Hoda Anwar1, Thomas J Vogl2, Mahasen A Abougabal3, Frank Grünwald4, Peter Kleine5, Sherif Elrefaie3, Nour-Eldin A Nour-Eldin2,6. 1. Nuclear Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology and Nuclear Medicine, Faculty of Medicine-Cairo University, Cairo, Egypt. hoda.nagui@gmail.com. 2. Institute for Diagnostic and Interventional Radiology, Johann Wolfgang von Goethe University Hospital, Frankfurt am Main, Germany. 3. Nuclear Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology and Nuclear Medicine, Faculty of Medicine-Cairo University, Cairo, Egypt. 4. Department of Nuclear Medicine, Johann Wolfgang von Goethe University Hospital, Frankfurt am Main, Germany. 5. Department of Cardiothoracic Surgery, Johann Wolfgang von Goethe University Hospital, Frankfurt am Main, Germany. 6. Department of Diagnostic and Interventional Radiology, Cairo University Hospital, Cairo, Egypt.
Abstract
OBJECTIVE: Administration of postoperative chemotherapy to patients with completely resected stage I NSCLC is still a matter of debate. The aim of the present study was to evaluate the value of different baseline 18F-FDG PET parameters in identifying surgical stage I NSCLC patients who are at high risk of recurrence, and thus are indicated for further postoperative treatment. METHODS: This is a retrospective study, which included 49 patients (28 males, 21 females) with the median age of 69 years (range 28-84), who had pathologically proven stage I NSCLC. All patients underwent 18F-FDG PET/CT at baseline followed by complete surgical resection of the tumor (R0). Baseline SUVmax, MTV and TLG were measured. Patients' follow-up records were retrospectively reviewed, and DFS (disease-free survival) was assessed. For each parameter, the most accurate cut-off value for the prediction of recurrence was calculated using the ROC curve analysis and the Youden index. DFS was evaluated for patients above and below the calculated cut-off value using the Kaplan-Meier method and the difference in survival between the two groups was estimated using the log-rank test. RESULTS: Median observation time of the patients after surgery was 28.7 months (range 3.5-58.8 months). 9 patients developed recurrence. The calculated cut-off values for SUVmax, MTV and TLG were 6, 6.6 and 33.6, respectively. Using these cut-offs, the observed sensitivity for SUVmax, MTV and TLG for prediction of recurrence was 100%, 89% and 89%, respectively, while the observed specificity was 43%, 73% and 65%, respectively. The difference in survival between patients below and above the cut-off value was statistically significant in all three studied parameters. The highest AUC was observed for MTV (AUC = 0.825, p = 0.003), followed by TLG (AUC = 0.789, p = 0.007), and lastly SUVmax (AUC = 0.719, p = 0.041). ROC curve analysis showed that volumetric parameters had better predictive performance than SUVmax as regards recurrence. CONCLUSION: PET-derived parameters at baseline were predictive of recurrence in stage I surgical NSCLC patients. Moreover, the metabolic volume of the tumor was the most significant parameter for this purpose among the studied indices.
OBJECTIVE: Administration of postoperative chemotherapy to patients with completely resected stage I NSCLC is still a matter of debate. The aim of the present study was to evaluate the value of different baseline 18F-FDG PET parameters in identifying surgical stage I NSCLCpatients who are at high risk of recurrence, and thus are indicated for further postoperative treatment. METHODS: This is a retrospective study, which included 49 patients (28 males, 21 females) with the median age of 69 years (range 28-84), who had pathologically proven stage I NSCLC. All patients underwent 18F-FDG PET/CT at baseline followed by complete surgical resection of the tumor (R0). Baseline SUVmax, MTV and TLG were measured. Patients' follow-up records were retrospectively reviewed, and DFS (disease-free survival) was assessed. For each parameter, the most accurate cut-off value for the prediction of recurrence was calculated using the ROC curve analysis and the Youden index. DFS was evaluated for patients above and below the calculated cut-off value using the Kaplan-Meier method and the difference in survival between the two groups was estimated using the log-rank test. RESULTS: Median observation time of the patients after surgery was 28.7 months (range 3.5-58.8 months). 9 patients developed recurrence. The calculated cut-off values for SUVmax, MTV and TLG were 6, 6.6 and 33.6, respectively. Using these cut-offs, the observed sensitivity for SUVmax, MTV and TLG for prediction of recurrence was 100%, 89% and 89%, respectively, while the observed specificity was 43%, 73% and 65%, respectively. The difference in survival between patients below and above the cut-off value was statistically significant in all three studied parameters. The highest AUC was observed for MTV (AUC = 0.825, p = 0.003), followed by TLG (AUC = 0.789, p = 0.007), and lastly SUVmax (AUC = 0.719, p = 0.041). ROC curve analysis showed that volumetric parameters had better predictive performance than SUVmax as regards recurrence. CONCLUSION: PET-derived parameters at baseline were predictive of recurrence in stage I surgical NSCLCpatients. Moreover, the metabolic volume of the tumor was the most significant parameter for this purpose among the studied indices.
Authors: Germán Andrés Jiménez Londoño; Ana Maria García Vicente; Jesús J Bosque; Mariano Amo-Salas; Julián Pérez-Beteta; Antonio Francisco Honguero-Martinez; Víctor M Pérez-García; Ángel María Soriano Castrejón Journal: Eur Radiol Date: 2022-02-08 Impact factor: 5.315