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Context: The prognostic criteria for early-stage nonsmall cell lung cancer (NSCLC) wait to be explored. Aim: In this study, our aim was to evaluate the prognostic significance of the positron emission tomography/computed tomography (PET/CT) maximum standardized uptake value (SUVmax) value of the primary tumor in patients with a diagnosis of early-stage NSCLC who received surgical treatment. Settings and Design: This was a multicenter retrospective design. Materials and Methods: Patients who had been diagnosed with early-stage NSCLC and who underwent surgery for the condition were included in this study. The preoperative fluorodeoxyglucose (18F-FDG) PET/CT results of the patients were retrospectively accessed from their medical files. The disease-free survival (DFS) rates of patients who had SUVmax values above and below the determined cutoff value were compared. Statistical Analysis Used: SPSS version 22 and Kaplan–Meier method were used for statistical analysis. Results: A total of 92 patients were included in the study. The median age of the patients was 60 years (range: 36–79). The determined cutoff SUVmax value of the primary tumor was 13.6. A comparison of the DFS rates of the patients with an SUVmax value above and below 13.6 revealed a significant difference in patients with Stage I (22.9 months vs. 50.3 months; P = 0.02) and Stage II (28 months vs. 40.4 months; P = 0.04), Stage I + II (43.5 months vs. 26.1 months; P = 0,02), and Stage IIIA (14.7 months vs. 13.6 months; P = 0.92) NSCLC. Conclusions: We found that in early-stage NSCLC patients, the SUVmax value of the primary mass in 18F FDG PET/CT was a prognostic indicator for the DFS rates
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Background: Small-cell lung cancer (SCLC) accounts for 15%-20% of all lung cancer cases. positron emission tomography - computed tomography (PET/CT) has become increasingly used as an initial staging tool in patients with SCLC. We aimed to explore the relationships between primary tumor 18F-FDG uptake measured as the maximum standardized uptake value (SUV max) and clinical stage at PET/CT for small cell lung cancer patients (SCLC).Methods: Patients with SCLC who underwent 18F-FDG PET/CT scans before the treatment were included in the study at Bach Mai hospital of Vietnam, from November 2014 to May 2018. The primary tumor and secondary lesion SUVmax was calculated; the tumor size was measured; the TNM status was determined mainly by FDG PET/CT imaging according to The 8th Edition of the TNM Classification for Lung Cancer were recorded. An evaluation was made of the linear relationship between tumor size, T stage, N stage, and M stages of the patients and their SUVmax using Spearman’s correlation.Results: Total 37 cases (34 men and 3 women; age range 38 - 81 years, median 64 years) were analyzed. The average of primary tumor size and SUVmax were 5.95±2.77 cm and 10.21±4.75, respectively. The SUVmax of primary tumor is significantly greater than that of nodal and distant organ metastasis (10.21±4.75 vs 8.20±4.35 and 6.44±3.17, p<0.01). There was a moderate correlation between SUVmax and tumor size (r =0.596, p<0.001), tumor stage (r = 0.502, p<0.01) but not significant with nodal stage (r =-0.218, p=0.194), metastasis stage (r = -0.055, p=0.747), and overall stage (r=-0.060, p=0.725).Conclusions: SUVmax was significantly correlated with tumor size, but not with distant metastases or lymph node involvement. Therefore, SUVmax on positron emission tomography is not predictive of the presence of metastases in patients with SCLC.
