The Value of 18F-FDG PET/CT Multiparameter for Prognostic Assessment of Non-small Cell Lung Cancer

Objective To establish a quantitative model using ¹⁸ F-fluorodeoxyglucose positron emission tomography/computed tomography ( ¹⁸ F-FDG PET/CT) parameters for the evaluation of prognosis in patients with non-small cell lung cancer (NSCLC). Methods A total of 110 patients with NSCLC in our hospital from March 2019 to October 2021 were prospectively included, according to the tumor-node-metastasis (TNM) staging system, they were divided into 25 cases with stage I, 49 cases with stage II, and 36 cases with stage III. After 6 months of follow-up, 32 patients occurred tumor progression and 78 patients had non-tumor progression. The demographic information (sex, age, hypertension, and diabetes), tumor pathology (pathological classification and histological grade), imaging [tumor location, diameter, TNM stage, standard uptake value (SUV) max and SUV mean, metabolic tumor volume (MTV) and total lesion glycolysis (TLG)] were compared between the two groups. Results Compared with non-tumor progression group, age, tumor diameter, TNM stage, SUVmax, SUV mean, MTV and TLG in tumor progression group increased, low-histological differentiation increased(P < 0.05). Non collinearity indexes were screened based on LASSO regression to obtain TNM stage, SUVmax, MTV and TLG. Multivariate Cox regression analysis showed that stage III (HR = 5.264,95% CI = 4.421 ~ 7.648, P < 0.001), SUVmax (HR = 3.621,95% CI = 2.754 ~ 5.022, P < 0.001), MTV (HR = 3.009,95% CI = 2.323 ~ 4.457, P < 0.001) and TLG (HR = 2.659,95% CI = 1.859 ~ 3.523, P < 0.001) were the independent risk factors to tumor progression of NSCLC patients. Establish the quantitative model Y= -0.231 + 1.958×(phase III) + 1.323×(SUVmax) + 1.085 ×(MTV) + 0.859 ×(TLG). Receiver operating curve (ROC) showed that area under the curve (AUC) by the model for predicting tumor progression was 0.859 (95% CI = 0.801 ~ 0.956, P < 0.001). The calibration curve and decision curve showed that the consistency and benefit of the model were good. Conclusion ¹⁸ F-FDG PET/CT is an important imaging tool to evaluate the prognosis of NSCLC patients, measuring multiple parameters SUVmax. MTV and TLG are closely related to the risk of tumor progression. Establishing a quantitative model combined with TNM staging to predict tumor progression, which has good clinical value.