Abstract
Positron emission tomography (PET) with 18F-fluorodeoxyglucose (18F-FDG) is widely used in the management of lung adenocarcinoma. Pyruvate kinase M2 (PKM2) plays a key role in glycolysis. We therefore investigated whether PKM2 expression affects 18F-FDG uptake in a retrospective analysis of 76 patients who underwent 18F-FDG PET/computed tomography (CT) scans for staging before surgical resection. We found that PKM2 expression was higher in tumors than peritumoral tissue (p < 0.05). Patients with high PKM2 expression had reduced overall (p < 0.05) and disease-free (p < 0.05) survival as compared to those with low PKM2 expression. Comparison of the primary tumor maximum standardized uptake value (SUVmax) between patients with high and low PKM2 expression revealed that the SUVmax was higher in primary tumors with high PKM2 expression than low PKM2 expression (p < 0.05). Multivariate analysis confirmed the association between SUVmax and PKM2 expression (p < 0.05). PKM2 status was predicted with 81.6% accuracy when the SUVmax cutoff value of 6.4. Thus,18F-FDG PET/CT is predictive of the PKM2 status in lung adenocarcinoma patients and could aid in determining therapeutic strategies.
Highlights
Lung cancer is one of the most common malignancies worldwide, among which lung adenocarcinoma is the most common histologic type [1]
We investigated the relationship between Pyruvate kinase M2 (PKM2) expression and 18F-FDG uptake to determine whether 18F-FDG uptake could be used to predict PKM2 status in lung adenocarcinoma patients
Our results suggest that 18F-FDG Positron emission tomography (PET) can be used to predict PKM2 status, and that 18F-FDG PET may help determine the therapeutic strategy for lung adenocarcinoma patients by predicting tumor response to PKM2-targeted therapies
Summary
Lung cancer is one of the most common malignancies worldwide, among which lung adenocarcinoma is the most common histologic type [1]. There have been advances in the early diagnosis and treatment of lung cancer, the 5-year survival rate is still poor [2]. This may be explained by the high metastasis rate of lung cancer and resistance to chemotherapeutics [3]. Improving the survival rate of lung adenocarcinoma patients requires the identification of biomarkers that can better predict tumor behavior (e.g. progression or metastatic capability). Glycolysis is closely associated with cellular proliferation and drug resistance in cancer cells, and treatments that target glucose metabolism represent a new strategy for cancer therapy. It is important to identify the clinical characteristics of patients that can predict PKM2 status and the efficacy of PKM2-targeted therapies
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