Skip to main content
Key Specialties
Anesthesiology Cardiology Dermatology Diabetology Endocrinology Gastroenterology and Hepatology General Medicine Geriatrics Hematology Infectious Diseases Internal Medicine Nephrology Neurology Obstetrics and Gynecology Oncology Ophthalmology Pediatrics Psychiatry Radiology Respiratory Medicine Rheumatology Surgery Urology
Congress Coverage
ASH 2024 Annual Meeting 2024 ESMO Congress 2024 ERS Congress 2024 EASD Congress 2024 ESC Congress 2024 EAN Congress 2024 ASCO Annual Meeting 2024 ACC Congress
Clinical Collections
Women’s Health Knowledge Hub Advances in Alzheimer’s

Navigating neuroimaging in Alzheimer disease care

PET imaging is playing an increasingly critical role in managing AD, but how can you effectively integrate it into clinical practice? Our expert-led program will empower you with practical strategies and real-world case studies.

This content is intended for healthcare professionals outside of the UK.
ADVANCED SEARCH
Log in
Top
Annals of Nuclear Medicine
Published in:

09-05-2024 | Original Article

The prognostic value of lymph node to primary tumor standardized uptake value ratio in cancer patients: a meta-analysis

Authors: Wing-Keen Yap, Ken-Hao Hsu, Ting-Hao Wang, Chia-Hsin Lin, Chung-Jan Kang, Shih-Ming Huang, Huan-Chun Lin, Tsung-Min Hung, Kai-Ping Chang, Tsung-You Tsai

Published in: Annals of Nuclear Medicine | Issue 8/2024

Login to get access

Abstract

Objective

The lymph node to primary tumor standardized uptake value ratio (NTR) is an innovative parameter derived from positron emission tomography/computed tomography (PET/CT) scans that captures the intricate relationship between primary tumors and associated lymph nodes. This meta-analysis aimed to investigate the prognostic value of NTR in cancer patients.

Methods

A systematic search of PubMed, Cochrane, and Embase databases was conducted to identify studies investigating the association between NTR and survival outcomes in cancer patients. The pooled adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were calculated using a random-effects model.

Results

Twelve studies comprising a total of 2037 patients were included in the meta-analysis. Elevated NTR was significantly associated with worse overall survival aHR (2.21, 95% CI 1.63 to 2.99), disease-free survival aHR (3.27, 95% CI 2.12 to 5.05), and distant metastasis-free survival aHR (2.07, 95% CI 1.55 to 2.78) in cancer patients. Subgroup analyses by cancer type showed consistent results across various malignancies, including head and neck squamous cell carcinoma, endometrial carcinoma, lung cancer, breast cancer, and nasopharyngeal carcinoma.