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Objective To investigate the relationship between SUVmax on preoperative 68Ga-PSMA PET-CT and the clinicopathological characteristics of patients treated with radical prostatectomy.Methods The clinicopahtological data of patients evaluated with 68Ga-PSMA PET-CT preoperatively and treated with radical prostatectomy between May 2016 and August 2019 were retrospectively reviewed.31 patients with a mean age (63.1 ± 4.9) and baseline PSA (72.71 ± 173.15) ng/ml were enrolled.Their BMI mean (24.6 ± 3.0) kg/m2.Baseline testosterone of 14 patients was (4.72 ± 1.64) ng/ml.Based on the Gleason scores related ISUP classification,all patients were classified into grade one in 5 cases,grade 2in 7 cases,grade 3 in 4 cases,grade 4 in 10 cases and grade 5 in 5 cases.The clinical classification included 6 cases in T2a stage,2 cases in T2b stage,17 cases in T2c stage,1 case in T3a stage,4 cases in T3b stage and 1 case in T4 stage.SUVmax was accessed by two independent professional nuclear medicine physicians.SUVmax was 12.49 ± 9.38.SPSS 16.0 software was used to do statistic analysis.Results The post-operative pathological results showed the surgical margin positive in 19 cases,negative in 12 cases,vascular positive in 5 cases,negative in 20 case,positive nerve invasion in 20 cases and negative in 11 cases.2 patients were low risk,7 patients were medium risk and 22 patients were high risk according to D'Amico classification.Based on the basis of PSA(≤ 10 or ＞ 10) and Gleason score (≤6 or ＞ 6),6 patients were in group with low PSA and low Gleason score,5 patients were low PSA and high Gleason score,9 patients were high PSA and low Gleason score,11 patients were high PSA and high Gleason score.SUVmax had a significant positive relationship with pathological ISUP (r =0.434,P =0.015) and SUVmax in patients with positive intravascular tumor emboli was significantly higher than those with negative intravascular tumor emboli (14.78 ± 10.68 vs.8.17 ± 2.81,P =0.005).No significant correlation was found between SUVmax and baseline PSA,testosterone,pathologic T stage,surgical margin,nerve invasion,pelvic lymph node status as well as risk stratification.SUVmax could distinguish pathologic ISUP grade 5 with a maximum AUC 0.747 (P =0.033) and the sensitivity was 88.9％.The specificity was 77.3％ when SUVmax ≥ 11.34.SUVmax in patients with upgrading ISUP was significantly higher than that in patients with downgrading ISUP (16.01 ± 5.40 vs.4.98 ± 2.11,P =0.007).Conclusions SUVmax measured on preoperative 68 Ga-PSMA PET-CT may have a clinical significance in predicting unfavorable pathological factors for patients treated with radical prostatectomy.
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Objective@#To investigate the relationship between SUVmax on preoperative 68Ga-PSMA PET-CT and the clinicopathological characteristics of patients treated with radical prostatectomy.@*Methods@#The clinicopahtological data of patients evaluated with 68Ga-PSMA PET-CT preoperatively and treated with radical prostatectomy between May 2016 and August 2019 were retrospectively reviewed. 31 patients with a mean age (63.1±4.9) and baseline PSA (72.71±173.15)ng/ml were enrolled. Their BMI mean (24.6±3.0)kg/m2. Baseline testosterone of 14 patients was (4.72±1.64)ng/ml.Based on the Gleason scores related ISUP classification, all patients were classified into grade one in 5 cases, grade 2in 7 cases, grade 3 in 4 cases, grade 4 in 10 cases and grade 5 in 5 cases. The clinical classification included 6 cases in T2a stage, 2 cases in T2b stage, 17 cases in T2c stage, 1 case in T3a stage, 4 cases in T3b stage and 1 case in T4 stage. SUVmax was accessed by two independent professional nuclear medicine physicians. SUVmax was 12.49±9.38. SPSS 16.0 software was used to do statistic analysis.@*Results@#The post-operative pathological results showed the surgical margin positive in 19 cases, negative in 12 cases, vascular positive in 5 cases, negative in 20 case, positive nerve invasion in 20 cases and negative in 11 cases. 2 patients were low risk, 7 patients were medium risk and 22 patients were high risk according to D′Amico classification. Based on the basis of PSA(≤10 or>10) and Gleason score(≤6 or>6), 6 patients were in group with low PSA and low Gleason score, 5 patients were low PSA and high Gleason score, 9 patients were high PSA and low Gleason score, 11 patients were high PSA and high Gleason score. SUVmax had a significant positive relationship with pathological ISUP(r=0.434, P=0.015) and SUVmax in patients with positive intravascular tumor emboli was significantly higher than those with negative intravascular tumor emboli(14.78±10.68 vs. 8.17±2.81, P=0.005). No significant correlation was found between SUVmax and baseline PSA, testosterone, pathologic T stage, surgical margin, nerve invasion, pelvic lymph node status as well as risk stratification. SUVmax could distinguish pathologic ISUP grade 5 with a maximum AUC 0.747 (P=0.033) and the sensitivity was 88.9%. The specificity was 77.3% when SUVmax≥11.34. SUVmax in patients with upgrading ISUP was significantly higher than that in patients with downgrading ISUP (16.01±5.40 vs. 4.98±2.11, P=0.007).@*Conclusions@#SUVmax measured on preoperative 68Ga-PSMA PET-CT may have a clinical significance in predicting unfavorable pathological factors for patients treated with radical prostatectomy.
