Prognostic value of pretreatment volume-based quantitative 18F-FDG PET/CT parameters in patients with malignant pleural mesothelioma

Our plain-English summary of Prognostic value of pretreatment volume-based quantitative 18F-FDG PET/CT parameters in patients with malignant pleural mesothelioma, by K. Kitajima, H. Doi, K. Kuribayashi, et al (European Journal of Radiology, 2017).

The study

• Authors: K. Kitajima, H. Doi, K. Kuribayashi, M. Hashimoto, T. Tsuchitani, M. Tanooka, K. Fukushima, T. Nakano, S. Hasegawa, S. Hirota
• Journal: European Journal of Radiology
• Published: 2017;86:176-183
• Cited by: 18 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Purpose: To investigate the relationships between pretreatment volume-based quantitative 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) parameters and overall survival (OS) in patients with malignant pleural mesothelioma (MPM).

Materials And Methods: We retrospectively reviewed data from 201 MPM patients, of whom 38 underwent surgical resection, and calculated the maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG), including primary tumors and nodal or distant metastatic lesions, on pretreatment 18F-FDG PET/CT. Relationships between clinicopathological factors (age, sex, performance status, European Organization for Research and Treatment of Cancer [EORTC] score, histological subtype, TNM stage, and treatment strategy), volume-based quantitative PET/CT parameters, and OS were evaluated using a Cox proportional hazards model and log-rank test.

Results: The median follow-up was 15 months (range, 1-96 months; median, 17 months). In a univariate analysis of all patients, older age (p<0.05), high EORTC score (p<0.001), non-epithelioid histological subtype (p<0.001), high T stage (p<0.001), positive N/M status (p<0.05, p<0.001), advanced TNM stage (p<0.001), non-surgical treatment (p<0.001), and high SUVmax (p<0.001), MTV (p<0.001), or TLG (p<0.001) were associated with significantly shorter OS. A multivariate analysis confirmed non-epithelioid subtype (hazard ratio [HR]: 1.69, 95% confidence interval [CI]: 1.14-2.48; p<0.05), non-surgical treatment (HR: 0.58, 95% CI: 0.34-0.95; p<0.05), and high TLG (HR: 1.97, 95% CI: 1.14-3.44; p<0.05) as independent negative predictors.

Conclusions: Pretreatment volume-based quantitative 18F-FDG PET/CT parameters, especially TLG, could serve as potential surrogate markers for MPM prognosis.

Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

In plain English

This retrospective study from Hyogo College of Medicine in Japan looked at 201 patients with malignant pleural mesothelioma. Each had a whole-body 18F-FDG PET/CT scan before treatment between June 2007 and December 2014. This type of scan shows how much sugar tumors take up. The authors measured three things: the highest uptake (SUVmax), the volume of active tumor (MTV), and total lesion glycolysis (TLG), which combines volume and uptake. The article did not report on asbestos exposure. Over a median follow-up of 15 months, 150 of the 201 patients died. Thirty-eight had surgery and 163 had chemotherapy without tumor removal. Across all patients, high values of all three measures were linked to shorter survival. When factors were analyzed together, three remained independent predictors: non-epithelioid tumor type (hazard ratio 1.69, 95% CI 1.14 to 2.48), treatment without surgery, and TLG of 525 g or more (hazard ratio 1.97, 95% CI 1.14 to 3.44). In the surgery group, no factor remained an independent predictor. The authors concluded that these measures, especially TLG, could serve as potential markers of prognosis.

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: retrospective cohort study (review of patient records and pretreatment PET/CT scans)
• Who was studied: 201 patients with newly diagnosed malignant pleural mesothelioma (165 men, 36 women; median age 66, range 31 to 84) scanned before treatment between June 2007 and December 2014 at Hyogo College of Medicine, Japan. 254 were first reviewed; 40 scanned on another machine and 13 lost to follow-up were excluded.
• Exposure: No asbestos exposure data were reported. The factors studied were pretreatment PET/CT measures (SUVmax, metabolic tumor volume, total lesion glycolysis) and clinical factors such as tumor subtype, stage and treatment.
• Main results:
  • Among all 201 patients, 150 (74.6%) died during follow-up. The 1-year overall survival rate was 62.3% and the 2-year rate was 36.3%.
  • Cut-off values chosen for the analysis were 5.60 for SUVmax, 278 mL for MTV and 525 g for TLG.
  • All patients, analyzed one factor at a time: high SUVmax, MTV and TLG were each associated with significantly shorter survival (p less than 0.001).
  • All patients, multivariate analysis: high TLG was an independent predictor of poor survival (HR 1.97, 95% CI 1.14 to 3.44).
  • All patients, multivariate analysis: non-epithelioid histological subtype was an independent predictor (HR 1.69, 95% CI 1.14 to 2.48).
  • All patients, multivariate analysis: non-surgical treatment was listed as an independent predictor (HR 0.58, 95% CI 0.34 to 0.95).
  • Surgically treated group (38 patients): 1-year overall survival was 81.6% and 2-year was 60.5%. Multivariate analysis found no independent predictors of survival in this group.
  • Non-surgically treated group (163 patients): non-epithelioid subtype (HR 1.82, 95% CI 1.20 to 2.72) and high TLG (HR 1.99, 95% CI 1.11 to 3.61) were independent predictors of poor survival.
• The authors' conclusion: The authors concluded that pretreatment volume-based PET/CT measures, especially TLG, could serve as potential markers of prognosis in malignant pleural mesothelioma and could help identify patients in need of further chemotherapy.
• Limitations the authors state:
  • Retrospective design
  • Possible selection bias
  • Small number of patients in the surgically treated group

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Overall Survival, Surgical Resection, Performance Status, Histological Subtype, Non-epithelioid, Multivariate Analysis, Hazard Ratio.

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• Volume-based parameter of 18)F-FDG PET/CT in malignant pleural mesothelioma: prediction of therapeutic response and prognostic implications — H.Y. Lee, S.H. Hyun, et al. (2010)
• Optimal gross tumor volume definition in lung-sparing intensity modulated radiotherapy for pleural mesothelioma: an in silico study — A. Botticella, G. Defraene, et al. (2016)
• Prognostic value of 18F-FDG standard uptake value by integrated PET/CT in the staging of malignant pleural mesothelioma — G. Genestreti, A. Moretti, et al. (2012)
• The value of 18F-FDG PET/CT in two cases of Primary Pericardial Mesothelioma — A. Utrera-Costero, J.C. Bernal-Vergara, et al. (2022)
• Present and future roles of FDG-PET/CT imaging in the management of malignant pleural mesothelioma — K. Kitajima, H. Doi, et al. (2016)

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