The association of 18F-FDG PET/CT parameters with survival in malignant pleural mesothelioma

• Published in: European journal of nuclear medicine and molecular imaging 2014-02, Vol.41 (2), p.276-282
• Main Authors: Klabatsa, Astero, Chicklore, Sugama, Barrington, Sally F., Goh, Vicky, Lang-Lazdunski, Loic, Cook, Gary J. R.
• Format: Article
• Language: English
• Subjects: Aged; Cardiology; Female; Fluorodeoxyglucose F18; Humans; Imaging; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - mortality; Male; Medicine; Medicine & Public Health; Mesothelioma - diagnostic imaging; Mesothelioma - mortality; Mesothelioma, Malignant; Middle Aged; Multimodal Imaging; Nuclear Medicine; Oncology; Original Article; Orthopedics; Positron-Emission Tomography; Predictive Value of Tests; Prognosis; Radiology; Radiopharmaceuticals; Tomography, X-Ray Computed
• ISSN: 1619-7070; 1619-7089
• DOI: 10.1007/s00259-013-2561-1

Purpose Malignant pleural mesothelioma (MPM) is a disease with poor prognosis despite multimodal therapy but there is variation in survival between patients. Prognostic information is therefore potentially valuable in managing patients, particularly in the context of clinical trials where patients could be stratified according to risk. Therefore we have evaluated the prognostic ability of parameters derived from baseline 2-[ 18 F]fluoro-2-deoxy- D -glucose positron emission tomography/computed tomography ( 18 F-FDG PET/CT). Methods In order to determine the relationships between metabolic activity and prognosis we reviewed all 18 F-FDG PET/CT scans used for pretreatment staging of MPM patients in our institution between January 2005 and December 2011 ( n  = 60) and measured standardised uptake values (SUV) including mean, maximum and peak values, metabolic tumour volume (MTV) and total lesion glycolysis (TLG). Overall survival (OS) or time to last censor was recorded, as well as histological subtypes. Results Median follow-up was 12.7 months (1.9–60.9) and median OS was 14.1 months (1.9–54.9). By univariable analysis histological subtype ( p  = 0.013), TLG ( p  = 0.024) and MTV ( p  = 0.038) were significantly associated with OS and SUV max was borderline ( p  = 0.051). On multivariable analysis histological subtype and TLG were associated with OS but at borderline statistical significance ( p  = 0.060 and 0.058, respectively). No statistically significant differences in any PET parameters were found between the epithelioid and non-epithelioid histological subtypes. Conclusion 18 F-FDG PET/CT parameters that take into account functional volume (MTV, TLG) show significant associations with survival in patients with MPM before adjusting for histological subtype and are worthy of further evaluation to determine their ability to stratify patients in clinical trials.