Prognostic value of maximum standard uptake value, metabolic tumour volume, and total lesion glycolysis of 18F-FDG PET/CT in patients with malignant pleural mesothelioma: a systematic review and meta-analysis

Our plain-English summary of Prognostic value of maximum standard uptake value, metabolic tumour volume, and total lesion glycolysis of 18F-FDG PET/CT in patients with malignant pleural mesothelioma: a systematic review and meta-analysis, by W. Wen, D. Xu, Y. Piao, et al (Cancer Cell International, 2022).

The study

• Authors: W. Wen, D. Xu, Y. Piao, X. Li
• Journal: Cancer Cell International
• Published: 2022;22(1):60
• Type of article: Review
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Purpose: Present work systematically reviewed relevant literature based on 18F-FDG PET parameters and conducted a meta-analysis to examine the prognostic value of maximal standard uptake value (SUVmax), total lesional glycolysis (TLG), and metabolic tumour volume (MTV) in the prognosis of malignant pleural mesothelioma (MPM).

Methods: The relevant literature published in English were searched on PubMed, Cochrane Library, and EMBASE databases. We also evaluated the significance of SUVmax, TLG, and MTV in prognosis prediction using pooled hazard ratios (HRs).

Results: The current study comprised 12 primary studies with a total of 1307 MPM cases. According to our results, the pooled HR (95% confidence interval [CI]) of increased SUVmax for overall survival (OS) was 1.30 (95% CI 1.13-1.49, P = 0.000), whereas the increased TLG was 1.81(95% CI 1.25-2.61, P = 0.089). The increased MTV was not significantly related to OS (1.14 [95% CI 0.87-1.50, P = 0.18]).However, study design-stratified subgroup analysis suggested that differences in OS of retrospective and prospective subgroups were statistically significant, and no significant heterogeneity among different studies was observed.

Conclusion: Based on the findings from the present work, PET/CT can significantly affect the prognosis prediction in MPM cases. Also, the increased SUVmax and TLG values predict an increased risk of mortality.

© 2022. The Author(s).

In plain English

This was a systematic review and meta-analysis. The authors pooled results from 12 published studies, covering 1307 patients with malignant pleural mesothelioma, to test whether three measurements from a pre-treatment 18F-FDG PET/CT scan were linked to overall survival: SUVmax, metabolic tumour volume (MTV) and total lesion glycolysis (TLG). The article did not study asbestos exposure. In this analysis, a hazard ratio above 1 meant poorer survival for patients with higher values. Across 11 studies, higher SUVmax was associated with poorer survival (pooled hazard ratio 1.30, 95% CI 1.13–1.49). Tests suggested possible publication bias, and after a statistical correction the result was 1.056 (95% CI 1.029–1.084). Across 7 studies, higher TLG was associated with poorer survival (1.81, 95% CI 1.25–2.61). Across 6 studies, MTV was not statistically significantly associated with survival (1.14, 95% CI 0.87–1.50). The authors concluded that patients with higher SUVmax and TLG had an increased risk of death, and called for larger prospective studies. They noted small samples and differences in disease stage, tissue type and treatment between the studies.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Systematic review and meta-analysis of published studies (pooled hazard ratios)
• Who was studied: 12 published studies with a total of 1307 patients with histologically confirmed malignant pleural mesothelioma, from Turkey, Japan, South Korea, the USA, the UK and Italy; studies were found by searching Cochrane Library, PubMed and EMBASE from 2006 to May 2021
• Exposure: Not asbestos. The factors studied were pre-treatment 18F-FDG PET/CT measurements: maximum standard uptake value (SUVmax), metabolic tumour volume (MTV) and total lesion glycolysis (TLG)
• Main results:
  • Higher SUVmax was associated with poorer overall survival across 11 studies: random-effects pooled HR 1.30 (95% CI 1.13–1.49); fixed-effects HR 1.06 (95% CI 1.03–1.09), with heterogeneity I2 = 69.2%
  • For SUVmax, Egger's and Begg's tests indicated possible publication bias. After trim and fill analysis, the pooled HR was 1.056 (95% CI 1.029–1.084), which the authors described as no significant change
  • SUVmax subgroup by study design: in 2 prospective studies the HR was 1.05 (95% CI 1.03–1.08)
  • SUVmax subgroup by study design: in 9 retrospective studies the HR was 1.69 (95% CI 1.39–2.07)
  • Higher MTV was not statistically significantly associated with overall survival across 6 studies: combined HR 1.14 (95% CI 0.87–1.50)
  • Higher TLG was associated with poorer overall survival across 7 studies: random-effects HR 1.81 (95% CI 1.25–2.61); fixed-effects HR 1.49 (95% CI 1.24–1.80). The P = 0.089 printed here goes with the heterogeneity statistic (I2 = 50.5%)
• The authors' conclusion: The authors concluded that patients with malignant pleural mesothelioma who had higher SUVmax and TLG had an increased risk of death. They could not show that MTV predicted death, and they called for larger prospective studies.
• Limitations the authors state:
  • Some included reports did not give enough detail about PET scanning data and patients
  • The sample sizes of the included reports were small
  • The included patients had different stages and histological grades and received different treatments, which may have influenced survival
  • Only English-language studies were included, which may have introduced language bias
  • Only articles from electronic databases were used, which may have introduced publication bias
  • The included studies used different SUVmax cut-off values, and no standard prognostic threshold could be determined
  • Too few studies reported TLG to allow subgroup analysis

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Systematic Review, Meta-Analysis, Prognosis, Hazard Ratio, confidence interval, Overall Survival.

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