Prediction of Prognosis in Malignant Pleural Mesothelioma using [18F] Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Metabolic Parameters.

Background: Malignant pleural mesothelioma (MPM) is known to have poor prognosis and low survival rate. Prognostic information provided by 18 fluorodeoxyglucose (FDG) PET/CT metabolic parameters in initial staging of MPM patients was the aim of this study.Materials & Methods: All 18F-FDG PET/ CT scans used for pretreatment staging of MPM (n =56) were reviewed. Overall survival (OS) was correlated with standardized uptake values (SUV) including mean, maximum and peak values, metabolic tumor volume (MTV) and total lesion glycolysis (TLG)for primary and primary/liver ratio as well as demographic, clinical characteristics and pathological data. Results: Overall survival rate at 1 year was 70.1. ROC curve analysis of 18F-PET/CT for primary site; SUVmax (p=0.030), SUVpeak (p=0.023), SUVmean (p=0.019), TLG (p =0.010) and only TLG (p =0.038) of primary/liver ratio were significantly associated with prediction of disease progression. The other parameters were of borderline significance. By univariate OS analysis in relation to 18F-PET/CT for primary site; SUVmean (P=0.002) SUVpeak (P=0.026) TLG (P=0.006) and for primary/liver ratio; SUVmax (P=0.004), SUVpeak (P=0.005),SUVmean (P= 0.017) and TLG (P=0.016) were significantly associated with OS. Regarding multivariate analysis including the 3 significant variables on univariate level, only SUVmean (P=0.005) for primary site & SUVmax (P= 0.007) for PET/CT of primary site/ liver ratio, were independently predicting OS at the final step of the model. Conclusions: Functional 18F-FDG PET/CT volume based metabolic parameters indices for primary and primary to liver ratio are non-invasive, low cost and time effective method to provide prognostic information for malignant pleural mesothelioma.