Prognostic value of 18F-FDG PET/CT in surgical non-small cell lung cancer: A meta-analysis

Abstract

Background: The identification of surgical non-small cell lung cancer (NSCLC) patients with poor prognosis is a priority in clinical oncology because of their high 5-year mortality. This meta-analysis explored the prognostic value of maximal standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) on disease-free survival (DFS) and overall survival (OS) in surgical NSCLC patients. Materials and Methods: MEDLINE, EMBASE and Cochrane Libraries were systematically searched until August 1, 2015. Prospective or retrospective studies that evaluated the prognostic roles of preoperative 18F-FDG PET/CT with complete DFS and OS data in surgical NSCLC patients were included. The impact of SUVmax, MTV or TLG on survival was measured using hazard ratios (HR). Sub-group analyses were performed based on disease stage, pathological classification, surgery only and cut-off values. Results: Thirty-six studies comprised of 5807 patients were included. The combined HRs for DFS were 2.74 (95%CI 2.33-3.24, unadjusted) and 2.43 (95%CI: 1.76-3.36, adjusted) for SUVmax, 2.27 (95%CI 1.77-2.90, unadjusted) and 2.49 (95%CI 1.23-5.04, adjusted) for MTV, and 2.46 (95%CI 1.91-3.17, unadjusted) and 2.97 (95%CI 1.68-5.28, adjusted) for TLG. The pooled HRs for OS were 2.54 (95%CI 1.86-3.49, unadjusted) and 1.52 (95%CI 1.16-2.00, adjusted) for SUVmax, 2.07 (95%CI 1.16-3.69, unadjusted) and 1.91 (95%CI 1.13-3.22, adjusted) for MTV, and 2.47 (95%CI 1.38-4.43, unadjusted) and 1.94 (95%CI 1.12-3.33, adjusted) for TLG. Begg's test detected publication bias, the trim and fill procedure was performed, and similar HRs were obtained. The prognostic role of SUVmax, MTVandTLG remained similar in the sub-group analyses. Conclusions: High values of SUVmax, MTV and TLG predicted a higher risk of recurrence or death in patients with surgical NSCLC. We suggest the use of FDG PET/CT to select patients who are at high risk of disease recurrence or death and may benefit from aggressive treatments.