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Oncol."],"abstract":"<jats:sec><jats:title>Aim<\/jats:title><jats:p>To investigate the diagnostic potential of and associations between tumor <jats:sup>18<\/jats:sup>F\u2010FDG uptake on PET imaging and cancer-associated weight loss.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>774 non-small cell lung cancer (NSCLC) patients with pre-treatment PET evaluated between 2006 and 2014 were identified. Using the international validated definition of cachexia, the presence of clinically significant pretreatment cancer-associated weight loss (WL) was retrospectively determined. Maximum Standardized Uptake Value (SUV<jats:sub>Max<\/jats:sub>) of <jats:sup>18<\/jats:sup>F\u2010FDG was recorded and dichotomized based on 3 experimental cutpoints for survival analyses. Each SUV<jats:sub>Max<\/jats:sub> cutpoint prioritized either survival differences, total cohort comparison sample sizes, or sample size by stage. Patient outcomes and associations between SUV<jats:sub>Max<\/jats:sub> and cancer-associated weight loss were assessed by multivariate, categorical, and survival analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patients were found to have an increased likelihood of having WL at diagnosis associated with increasing primary tumor SUV<jats:sub>Max<\/jats:sub> after controlling for potentially confounding patient and tumor characteristics on multivariate logistic regression (OR 1.038; 95% CI: 1.012, 1.064; <jats:italic>P=0.0037<\/jats:italic>). After stratifying the cohort by WL and dichotomized SUV<jats:sub>Max<\/jats:sub>, both factors were found to be relevant in predicting survival outcomes when the alternative variable was constant. Of note, the most striking survival differences contributed by WL status occurred in high SUV<jats:sub>Max<\/jats:sub> groups, where the presence of WL predicted a median survival time detriment of up to 10 months, significant regardless of cutpoint determination method applied to categorize high SUV<jats:sub>Max<\/jats:sub> patients. SUV<jats:sub>Max<\/jats:sub> classification was found to be most consistently relevant in both WL and no WL groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The significant positive association between significant pretreatment cancer-associated weight loss and primary tumor SUV<jats:sub>Max<\/jats:sub> underscores increased glucose uptake as a component of catabolic tumor phenotypes. This substantiates <jats:sup>18<\/jats:sup>F\u2010FDG PET analysis as a prospective tool for assessment of cancer-associated weight loss and corresponding survival outcomes. Furthermore, the survival differences observed between WL groups across multiple SUV<jats:sub>Max<\/jats:sub> classifications supports the importance of weight loss monitoring in oncologic workups. Weight loss in the setting of NSCLCs with higher metabolic activity as determined by <jats:sup>18<\/jats:sup>F\u2010FDG PET signal should encourage more aggressive and earlier palliative care interventions.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2022.900712","type":"journal-article","created":{"date-parts":[[2022,6,24]],"date-time":"2022-06-24T07:25:56Z","timestamp":1656055556000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Primary Tumor Fluorine\u201018 Fluorodeoxydglucose (18F\u2010FDG) Is Associated With Cancer-Associated Weight Loss in Non-Small Cell Lung Cancer (NSCLC) and Portends Worse Survival"],"prefix":"10.3389","volume":"12","author":[{"given":"Santiago","family":"Olaechea","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bhavani S.","family":"Gannavarapu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Alvarez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne","family":"Gilmore","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brandon","family":"Sarver","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donglu","family":"Xie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rodney","family":"Infante","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Puneeth","family":"Iyengar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,6,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(10)70218-7","article-title":"Definition and Classification of Cancer Cachexia: An International Consensus","volume":"12","author":"Fearon","year":"2011","journal-title":"Lancet Oncol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdu086","article-title":"Validation of the Consensus-Definition for Cancer Cachexia and Evaluation of a Classification Model\u2013a Study Based on Data From an International Multicentre Project (EPCRC-CSA)","volume":"25","author":"Blum","year":"2014","journal-title":"Ann Oncol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s13539-010-0002-6","article-title":"Cachexia as a Major Underestimated and Unmet Medical Need: Facts and Numbers","volume":"1","author":"von Haehling","year":"2010","journal-title":"J Cachexia Sarcopenia Muscle"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1038\/oncsis.2016.3","article-title":"Understanding Cachexia as a Cancer Metabolism Syndrome","volume":"5","author":"Porporato","year":"2016","journal-title":"Oncogenesis"},{"key":"B5","doi-asserted-by":"publisher","first-page":"2321","DOI":"10.3390\/ijms21072321","article-title":"Cancer Cachexia and Related Metabolic Dysfunction","volume":"21","author":"Fonseca","year":"2020","journal-title":"Int J Mol Sci"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmet.2012.06.011","article-title":"Cancer Cachexia: Mediators, Signaling, and Metabolic Pathways","volume":"16","author":"Fearon","year":"2012","journal-title":"Cell Metab"},{"key":"B7","doi-asserted-by":"publisher","first-page":"17","DOI":"10.4251\/wjgo.v7.i4.17","article-title":"Cancer Cachexia, Mechanism and Treatment","volume":"7","author":"Aoyagi","year":"2015","journal-title":"World J Gastrointest Oncol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2017.00092","article-title":"Validation of the CAchexia SCOre (CASCO). 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