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PURPOSE: This study evaluated the usefulness of semiquantitative and volumetric PET parameters for predicting prognosis in patients with advanced gastric cancer (AGC).METHODS: We enrolled 213 patients who underwent ¹⁸F-fluoro-2-deoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) prior to curative surgery for AGC. Maximum standardized uptake value (SUVmax) and tumor-to-liver uptake ratio (TLR) were measured in all patients. Metabolic tumor volume (MTV) and total lesion glycolysis were measured in volume-measurable patients. For further quantification of FDG uptake, we developed PET prognostic scores by combining SUVmax and MTV (1: low SUVmax/low MTV; 2: high SUVmax/low MTV; 3: high SUVmax/high MTV). Comparison of PET parameters between recurrence and non-recurrence groups was performed. Univariate and multivariate analyses for recurrence-free survival (RFS) and overall survival (OS) were subsequently performed.RESULTS: The recurrence rate was 32.4% (69/213 patients). Mean SUVmax and mean MTV of the recurrence group were significantly higher than those of the non-recurrence group (p = 0.026 and p = 0.025). TLR showed marginal significance (p = 0.051). In multivariate analysis for RFS including all patients, SUVmax (p = 0.022), TLR (p = 0.010), and PET score (p = 0.003) were independent prognostic factors. In post hoc analysis of PET score, significant differences in RFS were observed between PET scores 2 and 3 as well as scores 1 and 3. No significant difference in RFS was observed between scores 1 and 2. Only PET score was statistically significant for OS in univariate analysis. None of the PET parameters were statistically significant for OS in multivariate analysis.CONCLUSION: High SUVmax and high MTV of the primary tumor suggest a high risk of recurrence for AGC patients. Even if SUVmax is similar, the prognosis may vary depending on MTV. Combining PET parameters results in a better prediction for prognosis.
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Humans , Electrons , Glycolysis , Multivariate Analysis , Positron Emission Tomography Computed Tomography , Prognosis , Recurrence , Stomach Neoplasms , Tumor BurdenABSTRACT
Background: Psoriasis is a systemic inflammatory disorder associated with an increased risk of cardiovascular disease. Objective: To evaluate the utility of [[18]F]-fluorodeoxyglucose positron emission tomography/computed tomography in identifying vascular and systemic inflammation in psoriasis patients with moderate-to-severe disease and to analyze its usefulness in assessing the effect of systemic treatment. Methods: This was a randomized, double-blind pilot study conducted in a tertiary care center. Baseline standardized uptake value score was estimated by18F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with moderate-to-severe psoriasis and compared with historical controls. Patients were then randomized using computer-generated randomization list into methotrexate or placebo (with or without pioglitazone) groups.18F-fluorodeoxyglucose positron emission tomography/computed tomography was repeated at 12 weeks and composite standardized uptake value score determined. The correlation between Psoriasis Activity and Severity Index and SUVmax was assessed. Results: A total of 16 patients were randomized to different treatment groups. Significant increase in mean SUVmax was observed in the ascending aorta in psoriasis patients as compared to historical controls (2.03 ± 0.53 vs 1.51 ± 0.36, P < 0.03). There was no difference in composite standardized uptake value score after 12 weeks of treatment in any of the treatment groups (P = 0.82), although an improvement in Psoriasis Activity and Severity Index score in the methotrexate arm was observed. No correlation was found between mean SUVmax and Psoriasis Activity and Severity Index scores in various aortic segments (r = 0.3–0.7). Limitations: Small sample size, short follow-up, historical controls, exclusion of patients with comorbid conditions and lack of surrogate markers of systemic inflammation. Conclusion: 18F-fluorodeoxyglucose positron emission tomography imaging showed higher vascular inflammation in ascending aorta of psoriasis patients as compared to historical controls. Systemic treatment with methotrexate and pioglitazone did not influence the vascular inflammation in the short term.
