title: Relationship between Overall Survival of Patients with Non-Small Cell Lung Cancer and Whole-Body Metabolic Tumor Burden Seen on Postsurgical Fluorodeoxyglucose PET Images.
abstract: OBJECTIVE
  To test the hypothesis that whole-body metabolic tumor burden (MTBWB) on postsurgical fluorodeoxyglucose (FDG) positron emission tomographic (PET)/computed tomographic (CT) images in patients with non-small cell lung cancer (NSCLC) is associated with their overall survival (OS).
  
  
  METHODS
  The institutional review board approved this study and waived the requirement for obtaining informed consent. One hundred forty-two patients with NSCLC (69 men, 73 women; median age, 67.7 years) who underwent postsurgical FDG PET/CT were retrospectively reviewed. The whole-body metabolic tumor volume (MTVWB), whole-body total lesion glycolysis (TLGWB), and whole-body maximum standardized uptake value (SUVWBmax) were measured. OS served as the primary end point of the study. Kaplan-Meier curves and Cox regression were used to assess the association between PET/CT markers and OS.
  
  
  RESULTS
  The interobserver variability was low, as demonstrated with intraclass correlation coefficients higher than 0.94 for SUVWBmax, MTVWB, and TLGWB. When compared with those with negative postsurgical FDG PET/CT findings, a significant decrease of OS was found in patients with the presence of FDG-avid tumor on the basis of both a log-rank test (P = .001) and a univariate Cox model (hazard ratio = 2.805, P = .001). In patients with FDG-avid tumor, there was a significant association between OS and ln MTVWB (P < .001), ln TLGWB (P < .001), and ln SUVWBmax (P < .010) in either univariate or multivariate analysis, after adjusting for patient age, sex, TNM restage, and therapy after postsurgical PET/CT studies. The OS differences between the groups dichotomized by the median value of MTVWB (11.54 mL, P = .004), TLGWB (32.38 mL, P < .001), or SUVWBmax (4.93, P = .023) were significant.
  
  
  CONCLUSIONS
  MTBWB and tumor maximum standardized uptake at postsurgical FDG PET/CT are related to the patient's OS in NSCLC, independent of age, sex, TNM restaging, and therapy after postsurgical PET/CT studies.
authors.affiliation: From the Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China (C.Z.); Department of Public Health Sciences (C.L.), Department of Radiology (B.C.P., D.E.A., Y.P.), and Cancer Registry (C.A.S.), University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637.
authors.forename: Chenpeng
authors.initials: C
authors.lastname: Zhang
authors.forename: Chuanhong
authors.initials: C
authors.lastname: Liao
authors.forename: Bill C
authors.initials: BC
authors.lastname: Penney
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Appelbaum
authors.forename: Cassie A
authors.initials: CA
authors.lastname: Simon
authors.forename: Yonglin
authors.initials: Y
authors.lastname: Pu
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000378:metabolism / Q000401:mortality* / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000401:mortality* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18