage IIIb, and 105 ml for stage IIIc), MTV was able to further predict differences in survival for stages IIIa-c. The combination of TNM and MTV staging system showed better discrimination for overall survival in locally advanced disease stages, compared to TNM alone.
Higher metabolic tumor volume is significantly associated with worse overall survival and combined with TNM staging, it provides more precise information about the disease prognosis in locally advanced NSCLC treated with chemoradiotherapy compared to TNM alone. As a PET parameter with volumetric information, MTV represents a useful addition to TNM.
非小细胞肺癌（NSCLC）的分期通常基于[F]FDG PET/CT，特别是用于排除远处转移并指导局部治疗方法，如手术切除和放疗。尽管人们希望PET/CT相比传统成像能提高初始分期的价值，但它通常仅限于TNM的特征描述。本研究的首要目的是评估高于肝脏本底摄取的PET参数代谢肿瘤体积（MTV）作为肺癌的预后标志物。第二个目的是研究将MTV纳入TNM分类系统以预测接受放化疗的局部晚期NSCLC疾病预后的可能性。
对多中心随机临床PETPLAN试验中235例经组织学证实的局部晚期NSCLC患者以及一家医院登记处的临床队列进行回顾性评估。测定高于肝脏本底摄取的PET参数SUVmax、SULpeak、MTV和TLG。采用Kaplan-Meier曲线和分层Cox比例风险回归模型研究PET参数、TNM以及临床变量的预后价值。进行亚组分析以比较根据TNM、MTV以及两者组合的风险比。
在多变量Cox回归分析中，MTV与显著更差的总生存期相关，独立于分期和其他预后变量。在接受放化疗的局部晚期疾病阶段，较高的MTV与更差的生存期显著相关（中位生存期分别为17个月和32个月）。使用简单的临界值（Ⅲa期为45 ml，Ⅲb期为48 ml，Ⅲc期为105 ml），MTV能够进一步预测Ⅲa - c期患者生存期的差异。与单独的TNM相比，TNM和MTV分期系统的组合在局部晚期疾病阶段对总生存期具有更好的区分度。
较高的代谢肿瘤体积与显著更差的总生存期相关，并且与TNM分期相结合，与单独的TNM相比，它能为接受放化疗的局部晚期NSCLC提供更精确的疾病预后信息。作为具有体积信息的PET参数,MTV是TNM的有益补充。
