SUVMax From Positron Emission Tomography (PET) in Patients With Solid Tumour is Associated With Cancer Staging And Survival

Abstract

Introduction: Malaysia as a rapidly developing country is undergoing epidemiological transition. Non-communicable diseases, such as cancers are expected rise, and demand for applications of newer medical technologies will increase. Positron Emission Tomography / Computed Tomography (PET/CT) via of fluorine-18 (18F) isotope tagging with fluorodeoxyglucose (FDG) tracer (18F-FDG) has emerged as a valuable imaging modality in oncology management, particularly in diagnosis, staging and prognosis of cancers. SUVmax, derived from PET, allows for quantitative measure of functional/metabolic activity of tumours. However, the value of diagnostic and prognostic value SUVmax is highly variant, population and centre-dependent. Research in this area is growing fast internationally but locally very scarce and limited, which may hamper the establishment of local standards and utility of PET. The aim of this study is to assess the diagnostic and prognostic properties of SUVmax from FDG-PET in patients with solid malignant tumours, in the Centre for Diagnostic Nuclear Imaging (PPDN), UPM Serdang. Methodology: A cross-sectional and cohort design were employed. Cases were recruited from January 2013 cohort and followed up until June 2018. A total of 102 cases were selected. Information on SUVmax values, cancer staging and other co-factors were extracted from patient records. Information on survival were retrieved from telephone calls. Results: SUVmax is positively associated with Cancer Stage. From multiple linear regression, Cancer Stage and BMI are significant predictors of SUVmax (P<0.001). ROC curve analyses showed the SUVmax cut-off point between Stage 1 and Stage 2 to be 4.59 (AUC = 0.827), between Stage 2 and Stage 3 to be 5.95 (AUC = 0.811), and between Stage 3 and Stage 4 to be 8.16 (AUC =0.68). All were statistically significant. Kaplan-Meier curve showed that there is a different between lower levels of SUVmax and higher levels of SUVmax. Cox proportional hazards regression model showed that SUVmax and Age are significant predictors of survival. Cox Proportional Hazards Regression analysis showed that SUVmax and age being significant factor for survival. Each unit increase in SUVmax is expected to increase the hazards of dying 1.127 times. (b=0.12, HR=1.127, p<0.001). Conclusion: SUVmax is associated with cancer stage and patient survival. SUVmax is able to provide information on disease stage and patient survival.