Validation of an independent prognostic value of the asphericity of F18-fluorodeoxyglucose (FDG) uptake in non-small cell lung cancer (NSCLC) patients undergoing treatment in curative intent

Background

In patients with non-small cell lung cancer (NSCLC), asphericity (ASP) of the primary tumor’s metabolic tumor volume (MTV) has shown prognostic significance. This study aimed at validation in an independent, sufficiently large cohort.
Patients and Methods

Retrospective study in 311 NSCLC patients undergoing FDG-PET/CT before curatively intended treatment (always including surgery). 140 patients had UICC stage I, 78 stage II, and 93 stage III (adenocarcinoma [ADC]:153; squamous cell carcinoma [SCC]:141). Primary tumor MTV was delineated with semiautomated background-adapted threshold relative to SUVmax. Cox regression (PFS/OS) for PET (MTV, ASP, SUVmax), clinical (T/N descriptor, UICC stages), histological and treatment variables (Rx/1 vs. R0 resection, chemotherapy/radiotherapy yes/no).
Results

Events (progression/relapse) occurred in 167/311 patients, 137 died (median survivor follow-up, 37 months). In multivariable Cox regression for OS, ASP>33.3% (HR, 1.58 [1.04-2.39]), male sex (1.84), age (1.04 per year), EGOG≥2 vs. 0/1 (2.68), stage II vs. I (1.96), and Rx/1 vs. R0 resection (2.1) were significant. Among separate UICC stages, ASP only predicted OS in stage II (optimal, >19.5%; median OS, 33 vs. 59 months). Regarding PFS, ASP>21.2%, male sex, EGOG≥2, stage II vs. I, and Rx/1 resection were prognostic. ASP remained prognostic in stage II (optimal, >19.5%; PFS, 12 vs. 47 months). Log-rank test for ASP was significant at any cut-off ≥18% (OS) or from 9-59% (PFS).
Conclusion

ASP was validated as prognostic factor for PFS and OS in patients with NSCLC and curative treatment intent, especially stage II. High ASP in stage II could imply intensified treatment or intensified follow-up.