Prognostic Role of Pleural Fluid SUVpeak Value obtained from 18F-FDG PET/CT in patients with Malignant Pleural Effusion.

Abstract

Purpose: Assessing the prognosis of patients with malignant pleural effusion (MPE) is cruical to manage the treatment. We aimed to investigate the role of pleural fluid SUVpeak value in predicting mortality.

Methods: In our single center, prospective cohort study, we enrolled 158 patients with MPE. PET/CT was independently evaluated by two nuclear medicine physicians. To identify independent predictors of 90-day mortality, we conducted both univariate and multivariate Cox regression analyses. Furthermore, we assessed the discriminatory ability of these predictors compared to the LENT score using the DeLong statistic.

Results: In our study, we enrolled 158 patients with a mean age of 66.29±12.6 years, of whom 100 (63.3%) were male. The majority of patients (84.9%) had primary lung cancer, while 24 (15.1%) had metastases from extrapulmonary malignancies. Among the followed-up patients, 51 (32%) died within 90 days, with a median survival of 30 (17-61) days. LENT score (HR: 1.52, 95% CI: 1.14-2.03), pleural fluid albumin value (HR: 0.92, 95% CI: 0.87-0.97), pleural fluid SUVpeak value (HR: 1.39, 95% CI: 1.15-1.69), and pleural effusion size (HR: 1.01, 95% CI: 1.001-1.02) were found to be significant predictors. Furthermore, in assessing the predictive performance for 90-day mortality, ROC curve of a combination of the independent predictors was significantly higher than that of LENT score alone.

Conclusion: Our study revealed that the metabolic characteristics of pleural fluid might predict 90-day mortality in patients with MPE. We established that the incorporation of pleural fluid SUVpeak value into the LENT score has the potential to enhance its discriminative ability.