☆ 4.5 Article

Clinical implications of circulating cell-free DNA quantification and metabolic tumor burden in advanced non-small cell lung cancer

LUNG CANCER (2019)

Journal

LUNG CANCER

Volume 134, Issue -, Pages 158-166

Publisher

ELSEVIER IRELAND LTD

DOI: 10.1016/j.lungcan.2019.06.014

Keywords

Non-small-cell lung carcinoma; Cell-free nucleic acids quantification; Metabolic tumor volume; Total lesion glycolysis; Prognosis

Funding

Korea Health Technology R&D Project of the Korea Health Industry Development Institute, Republic of Korea [HI14C0066]
Bio & Medical Technology Development Program of the National Research Foundation, Republic of Korea [NRF-2015M3A9D7031070]
Korea University Grant [K1813121]
National Research Foundation of Korea [2015M3A9D7031070] Funding Source: Korea Institute of Science & Technology Information (KISTI), National Science & Technology Information Service (NTIS)

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Abstract

Objectives: This study unravels the significance of cell-free DNA (cfDNA) quantification as a promising measure of the biological behavior/aggressiveness of tumors. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) measured by positron emission tomography/computed tomography scan enable a precise assessment of metabolic tumor burden. However, their clinical implications in identifying patients who need more aggressive treatment in advanced non-small cell lung cancer (NSCLC) are not fully understood. Materials and methods: In the current prospective trial, we analyzed 101 newly diagnosed advanced NSCLC (stage III-IV) patients with measurable baseline MTV, TLG, and cfDNA quantification. The best cut-offs for cfDNA levels, MTV, and TLG to predict progression-free survival and overall survival were determined using X-tile analysis. Results: There were significant positive correlations between cfDNA and MTV (r = 0.488, p < 0.001) and between cfDNA and TLG (r = 0.554, p < 0.001). High-cfDNA levels and high-MTV/TLG negatively correlated with overall survival (OS) (all p < 0.001). Patients with high-MTV showed similar median OS irrespective of their cfDNA levels (low-cfDNA vs. high-cfDNA = 9.2 vs 6.6 months; p > 0.05). However, patients with low-MTV and low-cfDNA levels showed longer OS than those with low-MTV and high-cfDNA levels (low-cfDNA vs. high-cfDNA = 49.3 vs 11.5 months; p < 0.001). The patient group with low-TLG also showed similar trends. The cfDNA level was an independent prognostic factor for OS by Cox-proportional hazard analysis. Conclusion: Although the patients with high metabolic tumor burden had a poor prognosis, regardless of the biological behavior/aggressiveness of the tumor, patients with low metabolic tumor burden and high cfDNA levels showed a poor prognosis. Taken together, this study indicates a stronger prognostic value of baseline cfDNA levels in identifying patients with advanced NSCLC and personalizing their treatment strategies for better survival.

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Baseline Total Metabolic Tumor Volume and Total Lesion Glycolysis Measured on 18F-FDG PET-CT Predict Outcomes in T-Cell Lymphoblastic Lymphoma

Xiaoyan Feng, Xin Wen, Ling Li, Zhenchang Sun, Xin Li, Lei Zhang, Jingjing Wu, Xiaorui Fu, Xinhua Wang, Hui Yu, Xinran Ma, Xudong Zhang, Xinli Xie, Xingmin Han, Mingzhi Zhang

Summary: This study found that high baseline SUVmax, TMTV, and TLG measured on PET-CT are strong predictors of worse outcome in T-LBL patients. A risk model integrating these parameters with CNS involvement can identify patients at high risk of disease progression.

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