Heterogeneity of Glycolytic Phenotype Determined by 18 F-FDG PET/CT Using Coefficient of Variation in Patients with Advanced Non-Small Cell Lung Cancer.

We investigated the role of Coefficient of Variation (CoV), a first-order texture parameter derived from 18 F-FDG PET/CT, in the prognosis of Non-Small Cell Lung Cancer (NSCLC) patients. Eighty-four patients with advanced NSCLC who underwent 18 F-FDG PET/CT before therapy were retrospectively studied. SUVmax, SUVmean, CoV, total Metabolic Tumor Volume (MTV TOT ) and whole-body Total Lesion Glycolysis (TLG WB ) were determined by an automated contouring program (SUV threshold at 2.5). We analyzed 194 lesions: primary tumors ( n = 84), regional ( n = 48) and non-regional ( n = 17) lymph nodes and metastases in liver ( n = 9), bone ( n = 23) and other sites ( n = 13); average CoVs were 0.36 ± 0.13, 0.36 ± 0.14, 0.42 ± 0.18, 0.30 ± 0.14, 0.37 ± 0.17, 0.34 ± 0.13, respectively. No significant differences were found between the CoV values among the different lesion categories. Survival analysis included age, gender, histology, stage, MTV TOT , TLG WB and imaging parameters derived from primary tumors. At univariate analysis, CoV ( p = 0.0184), MTV TOT ( p = 0.0050), TLG WB ( p = 0.0108) and stage ( p = 0.0041) predicted Overall Survival (OS). At multivariate analysis, age, CoV, MTV TOT and stage were retained in the model ( p = 0.0001). Patients with CoV > 0.38 had significantly better OS than those with CoV ≤ 0.38 ( p = 0.0143). Patients with MTV TOT ≤ 89.5 mL had higher OS than those with MTV TOT > 89.5 mL ( p = 0.0063). Combining CoV and MTV TOT , patients with CoV ≤ 0.38 and MTV TOT > 89.5 mL had the worst prognosis. CoV, by reflecting the heterogeneity of glycolytic phenotype, can predict clinical outcomes in NSCLC patients.