title: Prognostic value of volumetric parameters of (18)F-FDG PET in non-small-cell lung cancer: a meta-analysis.
abstract: OBJECTIVE
  We conducted a comprehensive systematic review of the literature on volumetric parameters from (18)F-FDG PET and a meta-analysis of the prognostic value of metabolic tumour volume (MTV) and total lesion glycolysis (TLG) in patients with lung cancer.
  
  
  METHODS
  A systematic search of MEDLINE and EMBASE was performed using the keywords "positron emission tomography (PET)", "lung cancer", and "volume". Inclusion criteria were: (18)F-FDG PET used as an initial imaging tool; studies limited to non-small-cell lung cancer (NSCLC); volume measurement of lung cancer; patients who had not undergone surgery, chemotherapy, or radiotherapy before the PET scan; and studies that reported survival data. Event-free survival and overall survival were evaluated as outcomes. The impact of MTV and TLG on survival was measured in terms of the hazard ratio (HR) effect size. Data from each study were analysed using Review Manager 5.2.
  
  
  RESULTS
  Thirteen eligible studies including 1,581 patients were analysed. Patients with high MTV showed a worse prognosis with an HR of 2.71 (95% CI 1.82 - 4.02, p < 0.00001) for adverse events and an HR of 2.31 (95% CI 1.54 - 3.47, p < 0.00001) for death. Patients with high TLG also showed a worse prognosis with an HR of 2.35 (95% CI 1.91 - 2.89, p < 0.00001) for adverse events and an HR of 2.43 (95% CI 1.89 - 3.11, p < 0.00001) for death. The prognostic value of MTV and TLG remained significant in a subgroup analysis according to TNM stage as well as the methods for defining cut-off values and tumour delineation.
  
  
  CONCLUSIONS
  Volumetric parameters from (18)F-FDG PET are significant prognostic factors for outcome in patients with NSCLC. Patients with a high MTV or TLG are at higher risk of adverse events and death. MTV and TLG were significant prognostic factors in patients with TNM stage I/II and stage III/IV NSCLC.
authors.affiliation: Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
authors.forename: Hyung-Jun
authors.initials: HJ
authors.lastname: Im
authors.forename: Kyoungjune
authors.initials: K
authors.lastname: Pak
authors.forename: Gi Jeong
authors.initials: GJ
authors.lastname: Cheon
authors.forename: Keon Wook
authors.initials: KW
authors.lastname: Kang
authors.forename: Seong-Jang
authors.initials: SJ
authors.lastname: Kim
authors.forename: In-Joo
authors.initials: IJ
authors.lastname: Kim
authors.forename: June-Key
authors.initials: JK
authors.lastname: Chung
authors.forename: E Edmund
authors.initials: EE
authors.lastname: Kim
authors.forename: Dong Soo
authors.initials: DS
authors.lastname: Lee
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18