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Objective:Previous studies have shown an association between programmed death-ligand 1 expression(PD-L1)in non-small cell lung cancer(NSCLC)and clinical factors and that PD-L1 is positively correlated with TNM staging.This study aimed to explore the prognostic significance of PD-L1 and its correlation with the maximum standardized uptake value(SUVmax).Methods:Clinicopath-ological data and the follow-up information of the 122 de novo primary NSCLC patients were analyzed.PD-L1 expression was detected by immunohistochemistry in this 122 surgically resected non-small cell lung carcinoma tissues.Survival outcomes were analyzed using the Kaplan-Meier method and multivariate Cox proportional hazards model.Correlation between SUVmax and PD-L1 expression was analyzed using Spearman's rank correlation analysis.Results:Multivariate analysis revealed that PD-L1 expression(HR=4.518,95% CI:1.176-17.352,P=0.028)and tumor size(HR=1.404,95%CI:1.020-1.933,P=0.037)were independent risk factors for overall survival(OS) in early NSCLC patients.Sex,age,pathological type,CEA level,and SUVmax group had no obvious effect on OS(P 0.05)in early NSCLC patients.In univariate analyses,sex,pathological type,tumor size,and SUVmax group affected OS in stageⅢ-ⅣNSCLC patients.How-ever,age,CEA level,and PD-L1 expression had no effect on OS.PD-L1 expression was not an independent risk factor for OS in stageⅢ-ⅣNSCLC patients.The SUVmax group had no association with PD-L1 in all patients.Conclusions:PD-L1 expression is an independent risk factor for OS in early NSCLC patients but not in stageⅢ-Ⅳpatients.
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Objective To evaluate the correlation between standardized uptake value (SUV) measured on 18F-FDG PET/CT scan and residual tumor after argon-helium knife cryoablation.Methods The clinical data of 40 patients with hepatic or pulmonary malignant tumors,who were treated with argon-helium knife cryoablation during the period from March 2008 to December 2015 at authors' hospital,were collected.18FFDG PET/CT scan was performed both before and after the treatment,and the SUV values of each patient were calculated.The data were analyzed based on the pathological findings and clinical follow-up results.Results A total of 42 lesions were detected in the 40 patients.After treatment,radionuclide concentration was demonstrated in 38 lesions,and 16 lesions were proved to be the tumor residual by follow-up imaging and pathological examination.In other 22 lesions the radionuclide concentration was due to inflammatory response.The SUV value of the tumor residual was strikingly higher than that of the inflammatory response (6.13±1.21 vs.2.64±0.96,P＜0.05).The group with low SUV value had a lower recurrence rate (P=0.020) and a higher survival rate (P=0.039).The tumor survival rate of the low SUV value group was significantly lower than that of the group with high SUV value (x2=14.994,P=0.000 2).Conclusion 18F-FDG PET/CT imaging has unique value in promptly detecting marginal residual lesion after argon-helium knife cryoablation,which provides useful information for the evaluation of cryoablation effect as well as for the making of further therapeutic plan.
