Prognositc significance of SUVmax on pretreatment 18F-FDG PET/CT in early-stage non-small cell lung cancer treated with stereotactic body radiotherapy: A meta-analysis

Abstract

Introduction: The prognostic importance of the 18F-FDG PET maximum standardized uptake value (SUVmax) for early stage non-small cell lung cancer (NSCLC) patients receiving stereotactic body radiotherapy (SBRT) is not well defined. The purpose of this meta-analysis is to evaluate the efficacy of SUVmax on pretreatment 18F-FDG PET imaging to predict prognosis after SBRT. Methods: All published English-language studies that assessed the treatment response after SBRT in patients with early-stage NSCLC using 18F-FDG PET were collected from the EMBASE and MEDLINE databases. All the included studies were published between January 2000 and June 2015 and limited to NSCLC, PET/CT, SBRT, and the impact of SUVmax on survival. The necessary data for the calculation of individual hazard ratios (HRs) were extracted from each publication. All the results were independently verified and examined by two reviewers to ensure accuracy. Results: After evaluating the original articles, 11 retrospective studies (1008 patients) were included into the meta-analysis. Data were available in 11 studies for pre-SBRT primary tumour SUVmax. Seven studies (798 patients) were included for the overall survival (OS) analysis with a combined HR of 1.10 (95% CI, 1.05–1.15). Five studies (487 patients) were included for the local control analysis with a combined HR of 1.13 (95% CI, 1.06–1.21). Three studies (365 patients) were analysed for distant metastasis with a combined HR of 1.09 (95% CI, 1.03–1.16). Conclusion: Patients with high levels of pre-SBRT SUVmax had poorer overall survival and local control and higher distant metastases. Further prospective studies are warranted to confirm the prognostic value of FDG uptake in early-stage NSCLC patients receiving SBRT.