Prognostic value of maximum standard uptake value, metabolic tumor volume, and total lesion glycolysis of 18F-FDG PET/CT in patients with renal carcinoma A protocol for systematic review and meta analysis

Purpose: We present a comprehensive systematic review of the documented literature on parameters derived from(18)F-fluorodeoxyglucose positron emission tomography (F-18-FDG PET) and meta-analysis of the prognostic value of maximal standard uptake value (SUVmax), metabolic tumor volume (MTV) and total lesional glycolysis (TLG) in patients with renal carcinoma (RCC). Patients and methods: Relevant articles in English from PubMed, EMBASE, and the Cochrane Library were retrieved. Pooled hazard ratio (HR) values were used to assess the prognostic value of SUVmax, MTV, and TLG. Results: A total of 10 primary studies involving 780 patients with RCC were included. The combined HRs for event-free survival were 1.32 (95% CI 1.10-1.58) for SUVmax, 2.40 (95% CI 1.20-4.79) for MTV, and 3.31 (95% CI 1.68-6.50) for TLG. Pooled HRs for overall survival were 1.264 (95% CI 1.124-1.421) for SUVmax, 3.52 (95% CI 1.451-8.536) for MTV, and 6.33 (95% CI 1.32-30.30) for TLG. Subgroup analysis revealed SUVmax as an independent risk factor for patients with recurrence or metastasis. Conclusion: The present meta-analysis confirmed that despite the clinical heterogeneity of RCC and adoption of various methods between studies, high SUVmax is a significant prognostic factor, especially in patients with recurrence or metastasis. MTV and TLG were associated with prediction of higher risk of adverse events or death in patients with RCC.