Objective  To assess the correlation between metabolic parameters on ¹⁸F-fluorodeoxyglucose positron emission tomography/ computed tomography (¹⁸F-FDG PET/CT) and the mutation status of the epidermal growth factor receptor (EGFR) gene in patients with advanced non-small-cell lung cancer (NSCLC) and to investigate the effect of EGFR mutation status on assessment of the prognosis based on metabolic parameters.

  Methods  A total of 109 patients with advanced NSCLC who underwent both ¹⁸F-FDG PET/CT and EGFR mutation status evaluation at The First Affiliated Hospital of Chongqing Medical University between January 2017 and December 2018 were retrospectively analyzed. The patients were assigned into the EGFR mutant and EGFR wild-type groups according to their EGFR mutation status. Metabolic parameters and clinical information were compared between the two groups, and their relationship with EGFR mutation status were analyzed. The progression-free survival (PFS) of these patients was record to analyze the influence of EGFR mutation status on prognosis, as predicted using ¹⁸F-FDG PET/CT findings.

  Results  Multivariate Logistic analysis demonstrated that female sex (OR=12.154, P < 0.001), adenocarcinoma (OR=4.822, P=0.019), and a maximum standardized uptake value (SUVmax) ≤9.58 (OR=4.347, P=0.005) were correlated with the presence of EGFR mutations. The receiver operating characteristic curves of PFS illustrated that metabolic tumor volume (MTV) (AUC=0.749, P=0.000 2) and total lesion glycolysis (TLG) (AUC=0.747, P=0.0003) could be used to evaluate the prognosis of NSCLC patients. According to the results of Cox regression analysis, patients with an MTV>14.85 (HR=2.724, P=0.004) in the EGFR mutant group and patients with an MTV>12.48 (HR=3.195, P=0.002) in the EGFR wild-type group had a higher risk of disease progression.

  Conclusions  EGFR mutations in advanced NSCLC patients are associated with low ¹⁸F-FDG uptake, and volumetric parameters are of great significance in the prediction of prognosis. However, different evaluation criteria using ¹⁸F-FDG PET/CT parameters should be adopted for evaluating the prognosis of patients with different types of EGFR mutations.