¹⁸F-FMT uptake seen within primary cancer on PET helps predict outcome of non-small cell lung cancer

L-[3-¹⁸F]-α-methyl tyrosine (¹⁸F-FMT) is an amino-acid tracer for PET imaging. We evaluated the prognostic significance of ¹⁸FFMT PET in patients with non-small cell lung cancer. Methods: Ninety-eight patients (80 men and 18 women; age range, 42-82 y; median age, 69 y) with stage I-IV non-small cell lung cancer were enrolled in this study. They included 57 with adenocarcinoma, 31 with squamous cell carcinoma, 5 with large cell carcinoma, and 5 with other conditions. The median follow-up duration was 17.0 mo. A pair of PET studies with ¹⁸F-FMT and ¹⁸F-FDG was performed, and tracer uptake by the primary tumor was evaluated using the maximal standardized uptake value (SUV_max). Overall survival and disease-free survival were calculated by the Kaplan-Meier method. The prognostic significance was assessed by univariate and multivariate analyses. Results: The best discriminative SUV_max cutoffs for ¹⁸F-FMT and ¹⁸F-FDG in the primary tumors were 1.6 and 11, respectively. In the univariate analysis, a high SUV_max was significant in predicting poor overall survival for ¹⁸F-FMT (P = 0.0129) and ¹⁸F-FDG PET (P = 0.0481). According to histologic types, ¹⁸F-FMT and ¹⁸F-FDG uptake were a stronger prognostic predictor in adenocarcinoma than in nonadenocarcinomatous disease. Patients with a high SUV_max for ¹⁸F-FMT showed significantly worse disease-free survival rates than those with a low SUV_max, and multivariate analysis confirmed that a high SUV_max for ¹⁸F-FMT was an independent and significant factor in predicting a poor prognosis in patients with adenocarcinoma (P = 0.0191). Conclusion: Uptake of ¹⁸F-FMT in primary tumors was an independent prognostic factor in patients with pulmonary adenocarcinoma.