Value of 18F-FDG PET metabolic parameters combined with the dynamic monitoring of molecular residual disease (MRD) in predicting the prognosis of non-small-cell lung cancer after surgery

Objective

To study the ability of the combination of ¹⁸F-FDG positron-emission tomography/computed tomography (PET/CT) metabolic parameters and the dynamic monitoring of molecular residual disease (MRD) in predicting the prognosis of non-small-cell lung cancer (NSCLC) after surgery.

Methods

The clinical data and disease-free survival (DFS) data of 157 NSCLC patients who underwent ¹⁸F-FDG PET/CT at 2 weeks before surgery and were regularly monitored for MRD after surgery were retrospectively analyzed. The correlation between PET metabolic parameters and the dynamic monitoring of MRD and the values of the two in predicting prognosis of NSCLC were analyzed.

Results

Survival analysis revealed that patients with elevated ¹⁸F-FDG PET metabolism had a worse prognosis, while MRD-positive patients had a significantly worse prognosis than MRD-negative patients. By combining of PET metabolic parameters and MRD status, the PET-high-metabolism + MRD-positive group had a worse prognosis than the PET-high-metabolism + MRD-negative group or the PET-low-metabolism + MRD-positive group and the PET-low-metabolism + MRD-negative group. The prognostic model established by tumor TNM staging, clinical data and PET metabolic parameters(comd 1 model) had a high predictive value (C-index: 0.759, 95 % CI: 0.683–0.835). After adding this model to the MRD detection results(comd 2 model), the prognostic accuracy of the model improved (C-index: 0.873, 95 % CI: 0.824–0.922).

Conclusion

The prognostic model made up of Tumor TNM staging,¹⁸F-FDG PET metabolic parameters and clinical data can accurately predict recurrence in NSCLC patients after surgery. Incorporating the results of the dynamic monitoring of MRD detection into the model can significantly enhance its the prognostic accuracy.