Conclusions

This meta-analysis provides evidence for a significant association between elevated NTR and worse survival outcomes in cancer patients. Elevated NTR may serve as a useful prognostic biomarker for cancer patients and could potentially be used to guide treatment decisions and monitor disease progression. Future studies should aim to validate these findings in larger and more diverse patient populations and investigate the underlying mechanisms for the observed association between NTR and survival outcomes.
Appendix
Available only for authorised users
Literature
1.
Ferlay J, Colombet M, Soerjomataram I, Parkin DM, Piñeros M, Znaor A, et al. Cancer statistics for the year 2020: an overview. Int J Cancer. 2021;149(4):778–89.CrossRef
2.
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA A Cancer J Clin. 2021;71(3):209–49.CrossRef
3.
Diao W, Tian F, Jia Z. The prognostic value of SUV(max) measuring on primary lesion and ALN by (18)F-FDG PET or PET/CT in patients with breast cancer. Eur J Radiol. 2018;105:1–7.CrossRefPubMed
4.
Liu J, Dong M, Sun X, Li W, Xing L, Yu J. Prognostic value of 18F-FDG PET/CT in surgical non-small cell lung cancer: a meta-analysis. PLoS One. 2016;11(1): e0146195.CrossRefPubMedPubMedCentral
5.
Torizuka T, Tanizaki Y, Kanno T, Futatsubashi M, Naitou K, Ueda Y, et al. Prognostic value of 18F-FDG PET in patients with head and neck squamous cell cancer. Am J Roentgenol. 2009;192(4):W156–60.CrossRef
6.
Wu Z, Zhao J, Gao P, Song Y, Sun J, Chen X, et al. Prognostic value of pretreatment standardized uptake value of F-18-fluorodeoxyglucose PET in patients with gastric cancer: a meta-analysis. BMC Cancer. 2017;17(1):275.CrossRefPubMedPubMedCentral
7.
Pandit N, Gonen M, Krug L, Larson SM. Prognostic value of [18F]FDG-PET imaging in small cell lung cancer. Eur J Nucl Med Mol Imaging. 2003;30(1):78–84.CrossRefPubMed
8.
Yap W-K, Chang Y-C, Hsieh C-H, Chao Y-K, Chen C-C, Shih M-C, et al. Favorable versus unfavorable prognostic groups by post-chemoradiation FDG-PET imaging in node-positive esophageal squamous cell carcinoma patients treated with definitive chemoradiotherapy. Eur J Nucl Med Mol Imaging. 2018;45(5):689–98.CrossRefPubMed
9.
Yap WK, Chang YC, Tseng CK, Hsieh CH, Chao YK, Su PJ, et al. Predictive value of nodal maximum standardized uptake value of pretreatment [18F]fluorodeoxyglucose positron emission tomography imaging in patients with esophageal cancer. Dis Esophagus. 2017;30(8):1–10.CrossRefPubMed
10.
Chen PJ, Yap WK, Chang YC, Tseng CK, Chao YK, Hsieh JC, et al. Prognostic value of lymph node to primary tumor standardized uptake value ratio in unresectable esophageal cancer. BMC Cancer. 2020;20(1):545.CrossRefPubMedPubMedCentral
11.
Chung HH, Cheon GJ, Kim JW, Park NH, Song YS. Prognostic importance of lymph node-to-primary tumor standardized uptake value ratio in invasive squamous cell carcinoma of uterine cervix. Eur J Nucl Med Mol Imaging. 2017;44(11):1862–9.CrossRefPubMed
12.
Chung HH, Cheon GJ, Kim JW, Park NH, Song YS. Prognostic value of lymph node-to-primary tumor standardized uptake value ratio in endometrioid endometrial carcinoma. Eur J Nucl Med Mol Imaging. 2018;45(1):47–55.CrossRefPubMed
13.
Gihbid A, Cherkaoui Salhi G, El Alami I, Belgadir H, Tawfiq N, Bendahou K, et al. Pretreatment [(18)F]FDG PET/CT and MRI in the prognosis of nasopharyngeal carcinoma. Ann Nucl Med. 2022;36(10):876–86.CrossRefPubMed
14.
Ho K-W, Fang K-H, Lu C-H, Hsu C-M, Lai C-H, Liao C-T, et al. Prognostic utility of neck lymph node-to-primary tumor standardized uptake value ratio in oral cavity cancer. Biomedicines. 2023;11(7):1954.CrossRefPubMedPubMedCentral
15.
Hung TM, Fan KH, Kang CJ, Huang SF, Lin CY, Ho AT, et al. Lymph node-to-primary tumor standardized uptake value ratio on PET predicts distant metastasis in nasopharyngeal carcinoma. Oral Oncol. 2020;110: 104756.CrossRefPubMed
