Incorporation of the SUVmax Measured From FDG PET and Neutrophil-to-lymphocyte Ratio Improves Prediction of Clinical Outcomes in Patients With Locally Advanced Non-small-cell Lung Cancer

Approximately 20% to 25% of patients with non-small-cell lung cancer (NSCLC) are diagnosed with locally advanced disease. Despite carefully implemented treatment, the survival outcomes of these patients remain poor, with 5-year overall survival rates of 10% to 20%, and locoregional recurrence rates of 35% to 70%. This retrospective analysis of 138 patients with locally advanced NSCLC was conducted to find out the prognostic factors and to improve prediction of clinical outcomes. Incorporation of the maximum standardized uptake value and neutrophil-to-lymphocyte ratio improves prediction of clinical outcomes in patients with locally advanced NSCLC. Introduction: The aim of the present study was to investigate the value of incorporation 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) maximum standardized uptake value (SUVmax) and neutrophil-to-lymphocyte ratio (NLR) for improving prediction of clinical outcomes of patients with locally advanced none small-cell lung cancer (LA NSCLC). Materials and Methods: We retrospectively enrolled 138 patients with unresectable LA NSCLC at our institution from July 2010 to August 2017. Spearman correlation analyses were used to estimate the correlations between SUVmax and NLR level. The univariate and multivariate Cox survival analyses were used to evaluate the prognostic indicators, including the incorporation of SUVmax and NLR. We defined the SUVmax and NLR grade (SNG = 0, 1, or 2) score as the number of risk factors among (1) SUVmax > 11.95 and (2) NLR > 3.82. The SNG score prognostic value was evaluated for overall survival (OS) and progression-free survival (PFS). Results: Univariate analysis showed that tumor stage, SUVmax, SUVmean, NLR, and SNG score were significantly associated with OS and PFS in patients with LA NSCLC. Kaplan-Meier analysis and log-rank test demonstrated significant differences in both OS and PFS among patients in SNG score (OS, P < .001; PFS, P < .001). Spearman correlation analyses showed that SUVmax had a correlation with the NLR (r = 0.237; P = .005). In subgroup analyses for patients with tumor pathologic stage IIIA/IIIB, we found that the SNG score was significantly associated with OS and PFS in each subgroup (P < .001, P < .001 for OS and P = .027, P < .001 for PFS, respectively). Multivariate analysis showed that the SNG score was a significantly independent prognostic factor for OS (hazard ratio, 1.612; 95% confidence interval, 1.157-2.246; P = .005) and PFS (hazard ratio, 2.241; 95% confidence interval, 1.486-3.379; P < .001). Conclusion: Incorporation of the SUVmax and NLR improves prediction of clinical outcomes in patients with LA NSCLC.