Diagnostic and Predictive Values of 18F-FDG PET/CT Metabolic Parameters in EGFR-Mutated Advanced Lung Adenocarcinoma

Il Ki Hong; Jeong Mi Lee; In Kyoung Hwang; Seung Sook Paik; Chanwoo Kim; Seung Hyeun Lee

doi:10.2147/CMAR.S259055

Diagnostic and Predictive Values of ¹⁸F-FDG PET/CT Metabolic Parameters in EGFR-Mutated Advanced Lung Adenocarcinoma

Cancer Manag Res. 2020 Jul 28:12:6453-6465. doi: 10.2147/CMAR.S259055. eCollection 2020.

Authors

Il Ki Hong¹, Jeong Mi Lee², In Kyoung Hwang², Seung Sook Paik², Chanwoo Kim³, Seung Hyeun Lee⁴

Affiliations

¹ Department of Nuclear Medicine, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, South Korea.
² Department of Internal Medicine, Graduate School, Kyung Hee University, Seoul, South Korea.
³ Department of Nuclear Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, South Korea.
⁴ Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, South Korea.

Abstract

Purpose: The clinical implications of the metabolic parameters of ¹⁸F-fluorodeoxyglucose positron emission tomography-computed tomography (¹⁸F-FDG PET/CT) in epidermal growth factor receptor (EGFR)-mutated lung cancer are not fully understood. The aim of this study was to evaluate the diagnostic and prognostic utility of the parameters in EGFR-mutated lung cancer patients.

Patients and methods: We retrospectively enrolled 134 patients with advanced lung adenocarcinoma (72 EGFR-negative and 62 EGFR-positive). We evaluated the correlation between EGFR mutational status and the maximum standardized uptake value (SUVmax), as well as the associations between treatment outcomes in EGFR-mutated patients and various metabolic parameters of primary tumors. For the best predictive parameters, we calculated the metabolic tumor volume (MTV) and total lesion glycolysis (TLG) using two SUV cutoffs: 1.5 (MTV_1.5, TLG_1.5) and 2.5 (MTV_2.5, TLG_2.5).

Results: Mean SUVmax was lower for EGFR-mutated tumors compared with EGFR wild-type (6.11 vs 10.41, p < 0.001) tumors. Low SUVmax was significantly associated with positive EGFR mutation (odds ratio = 1.74). Multivariate analysis for survival demonstrated that high MTV_1.5, TLG_1.5, MTV_2.5, and TLG_2.5 were independently associated with shorter progression-free survival (PFS) and overall survival (OS), and the highest hazard ratios were found in TLG_1.5 (3.26 for PFS and 4.62 for OS).

Conclusion: SUVmax may be predictive for EGFR mutational status, and MTV and TLG of primary tumors may be promising prognostic parameters; ¹⁸F-FDG PET/CT has potential utility for the risk stratification of EGFR-mutated patients treated with targeted therapy.

Keywords: 18F-fluorodeoxyglucose positron emission tomography-computed tomography; epidermal growth factor receptor mutation; lung cancer; metabolic parameters; survival.