16.
Kang HC, Wu HG, Yu T, Kim HJ, Paeng JC. Fluorodeoxyglucose positron-emission tomography ratio in non-small cell lung cancer patients treated with definitive radiotherapy. Radiat Oncol J. 2013;31(3):111–7.CrossRefPubMedPubMedCentral
17.
Ishibashi-Kanno N, Yamagata K, Hara T, Takaoka S, Fukuzawa S, Uchida F, et al. Prognostic prediction using maximum standardized uptake value ratio of lymph node-to-primary tumor in preoperative PET-CT for oral squamous cell carcinoma. J Stomatol Oral Maxillofac Surg. 2023;124(5): 101489.CrossRefPubMed
18.
Kim YH, Yoon HJ, Kim Y, Kim BS. Axillary lymph node-to-primary tumor standard uptake value ratio on preoperative (18)F-FDG PET/CT: a prognostic factor for invasive ductal breast cancer. J Breast Cancer. 2015;18(2):173–80.CrossRefPubMedPubMedCentral
19.
Li TC, Zhao X, Liu YN, Wang GL, Liu KF, Zhao K. Prognostic value of node-to-primary tumor maximum standardized uptake value ratio in T1–4N1-3M0 non-small cell lung cancer patients treated with concurrent chemo-radiotherapy. Nucl Med Commun. 2022;43(8):901–7.CrossRefPubMedPubMedCentral
20.
Lin CH, Hung TM, Chang YC, Hsieh CH, Shih MC, Huang SM, et al. Prognostic value of lymph node-to-primary tumor standardized uptake value ratio in esophageal squamous cell carcinoma treated with definitive chemoradiotherapy. Cancers (Basel). 2020;12(3):607.CrossRefPubMed
21.
Lou Y, Chen D, Lin Z, Sun J, Song L, Chen W, et al. The prognostic value of the ratio of standard uptake value of lymph node to primary tumor before treatment of locally advanced nasopharyngeal carcinoma. Eur Arch Otorhinolaryngol. 2023;280(1):347–56.CrossRefPubMed
22.
Shen EY, Hung TM, Tsan DL, Cheng NM, Kang CJ, Huang SF, et al. Utilization of the lymph node-to-primary tumor ratio of PET standardized uptake value and circulating Epstein-Barr virus DNA to predict distant metastasis in nasopharyngeal carcinoma. Radiother Oncol. 2022;177:1–8.CrossRefPubMed
23.
McInnes MDF, Moher D, Thombs BD, McGrath TA, Bossuyt PM, Clifford T, et al. Preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies: the PRISMA-DTA statement. JAMA. 2018;319(4):388–96.CrossRefPubMed
24.
Wells G, Shea B, O'Connell J. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa Health Research Institute Web site. 2014;7.
25.
Kong FF, Pan GS, Ni MS, Du CR, Hu CS, Ying HM. Prognostic value of lymph node-to-primary tumor ratio of PET standardized uptake value for nasopharyngeal carcinoma: a recursive partitioning risk stratification analysis. Ther Adv Med Oncol. 2024;16:17588359241233236.CrossRefPubMedPubMedCentral
26.
Liu T, David M, Batstone M, Clark J, Low TH, Goldstein D, et al. The utility of postoperative radiotherapy in intermediate-risk oral squamous cell carcinoma. Int J Oral Maxillofac Surg. 2021;50(2):143–50.CrossRefPubMed
27.
Hong CM, Park S-H, Chong GO, Lee YH, Jeong JH, Lee S-W, et al. Enhancing prognosis prediction using pre-treatment nodal SUVmax and HPV status in cervical squamous cell carcinoma. Cancer Imaging. 2019;19(1):43.CrossRefPubMedPubMedCentral
28.
Lee SJ, Kay CS, Kim YS, Son SH, Kim M, Lee SW, et al. Prognostic value of nodal SUVmax of 18F-FDG PET/CT in nasopharyngeal carcinoma treated with intensity-modulated radiotherapy. Radiat Oncol J. 2017;35(4):306–16.CrossRefPubMedPubMedCentral
29.
Hsieh CE, Cheng NM, Chou WC, Venkatesulu BP, Chou YC, Liao CT, et al. Pretreatment primary tumor and nodal SUVmax values on 18F-FDG PET/CT images predict prognosis in patients with salivary gland carcinoma. Clin Nucl Med. 2018;43(12):869–79.CrossRefPubMed
30.
Vatankulu B, Şanlı Y, Kaytan Sağlam E, Kuyumcu S, Özkan ZG, Yılmaz E, et al. Does metastatic lymph node SUVmax predict survival in patients with esophageal cancer? Mol Imaging Radionucl Ther. 2015;24(3):120–7.CrossRefPubMedPubMedCentral
31.
