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 18F-FMT 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 (SUVmax). 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 SUVmax cutoffs for 18F-FMT and 18F-FDG in the primary tumors were 1.6 and 11, respectively. In the univariate analysis, a high SUVmax 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 SUVmax for 18F-FMT showed significantly worse disease-free survival rates than those with a low SUVmax, and multivariate analysis confirmed that a high SUVmax 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.