Predictive value of asphericity of pretherapeutic FDG uptake in NSCLC

Objectives: FDG-PET/CT has become the standard for staging of local tumor extent, mediastinal lymph node involvement and distant metastatic disease in patients with non-small-cell lung cancer (NSCLC). However, its role for prognosis is less clear. The aim of the present study was to evaluate the prognostic value of a novel quantitative measure for the spatial heterogeneity of FDG uptake, the asphericity (ASP).

Methods: FDG-PET/CT had been performed in 68 patients (65.5±8.8y) with newly diagnosed NSCLC prior to treatment. PET images of the primary tumor were segmented using the ROVER 3D segmentation tool based on thresholding at the volume-reproducible intensity threshold after subtraction of local background. ASP defined as the deviation of the tumor's shape from sphere shape was computed. Kaplan-Meier analysis with respect to progression-free (PFS) and overall survival (OS) was performed for localization (central vs. peripheral), SUVmax, metabolically active tumor volume (MTV), total lesion glycolysis (TLG) and ASP. OS and PFS curves were separated by the median value and compared by log-rank tests.

Results: 38 patients experienced tumor progression or recurrence after a median interval of 6.2 months (range 1.4-23.7). 28 patients died after a median interval of 7.1 months (0.4-19.4). The localization of the tumor was a predictor of both PFS (p=0.04, 2-year PFS 58% vs 45% for peripheral vs central localization) and OS (p=0.02, 2-year OS 57% vs 33%). ASP was the only PET-based parameter with prognostic value for PFS (p=0.005): the probability of 2-year PFS decreased from 60 % in the patients with low ASP to 47 % in the patients with high ASP. None of the PET-based parameters was predictive for OS.

Conclusions: The asphericity of the pretherapeutic FDG-uptake provides more power for the prediction of PFS in NCSLC than conventional quantitative measures including SUVmax, MTV and TLG.