Bong-Il S, Kyoung SW. Prognostic value of nodal SUVmax on pretreatment F-18 FDG PET/CT in patients with gastric cancer. J Nucl Med. 2014;55(supplement 1):74.
32.
Hamberg LM, Hunter GJ, Alpert NM, Choi NC, Babich JW, Fischman AJ. The dose uptake ratio as an index of glucose metabolism: useful parameter or oversimplification? J Nucl Med. 1994;35(8):1308–12.PubMed
33.
Keyes JW Jr. SUV: standard uptake or silly useless value? J Nucl Med. 1995;36(10):1836–9.PubMed
34.
35.
Wang C, Zhao K, Hu S, Huang Y, Ma L, Li M, et al. The PET-derived tumor-to-liver standard uptake ratio (SUV (TLR) ) is superior to tumor SUVmax in predicting tumor response and survival after chemoradiotherapy in patients with locally advanced esophageal cancer. Front Oncol. 2020;10:1630.CrossRefPubMedPubMedCentral
36.
Shin S, Pak K, Kim IJ, Kim BS, Kim SJ. Prognostic value of tumor-to-blood standardized uptake ratio in patients with resectable non-small-cell lung cancer. Nucl Med Mol Imaging. 2017;51(3):233–9.CrossRefPubMed
37.
Zhang P, Chen W, Zhao K, Qiu X, Li T, Zhu X, et al. Tumor to liver maximum standardized uptake value ratio of FDG-PET/CT parameters predicts tumor treatment response and survival of stage III non-small cell lung cancer. BMC Med Imaging. 2023;23(1):107.CrossRefPubMedPubMedCentral
38.
van den Bosch S, Dijkema T, Philippens MEP, Terhaard CHJ, Hoebers FJP, Kaanders J, et al. Tumor to cervical spinal cord standardized uptake ratio (SUR) improves the reproducibility of (18)F-FDG-PET based tumor segmentation in head and neck squamous cell carcinoma in a multicenter setting. Radiother Oncol. 2019;130:39–45.CrossRefPubMed
39.
Hofheinz F, Apostolova I, Oehme L, Kotzerke J, van den Hoff J. Test-retest variability in lesion SUV and lesion SUR in (18)F-FDG PET: an analysis of data from two prospective multicenter trials. J Nucl Med. 2017;58(11):1770–5.CrossRefPubMedPubMedCentral
40.
van den Hoff J, Oehme L, Schramm G, Maus J, Lougovski A, Petr J, et al. The PET-derived tumor-to-blood standard uptake ratio (SUR) is superior to tumor SUV as a surrogate parameter of the metabolic rate of FDG. EJNMMI Res. 2013;3(1):77.CrossRefPubMedPubMedCentral
41.
Hofheinz F, Hoff J, Steffen IG, Lougovski A, Ego K, Amthauer H, et al. Comparative evaluation of SUV, tumor-to-blood standard uptake ratio (SUR), and dual time point measurements for assessment of the metabolic uptake rate in FDG PET. EJNMMI Res. 2016;6(1):53.CrossRefPubMedPubMedCentral
Metadata
Title
The prognostic value of lymph node to primary tumor standardized uptake value ratio in cancer patients: a meta-analysis
Authors
Wing-Keen Yap
Ken-Hao Hsu
Ting-Hao Wang
Chia-Hsin Lin
Chung-Jan Kang
Shih-Ming Huang
Huan-Chun Lin
Tsung-Min Hung
Kai-Ping Chang
Tsung-You Tsai
Publication date
09-05-2024
Publisher
Springer Nature Singapore
Published in
Annals of Nuclear Medicine / Issue 8/2024
Print ISSN: 0914-7187
Electronic ISSN: 1864-6433
DOI
https://doi.org/10.1007/s12149-024-01933-5

Other articles of this Issue 8/2024

Investigation on low-iodine diet implementation by medical staff before radioactive iodine treatment for differentiated thyroid carcinoma

  • Original Article

Prognostic significance of 68 Ga-FAPI PET/CT in patients with bone metastases in various cancers

Prognostic value of combining clinical factors, 18F-FDG PET-based intensity, volumetric features, and deep learning predictor in patients with EGFR-mutated lung adenocarcinoma undergoing targeted therapies: a cross-scanner and temporal validation study

DOCK–PET: database of CNS kinetic parameters in the healthy human brain for existing PET tracers

Evaluation of 68Ga-PSMA-11 PET/CT: a Phase 1 clinical study in Japanese patients with primary, recurrent, or suspected recurrent prostate cancer

Diagnostic performance of F-18 FDG PET/CT in differentiating autoimmune pancreatitis from pancreatic cancer: a systemic review and meta-analysis