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Objective@#To evaluate the value of 18F-FDG PET-CT in predicting the malignant potential of Gastrointestinal Stromal Tumors (GIST).@*Methods@#The clinical and pathological features of 31 patients with GIST confirmed by surgery or biopsy were retrospectively analyzed. The malignant potential of GIST before treatment was assessed by 18F-FDG PET-CT. The GIST risk classification was graded according to the Standard revised by the National Institutes of Health (NIH) in 2008. The relationship between the maximal standard uptake value (SUVmax) and GIST risk classification, tumor diameter, Ki-67 index, and mitotic count were analyzed respectively. The cut-off level of SUVmax for the diagnosis of malignant GIST was calculated from the Receiver Operating Characteristic (ROC) curve.@*Results@#Among the 31 cases of GIST patients, 14 cases were gastric primary (stomach group) and 17 cases were nongastric primary (outside stomach group). The SUVmax, tumor diameter, Ki-67 index and mitotic count of the 31 patients were 8.21±4.68, (7.82±5.12)cm, (10.03±11.07)% and (12.29±10.55)/50 HPF, respectively. SUVmax was significantly correlated with GIST risk classification (r=0.727, P<0.01), but not with tumor diameter, Ki-67 index and mitotic count (r=0.348, r=0.284, r=0.290, P=0.055, P=0.121, P=0.114). The SUVmax, tumor diameter, Ki-67 index and mitotic count in the stomach group were 4.36±2.36, (6.08±4.31)cm, (3.43±3.03)% and (5.71±2.20)/50 HPF, respectively. SUVmax was significantly correlated with tumor diameter, GIST risk classification and Ki-67 index (r=0.682, r=0.868, r=0.732, P<0.01) but not with mitotic count (r=0.510, P=0.063). The SUVmax of the GIST in the gastric group and the outside gastric group were 4.36±2.36 and 10.68±5.50, respectively. The difference was statistically significant (P=0.001). The SUVmax in the malignant group of GIST (middle or high risk grade) was 8.90±4.89, which was significantly higher than 2.22±0.86 in the benign group (low or very low risk grade). The difference was statistically significant between the two group (P<0.01). ROC curve analysis showed that a SUVmax cut-off of 3.75 was the most sensitive for predicting malignant GIST. When the area under the curve of 0.969, the sensitivity was 84.6% and the specificity was 100%.@*Conclusions@#The SUVmax was strongly correlated with the GIST risk category and also with the tumor diameter and Ki-67 index in the gastric primary GIST, so it can be used as an effective indicator in predicting malignant potential of GIST before treatment.
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Objective At present,nasopharyngeal carcinoma (NPC) is a head and neck cancer with special geographical distribution and biological behavior.Studies have shown that 18 F-FDG PET/CT parameters have certain prognostic values in patients with NPC in high-incidence areas.The aim of this study is to investigate the prognostic values of 18 F-FDG PET/CT parameters in patients with NPC in low-incidence areas.Methods The clinical data of 83 NPC patients who were diagnosed and treated in Beth Israel Medical Center, Albert Einstein Medical College from January 2003 to December 2013 were analyzed retrospectively.Based on 18 F-FDG PET/CT images,gross tumor volume (GTV) was delineated using the gradient method to obtain 18 F-FDG PET/CT parameters:maximum standardized uptake value (SUVmax ), metabolic tumor volume ( MTV),and total lesion glycolysis ( TLG).Results The number of patients followed was 37 at 3-years time.For all patients,the 3-year failure-free survival,locoregional relapse-free survival,and metastasis-free survival rates were 74%,88%,and 85%,respectively.The univariate analysis showed that SUVmax of the primary tumor (P=0.004) and TLG (P=0.014) were prognostic factors for 3-year locoregional relapse-free survival rate,and SUVmax of the primary tumor (P=0.024) and TLG (P=0.033) were prognostic factors for 3-year failure-free survival rate.The multivariate analysis showed that SUVmax of the primary tumor was the independent prognostic factor for 3-year failure-free survival rate. Conclusion SUVmax of the primary tumor before treatment is the independent prognostic factor for failure-free survival in patients with NPC.
