Prognostic Significance of FDG Uptake of Bone Marrow on PET/CT in Patients With Non–Small-Cell Lung Cancer After Curative Surgical Resection

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Abstract

Background

This study evaluated the relationship between 18F-fluorodeoxyglucose (FDG) uptake in bone marrow (BM) on positron emission tomography (PET)/computed tomography (CT) imaging and serum inflammatory markers and assessed the prognostic value of FDG uptake of BM in patients with non–small-cell lung cancer (NSCLC) who underwent curative surgical resection.

Patients and Methods

We retrospectively enrolled 110 NSCLC patients who underwent FDG PET/CT imaging and subsequent curative surgical resection. The maximum standardized uptake value of NSCLC (Tmax), mean FDG uptake of BM (BM SUV), and BM to liver uptake ratio (BLR) were measured. The relationships between BM SUV, BLR, and serum inflammatory markers were evaluated and the prognostic significance of PET/CT parameters for predicting recurrence-free survival (RFS) and overall survival (OS) were assessed.

Results

BM SUV and BLR were significantly associated with serum C-reactive protein (CRP) level, white blood cell count, and the neutrophil to lymphocyte ratio (NLR). BLR was also significantly correlated with serum albumin and the platelet to lymphocyte ratio. In univariate analysis, tumor, node, metastases (TNM) stage, serum CRP level, NLR, Tmax, and BLR were significant prognostic factors for RFS and OS, whereas histopathology and tumor size were significant prognostic factors for RFS. In multivariate analysis, BLR, histopathology, TNM stage, and Tmax were independent prognostic factors for RFS and TNM stage and Tmax were independent prognostic factors for OS.

Conclusion

FDG uptake of BM on PET/CT imaging was correlated with serum inflammatory markers and was an independent predictor for RFS, along with FDG uptake of NSCLC.

Micro-Abstract

The purpose of the present study was to evaluate the relationship between 18F-fluorodeoxyglucose (FDG) uptake in bone marrow (BM) on positron emission tomography imaging and serum inflammatory markers and to assess the prognostic value of FDG uptake in BM in non–small-cell lung cancer patients with curative surgical resection. The results showed that BM to liver uptake ratio (BLR) showed significant correlation with serum albumin and C-reactive protein levels, white blood cell count, neutrophil to lymphocyte ratio, and platelet to lymphocyte ratio. Moreover, BLR was an independent prognostic factor for predicting recurrence-free survival.

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