Prognostic value of 18F-FDG PET parameters in patients with locally advanced non-small cell lung cancer treated with induction chemotherapy

Aim: To investigate predictive and prognostic role of metabolic parameters using [¹⁸F]-2-fluoro-2-deoxy-D-glucose positron emission tomography (¹⁸F-FDG PET) in patients with locally advanced non-small cell lung cancer (NSCLC) treated with docetaxel-platinum induction chemotherapy (IC). Methods: Medical records of 31 patients with pre- and post-IC ¹⁸F-FDG PET were reviewed. Using ¹⁸F-FDG PET, metabolic parameters, including metabolic tumor response, adjusted peak standardized uptake values using lean body mass at baseline (pre-SUL_peak) and after IC (post-SUL_peak), and percentage change of pre- and post-SUL_peak (ΔSUL_peak), were assessed. Results: Response rate (RR) was 71%, with a metabolic RR of 83.9%. Nineteen (61.3%) patients underwent surgery, R0 resection was achieved for 17 (89.5%) patients. Median relapse-free survival (RFS) and overall survival (OS) were 8.9 months (95% CI: 4.5-12.1) and 24.1 months (95% CI: 17.1-34.1), respectively. Post-SUL_peak< 2 was identified as a favorable prognostic factor for RFS (hazard ratio [HR]: 0.12; P =.004), while ΔSUL_peak ≥60% and R0 resection were found as positive prognostic factors for OS (HR: 0.09 and 0.13; P =.011 and P =.042, respectively). Using a receiver operating characteristics curve, post-SUL_peak> 1.4 could predict recurrence with a sensitivity of 84% and a specificity of 100%. Conclusion: In patients with locally advanced NSCLC receiving IC, post-SUL_peak and ΔSUL_peak showed clinical significance for survival outcome.