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Purpose <p>To evaluate the prognostic value of <sup>18</sup>F-FDG PET/CT metabolic parameters—specifically SUV, MTV, and TLG—integrated into the TNM stage IV classification for patients with metastatic non-small cell lung cancer (NSCLC).</p> Methods <p>We retrospectively analyzed 272 consecutive patients with metastatic NSCLC who underwent baseline <sup>18</sup>F-FDG PET/CT. Metabolic parameters (SUVmax, SUVmean, MTV, and TLG) were measured for both the whole-body tumor burden (wb) and the metastatic component (m). Statistical analysis included univariate and multivariate Cox regression to identify independent predictors of overall survival (OS), and the Lausen test to dichotomize continuous metabolic variables for Kaplan–Meier survival curves.</p> Results <p>Univariate analysis showed that age, stage IV (A vs. B), and all metabolic parameters were significantly associated with OS. To address collinearity, a multistep multivariate approach selected SUVmax_m and MTV_wb as the most robust metabolic predictors. The final multivariate model confirmed that stage IV (<i>p</i> = 0.039), age (<i>p</i> = 0.024), SUVmax_m (<i>p</i> = 0.002), and MTV_wb (<i>p</i> &lt; 0.001) were independent prognostic factors. Notably, patients in stage IVA with high MTV_wb (&gt; 62.35&#xa0;ml) and those in stage IVB with low MTV_wb (≤ 933.30&#xa0;ml) exhibited similar intermediate survival rates, whereas patients in stage IVA with low MTV_wb and those in stage IVB with high MTV_wb showed the highest and lowest OS, respectively.</p> Conclusion <p>Metabolic <sup>18</sup>F-FDG PET/CT parameters, particularly MTV_wb and SUVmax_m, significantly refine the prognosis of stage IV NSCLC beyond traditional TNM subcategories, highlighting the importance of metabolic tumor burden in metastatic disease.</p>

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18F-FDG PET/CT Metabolic Parameters Add Prognostic Information to Stage IV Classification in Patients with Non-Small Cell Lung Cancer

  • 期刊论文

  • 发表日期：

    2026年7月14日

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  • Monique Beraldo Ordones,
  • Roque Alexis Perez Torres,
  • Marcelo Tatit Sapienza,
  • Carlos Alberto Buchpiguel,
  • Paulo Schiavom Duarte

摘要

Purpose

To evaluate the prognostic value of 18F-FDG PET/CT metabolic parameters—specifically SUV, MTV, and TLG—integrated into the TNM stage IV classification for patients with metastatic non-small cell lung cancer (NSCLC).

Methods

We retrospectively analyzed 272 consecutive patients with metastatic NSCLC who underwent baseline 18F-FDG PET/CT. Metabolic parameters (SUVmax, SUVmean, MTV, and TLG) were measured for both the whole-body tumor burden (wb) and the metastatic component (m). Statistical analysis included univariate and multivariate Cox regression to identify independent predictors of overall survival (OS), and the Lausen test to dichotomize continuous metabolic variables for Kaplan–Meier survival curves.

Results

Univariate analysis showed that age, stage IV (A vs. B), and all metabolic parameters were significantly associated with OS. To address collinearity, a multistep multivariate approach selected SUVmax_m and MTV_wb as the most robust metabolic predictors. The final multivariate model confirmed that stage IV (p = 0.039), age (p = 0.024), SUVmax_m (p = 0.002), and MTV_wb (p < 0.001) were independent prognostic factors. Notably, patients in stage IVA with high MTV_wb (> 62.35 ml) and those in stage IVB with low MTV_wb (≤ 933.30 ml) exhibited similar intermediate survival rates, whereas patients in stage IVA with low MTV_wb and those in stage IVB with high MTV_wb showed the highest and lowest OS, respectively.

Conclusion

Metabolic 18F-FDG PET/CT parameters, particularly MTV_wb and SUVmax_m, significantly refine the prognosis of stage IV NSCLC beyond traditional TNM subcategories, highlighting the importance of metabolic tumor burden in metastatic disease.