Abstract
Objectives
Stage IIIA non-small cell lung cancer (NSCLC) is heterogeneous in tumor burden, and its treatment is variable. Whole-body metabolic tumor volume (MTVWB) has been shown to be an independent prognostic index for overall survival (OS). However, the potential of MTVWB to risk-stratify stage IIIA NSCLC has previously been unknown. If we can identify subgroups within the stage exhibiting significant OS differences using MTVWB, MTVWB may lead to adjustments in patients’ risk profile evaluations and may, therefore, influence clinical decision making regarding treatment. We estimated the risk-stratifying capacity of MTVWB in stage IIIA by comparing OS of stratified stage IIIA with stage IIB and IIIB NSCLC.
Methods
We performed a retrospective review of 330 patients with clinical stage IIB, IIIA, and IIIB NSCLC diagnosed between 2004 and 2014. The patients’ clinical TNM stage, initial MTVWB, and long-term survival data were collected. Patients with TNM stage IIIA disease were stratified by MTVWB. The optimal MTVWB cutoff value for stage IIIA patients was calculated using sequential log-rank tests. Univariate and multivariate cox regression analyses and Kaplan-Meier OS analysis with log-rank tests were performed.
Results
The optimal MTVWB cut-point was 29.2 mL for the risk-stratification of stage IIIA. We identified statistically significant differences in OS between stage IIB and IIIA patients (p < 0.01), between IIIA and IIIB patients (p < 0.01), and between the stage IIIA patients with low MTVWB (below 29.2 mL) and the stage IIIA patients with high MTVWB (above 29.2 mL) (p < 0.01). There was no OS difference between the low MTVWB stage IIIA and the cohort of stage IIB patients (p = 0.485), or between the high MTVWB stage IIIA patients and the cohort of stage IIIB patients (p = 0.459). Similar risk-stratification capacity of MTVWB was observed in a large range of cutoff values from 15 to 55 mL in stage IIIA patients.
Conclusions
Using MTVWB cutoff points ranging from 15 to 55 mL with an optimal value of 29.2 mL, stage IIIA NSCLC may be effectively stratified into subgroups with no significant survival difference from stages IIB or IIIB NSCLC. This may result in more accurate survival estimation and more appropriate risk adapted treatment selection in stage IIIA NSCLC.
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Authors’ contributions
Guarantors of integrity of entire study: Joshua H. Finkle and Yonglin Pu.
Study concepts/study design or data acquisition or data analysis/interpretation: all authors;
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Approval of final version of submitted manuscript: all authors;
Agrees to ensure any questions related to the work are appropriately resolved by all authors;
Literature research: Joshua H. Finkle, Stephanie Y. Jo, Yonglin Pu.
Clinical studies: Haiyan Liu, Chenpeng Zhang, Xuee Zhu, Yonglin Pu.
Statistical analysis: Joshua H. Finkle
Manuscript editing: all authors
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This study was approved by our Institutional Review Board of the University of Chicago, which waived the requirement for informed consent and all methods were carried out in accordance with relevant guidelines and regulations.
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This work was supported in part by a grant (R21 CA181885) from the National Cancer Institute of the National Institutes of Health.
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Joshua H. Finkle and Stephanie Y. Jo contributed equally to this work.
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Finkle, J.H., Jo, S.Y., Ferguson, M.K. et al. Risk-stratifying capacity of PET/CT metabolic tumor volume in stage IIIA non-small cell lung cancer. Eur J Nucl Med Mol Imaging 44, 1275–1284 (2017). https://doi.org/10.1007/s00259-017-3659-7
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DOI: https://doi.org/10.1007/s00259-017-3659-7