Prognostic Value of Volumetric Parameters on Staging and Posttreatment FDG PET/CT in Patients With Stage IV Non-Small Cell Lung Cancer

Purpose This study aimed to evaluate the prognostic value of metabolic tumor burden as measured with metabolic tumor volume (MTV) and total lesion glycolysis (TLG), as well as SUVmax on initial staging and posttreatment F-18-FDG PET/CT in patients with stage IV non-small cell lung cancer (NSCLC). Methods Sixty-three NSCLC patients with stage IV who underwent staging and posttreatment FDG PET/CT after completion of the first-line chemotherapy were retrospectively enrolled. SUVmax, MTV, and TLG of primary cancer and all metastatic lesions (lymph node and distant metastases) on both PET/CT images were measured and their association with progression-free survival (PFS) and overall survival (OS) analyzed. Results Median PFS and OS in the patient population were 5.9 and 23.1 months, respectively. Among the PET/CT parameters, MTV and TLG of primary cancer lesions on initial PET/CT and MTV and TLG of metastatic lesions on posttreatment PET/CT were independent prognostic factors for both PFS and OS (P < 0.05). The median OS in patients who showed low values of those PET/CT parameters was more than 26.0 months, whereas patients with high values of those parameters had a median OS of less than 15.0 months. Conclusions Metabolic tumor burdens of primary cancer lesions on staging PET/CT and metastatic lesions on posttreatment PET/CT were independent prognostic factors in patients with stage IV NSCLC. Volume-based PET parameters could further stratify the prognosis of stage IV NSCLC patients.