Prognostic Significance of Standardized Uptake Value of Lymph Nodes on Survival for Stage III Non-small Cell Lung Cancer Treated With Definitive Concurrent Chemoradiotherapy.
Definitive concurrent chemoradiotherapy is the standard treatment for stage III non-small cell lung cancer (NSCLC). Previous studies showed that the tumor size and its metabolic activity are predictors of treatment outcome. We investigated whether there are new metabolic prognostic factors of survival for stage III NSCLC after definitive concurrent chemoradiotherapy.



A total of 57 consecutive patients treated with definitive concurrent chemoradiotherapy for their stage IIIA (n=22) and stage IIIB (n=35) (AJCC 7th edition) unresectable NSCLC were identified. A total of 43 (75.4%) patients had positron emission tomography with integrated computed tomography (PET-CT) scan performed at diagnosis that were subsequently reviewed and analyzed. Prognosticators of progression-free survival (PFS), distant metastasis-free survival (DMFS), and overall survival (OS) were analyzed.



The median PFS, DMFS, and OS were 14.1, 12.6, and 37.8 months, respectively, after a median follow-up of 41.5 months. PFS advantage was demonstrated in stage IIIA versus stage IIIB (median 38.6 vs. 13.5 mo, P=0.020), N-stage N0-N2 versus N3 (median 16.7 vs. 8.1 mo, P<0.001), planning target volume (PTV) <500 versus ≥500 cm (median 23.6 vs. 11.3 mo, P=0.008), and the maximum standardized uptake value (SUVmax) nodes <8 versus ≥8 (median 16.1 vs. 10.7 mo, P=0.048). DMFS advantage was noted in those with PTV<500 versus PTV≥500 cm (median 13.0 vs. 11.3 mo, P=0.045) and SUVmax nodes <8 versus ≥8 (median 13.5 vs. 8.0 mo, P=0.050). OS advantage was revealed in stage IIIA versus stage IIIB (median 56.5 vs. 22.7 mo, P=0.013) and SUVmax nodes <8 versus ≥8 (42.3 vs. 12.8 mo, P=0.009). Multivariate analysis demonstrated that SUVmax nodes <8 was the only prognostic factor of PFS, DMFS, and OS. Metabolic tumor volume and total lesion glycolysis were not prognostic factors.



SUVmax nodes <8 was the only prognostic factor of PFS, DMFS, and OS in our study. PET-CT scan at the time of diagnosis is useful in stratifying patients into favorable and unfavorable groups in stage III NSCLC treated with definitive concurrent chemoradiotherapy.
Departments of *Clinical Oncology †Diagnostic Radiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
Victor H F
VH
Lee
Wendy W L
WW
Chan
Elaine Y P
EY
Lee
Tim-Shing
TS
Choy
Patty P Y
PP
Ho
Dennis K C
DK
Leung
Ka-On
KO
Lam
Dora L W
DL
Kwong
To-Wai
TW
Leung
Pek-Lan
PL
Khong
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D002289:Carcinoma, Non-Small-Cell Lung / Q000556:secondary / Q000628:therapy*; D059248:Chemoradiotherapy; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000628:therapy*; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000378:metabolism*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017239:Paclitaxel / Q000008:administration & dosage; D000072078:Positron Emission Tomography Computed Tomography; D011379:Prognosis; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D011880:Radiotherapy Planning, Computer-Assisted; D015996:Survival Rate
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D016190:Carboplatin; D017239:Paclitaxel