The prognostic value of 18F-fluorodeoxyglucose positron emission tomography/ computed tomography parameters in patients with malignant pleural mesothelioma

Our plain-English summary of The prognostic value of 18F-fluorodeoxyglucose positron emission tomography/ computed tomography parameters in patients with malignant pleural mesothelioma, by B.M. Yenigün, Y. Kahya, Ç. Soydal, et al (Türk Göğüs Kalp Damar Cerrahisi Dergisi, 2021).

The study

• Authors: B.M. Yenigün, Y. Kahya, Ç. Soydal, N. Ata Tutkun, G. Kocaman, E.M. Koçak, E. Özkan, S. Dizbay Sak, A. Kayı Cangır
• Journal: Türk Göğüs Kalp Damar Cerrahisi Dergisi
• Published: 2021;29(1):92-100
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: In this study, we aimed to investigate the prognostic value of metabolic 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters in malignant pleural mesothelioma patients.

Methods: A total of 65 patients with malignant pleural mesothelioma (34 males, 31 females; median age: 60 years; range, 39 to 84 years) who underwent whole-body 18F-fluorodeoxyglucose positron emission tomography/computed tomography for staging before treatment between March 2008 and January 2018 were included. Relationships between clinicopathological factors and 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters and overall survival were evaluated using a log-rank test and Cox regression analysis.

Results: The median follow-up was 13 (range, 4 to 55) months. The Kaplan-Meier analysis revealed a mean survival time of 17±2.6 months. The cumulative two- and five-year survival rates were 34.8% and 7.8%, respectively. Univariate analysis showed that ≥60 age, left hemithorax involvement, a maximum standardized uptake value of ≥9.8, c-T4 status, c-M1 status, and non-surgery were negatively associated with overall survival (p<0.05). Multivariate analysis showed that ≥60 age, left hemithorax involvement, a maximum standardized uptake value of ≥9.8, c-M1 status, and a total lesion glycolysis of ≥180.2 g were negatively associated with overall survival (p<0.05).

Conclusion: Metabolic parameters of 18F-fluorodeoxyglucose positron emission tomography/computed tomography have the potential to provide prognostic information for malignant pleural mesothelioma patients who are receiving surgery and/or chemotherapy.

Copyright © 2021, Turkish Society of Cardiovascular Surgery.

In plain English

This retrospective study at one hospital in Turkey examined whether pre-treatment PET/CT scan measurements were linked to survival in malignant pleural mesothelioma. Of 232 patients screened, 65 were included (34 men, 31 women; median age 60). Almost all had a history of asbestos exposure; no fiber types were given. Over a median follow-up of 13 months, 55 died from the disease. Two- and five-year survival were 34.8% and 7.8%. Median survival was 10 months (95% CI 5.4 to 14.5) with a maximum tumor uptake value (SUVmax) of 9.8 or above, versus 29 months (13.3 to 44.6) below 9.8. In multivariate analysis, shorter survival was associated with SUVmax of 9.8 or above (hazard ratio 1.8, 95% CI 1.04 to 3.2), total lesion glycolysis of 180.2 g or above (1.9, 1.09 to 3.5), age 60 or over (2.4, 1.4 to 4.5), left-sided tumor (2.4, 1.3 to 4.4) and M1 status (6.3, 1.6 to 24.07). Metabolic tumor volume was not significantly associated with survival. The authors concluded these PET measures have potential prognostic value, noting the single-center retrospective design as a limitation.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Single-center retrospective study of survival (prognostic factor analysis using Kaplan-Meier, log-rank test and Cox regression)
• Who was studied: 65 patients with malignant pleural mesothelioma (34 males, 31 females; median age 60, range 39 to 84) who had whole-body 18F-FDG PET/CT for initial staging before treatment, selected from 232 consecutive patients screened at Ankara University School of Medicine, Turkey, March 2008 to January 2018
• Exposure: The factors studied were pre-treatment PET/CT measurements (SUVmax, metabolic tumor volume, total lesion glycolysis) and clinical factors. On asbestos, the article states only that almost all patients had a history of asbestos exposure. No fiber types, sources or doses are given.
• Main results:
  • Median follow-up was 13 months (range 4 to 55). Of the 65 patients, 55 (85%) died from malignant pleural mesothelioma.
  • For all 65 patients, cumulative two-year survival was 34.8% and five-year survival was 7.8%. Mean survival time was 17 plus or minus 2.624 months (range 2 to 64).
  • Patients with SUVmax below 9.8 had five-year survival of 12.7% and median survival of 29 months (95% CI 13.3-44.6). Patients with SUVmax of 9.8 or above had five-year survival of 3.7% and median survival of 10 months (95% CI 5.4-14.5) (p=0.002).
  • In univariate analysis, the following were negatively associated with overall survival: age 60 or over (HR 2.5, 95% CI 1.4-4.4), left hemithorax involvement (HR 1.7, 95% CI 1.1-3.1), SUVmax of 9.8 or above (HR 2.2, 95% CI 0.9-6.2), clinical T4 status (HR 3.5, 95% CI 1.3-9.3) and clinical M1 status (HR 6.03, 95% CI 1.7-20.9).
  • In multivariate analysis, the following were negatively associated with overall survival: age 60 or over (HR 2.4, 95% CI 1.4-4.5), left hemithorax involvement (HR 2.4, 95% CI 1.3-4.4), SUVmax of 9.8 or above (HR 1.8, 95% CI 1.04-3.2), M1 status (HR 6.3, 95% CI 1.6-24.07) and total lesion glycolysis of 180.2 g or above (HR 1.9, 95% CI 1.09-3.5).
  • In the Kaplan-Meier comparisons, survival did not differ significantly between metabolic tumor volume groups (p=0.483) or total lesion glycolysis groups (p=0.085).
  • The radical surgery group (15 patients) had five-year survival of 24.9% and median survival of 24 months. The non-surgery group (50 patients) had five-year survival of 3% and median survival of 13 months (p=0.034).
• The authors' conclusion: The authors concluded that SUVmax has significant prognostic value in malignant pleural mesothelioma and that total lesion glycolysis also appears to be an independent prognostic indicator. In their view, PET/CT metabolic parameters have the potential to provide prognostic information for patients receiving surgery and/or chemotherapy, and larger prospective studies are needed to confirm this.
• Limitations the authors state:
  • The study was retrospective and drew its patients from a single center. The authors said multi-center studies with long-term follow-up are needed to validate the results.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Staging, Overall Survival, Hemithorax, Multivariate Analysis, Chemotherapy.

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