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Objective To explore the value of 18 F-fluorodeoxyglucose (i8 F-FDG) PET/CT examination in the differential diagnosis of the gastric cancer and primary gastric lymphoma (PGL).Methods The clinical data of 80 patients with gastric cancer (60 with non-mucinous adenocarcinoma and 20 with mucinous adenocarcinoma) and 47 patients with PGL [22 with mucosa-associated lymphoid tissue (MALT) and 25 with diffuse large B-cell lymphoma (DLBCL)] who were admitted to the Tianjin Medical University Cancer Institute and Hospital from June 2006 to May 2014 were retrospectively analyzed.Spiral CT scan was first done and then followed by PET.The CT value of the lesions,maximum standardized uptake value (SUVmax) of patients and maximal gastrointestinal wall thickness (THKmax) were analyzed by the ANOVA test.The SUVmax comparison between groups was evaluated with the Student-Newman-Keuls.The lesions type was analyzed by the chi-square test.The THKmax and SUVmax among groups were analyzed by the Pearson correlation analysis.Results 18 F-FDG PET/CT imaging of patients with gastric cancer and PGL showed different types of gastric wall thickening,segmental and limited thickening of gastric wall were the main features of gastric cancer and diffuse and segmental thickening of gastric wall were the main features of PGL.The type Ⅰ,Ⅱ and Ⅲ of lesions were detected in 12,21 and 27 of 60 patients with nonmucinous adenocarcinoma,in 2,7 and 11 of 20 patients with mucinous adenocarcinoma,in 8,8 and 6 of 22 patients with MALT and in 13,7 and 5 of 25 patients with DLBCL respectively.There were significant differences in the 4 pathological types of lesions among all the patients (x2 =14.849,P ＜ 0.05).The lymph nodes beneath the renal hilum and at the retroperitoneum were involved in 16 patients with gastric cancer and in 10 patients with PGL,and 7 patients with gastric cancer and 12 patients with PGL were complicated with splenomegalia,respectively,showing a significant difference in the splenomegalia between patients with PGL and gastric cancer (x2=7.506,P ＜0.05).There was no significant difference in the metastasis of lymph nodes beneath the renal hilum and at the retroperitoneum between patients with PGL and gastric cancer (x2=0.178,P ＞0.05).Among 80 patients with gastric cancer,positive 18F-FDG was detected in 79 patients and negative 18F-FDG in 1 patient with T3 stage of mucinous adenocarcinoma.Among 47 patients with PGL,positive 18 F-FDG was detected in 46 patients and negative 18F-FDG in 1 patient with stage Ⅰ of MALT.The CT value of the lesion,SUVmax and THKmax in patients with non-mucinous adenocarcinoma,mucinous adenocarcinoma,MALT and DLBCL were (40 ± 8)HU,(39±11)HU,(41±11)HU,(38±9)HU and 9.9 ±6.6,5.6±1.9,4.6 ±2.9,18.3±7.6 and (2.1 ± 1.2) cm,(1.9 ± 0.9) cm,(1.3 ± 1.1) cm and (2.6 ± 1.5) cm,respectively,showing significant differences in the SUVmax among all the groups (F =26.920,P ＜ 0.05).In the pairwise comparisons,there were no significant difference between the MALT group and mucinous adenocarcinoma group (P ＞ 0.05),and significant differences among the other groups (P ＜ 0.05).The CT value of the lesions and THKmax among all the patients were compared,with no significant differences (F =0.578,4.510,P ＞ 0.05).There were no significant differences in the SUVmax and THKmax among all the patients (r =0.055,0.346,0.226,0.133,P ＞ 0.05).Conclusions There is an important diagnosis value of PET/CT examination in patients with gastric cancer and PGL.The pathological types of the lesions in patients with gastric cancer and PGL are different.The occurrence of splenomegalia in patients with PGL is easier than that with gastric cancer.SUVmax of patients with DLBCL is higher than those with gastric cancer and MALT.FDG uptake in patients with mucinous adenocarcinoma and MALT are not enough,and these may lead to false negative result of PET/CT examination.