Contribution of metabolic tumor volume and total lesion glycolysis to predict prognosis in early-stage lung cancer at preoperative staging

Abstract

Objective: To evaluate the effect of metabolic tumor volume (MTV) and total lesion glycolysis (TLG) values of the primary tumor measured by preoperative positron emission tomography/computed tomography (FDG-PET/CT) on survival in patients with operated non-small cell lung cancer (NSCLC).

Study Design: Cohort study.

Place and Duration of Study: Recep Tayyip Erdogan University, Faculty of Medicine, Department of Medical Oncology from January 2017 to June 2020, Turkey.

Methodology: Patients with operated NSCLC were reviewed retrospectively. Metabolic parameters of FDG-PET/CT such as pathological tumor features, type of operation, MTV/TLG values, and whether they received adjuvant therapy were evaluated. Disease-free survival (DFS) and overall survival (OS) times were calculated.

Results: Most of the 77 patients (96.1%) were male. The mean age is 64 +/- 8 years. Lobectomy was performed in 66 (85.7%) patients, and pneumonectomy was performed in 11 (14.3%) patients. The mean tumor diameter was 3.7 +/- 2.015cm. Squamous cell carcinoma was detected in 37 patients (48.1%) and adenocarcinoma in 35 patients (45.5%). Thirty-eight patients (49.4%) received adjuvant chemotherapy. SUVmax, MTV, and TLG values of the primary tumor were high in patients under 65 years of age and with a tumor diameter of >= 3cm. DFS was nine months (4.5-18), and OS was 19 months (11-29). The 2-year survival rate was 75.6%. It was observed that patients with adenocarcinoma relapsed more frequently, which negatively affected survival (p=0.023, and p=0.024 respectively). High MTV (p=0.01) and TLG (p=0.015) values were associated with poor prognosis.

Conclusion: NSCLC is a heterogeneous disease, and survival is affected by many factors. Our study showed that the subtype of adenocarcinoma and high MTV and TLG values of the primary tumor are poor prognostic factors in operated early-stage lung cancers.