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European Radiology

, Volume 27, Issue 5, pp 1912–1921 | Cite as

The role of 18F-fluorodeoxyglucose uptake of bone marrow on PET/CT in predicting clinical outcomes in non-small cell lung cancer patients treated with chemoradiotherapy

  • Jeong Won Lee
  • Ki Hyun Seo
  • Eun-Seog Kim
  • Sang Mi Lee
Nuclear Medicine

Abstract

Objectives

This study aimed to assess the relationship between bone marrow (BM) FDG uptake on PET/CT and serum inflammatory markers and to evaluate the prognostic value of BM FDG uptake for predicting clinical outcomes in non-small cell lung cancer (NSCLC) patients.

Methods

One hundred and six NSCLC patients who underwent FDG PET/CT for staging work-up and received chemoradiotherapy were enrolled. Mean BM FDG uptake (BM SUV) and BM-to-liver uptake ratio (BLR) were measured, along with volumetric parameters of PET/CT. The relationship of BM SUV and BLR with hematologic parameters and serum inflammatory markers was evaluated. Prognostic values of BM SUV and BLR for predicting progression-free survival (PFS) and overall survival (OS) were assessed.

Results

BM SUV and BLR were significantly correlated with white blood cell count and C-reactive protein level. On univariate analysis, BLR was a significant prognostic factor for both PFS and OS. On multivariate analysis, TNM stage and BLR were independent prognostic factors for PFS, and only TNM stage was an independent prognostic factor for OS.

Conclusions

In NSCLC patients, FDG uptake of BM reflects the systemic inflammatory response and can be used as a biomarker to identify patients with poor prognosis.

Key Points

• Bone marrow FDG uptake is correlated with serum inflammatory markers.

• Bone marrow FDG uptake is an independent prognostic factor for progression-free survival.

• Bone marrow FDG uptake can provide information on predicting lung cancer progression.

Keywords

Lung cancer Prognosis Positron emission tomography FDG Bone marrow 

Abbreviations and acronyms

NSCLC

Non-small cell lung cancer

PFS

Progression-free survival

OS

Overall survival

NLR

Neutrophil-to-lymphocyte ratio

PLR

Platelet-to-lymphocyte ratio

CRP

C-reactive protein

FDG

18F-Fluorodeoxyglucose

SUV

Standardized uptake value

BM

Bone marrow

Tmax

Maximum SUV of tumour

MTV

Metabolic tumour volume

TLG

Total lesion glycolysis

BLR

Bone marrow-to-liver uptake ratio of SUV

WBC

White blood cell

Notes

Acknowledgments

This work was supported in part by the Soonchunhyang University Research Fund, and by the research fund of Catholic Kwandong University International St. Mary’s Hospital (CKURF-201601650001). The scientific guarantor of this publication is Sang Mi Lee, M.D., Ph.D. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: Retrospective prognostic study performed at one institution

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Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • Jeong Won Lee
    • 1
    • 2
  • Ki Hyun Seo
    • 3
  • Eun-Seog Kim
    • 4
  • Sang Mi Lee
    • 5
  1. 1.Department of Nuclear MedicineCatholic Kwandong University College of Medicine, International St. Mary’s HospitalIncheonKorea
  2. 2.Institute for Integrative MedicineCatholic Kwandong University College of Medicine, International St. Mary’s HospitalIncheonKorea
  3. 3.Division of Pulmonary Medicine, Department of Internal MedicineSoonchunhyang University Cheonan HospitalCheonanKorea
  4. 4.Department of Radiation OncologySoonchunhyang University Cheonan HospitalCheonanKorea
  5. 5.Department of Nuclear MedicineSoonchunhyang University Cheonan HospitalCheonanKorea

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