Abstract
Purpose: To investigate the correlation between 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) metabolic parameters and clinicopathological factors in pathological subtypes of invasive lung adenocarcinoma and prognosis.Patients and Methods: Metabolic parameters and clinicopathological factors from 176 consecutive patients with invasive lung adenocarcinoma between August 2008 and August 2016 who underwent 18F-FDG PET/CT examination were retrospectively analyzed. Invasive lung adenocarcinoma was divided into five pathological subtypes:lepidic predominant adenocarcinoma (LPA), acinar predominant adenocarcinoma (APA), papillary predominant adenocarcinoma (PPA), solid predominant adenocarcinoma (SPA), and micropapillary predominant adenocarcinoma (MPA). The differences in metabolic parameters [maximal standard uptake value (SUVmax), mean standard uptake value (SUVmean), total lesion glycolysis (TLG), and metabolic tumor volume (MTV)] and tumor diameter for different pathological subtypes were analyzed. Patients were divided into two groups according to their prognosis: good prognosis group (LPA, APA, PPA) and poor prognosis group (SPA, MPA). Logistic regression was used to filter predictors and construct a predictive model, and areas under the receiver operating curve (AUC) were calculated. Cox regression analysis was performed on prognostic factors.Results: 82 (46.6%) females and 94 (53.4%) males of patients with invasive lung adenocarcinoma were enrolled in this study. Metabolic parameters and tumor diameter of different pathological subtype had statistically significant (P < 0.05). The predictive model constructed using independent predictors (Distant metastasis, Ki-67, and SUVmax) had good classification performance for both groups. The AUC for SUVmax was 0.694 and combined with clinicopathological factors were 0.745. Cox regression analysis revealed that Stage, TTF-1, MTV, and pathological subtype were independent risk factors for patient prognosis. The hazard ratio (HR) of the poor prognosis group was 1.948 (95% CI 1.042–3.641) times the good prognosis group. The mean survival times of good and poor prognosis group were 50.2621 (95% CI 47.818–52.706) and 35.8214 (95% CI 27.483–44.159) months, respectively, while the median survival time was 47.00 (95% CI 45.000–50.000) and 31.50 (95% CI 23.000–49.000) months, respectively.Conclusion: PET/CT metabolic parameters combined with clinicopathological factors had good classification performance for the different pathological subtypes, which may provide a reference for treatment strategies and prognosis evaluation of patients.
Highlights
Adenocarcinoma is the most common type of lung cancer, with a high incidence among women and is the most common type of lung cancer in non-smokers [1,2,3,4]
The purpose of this study was to use PET/CT metabolic parameters and clinicopathological factors to study the correlation between the pathological subtypes of invasive lung adenocarcinoma and prognosis, which may provide a reference for treatment strategies and prognosis evaluation
Of 176 patients with invasive lung adenocarcinoma included in this study, 94 (53.4%) were male and 82 (46.6%) were female
Summary
Adenocarcinoma is the most common type of lung cancer, with a high incidence among women and is the most common type of lung cancer in non-smokers [1,2,3,4]. The incidence and mortality of lung adenocarcinoma in China are on the rise, and rank first among all malignant tumors and are considered to be the most threatening to human health [5]. Lung cancer patients lack obvious clinical signs and symptoms in the early stages. The histological classification used for lung cancer in the past cannot meet the needs of clinical treatment or predictive prognosis, nor can it reflect progress in imaging, pathology and tumor molecular biology. The International Association for the Study of Lung Cancer (IASLC), American Thoracic Society (ATS), and European Respiratory Society (ERS) first proposed a new international classification standard for lung adenocarcinoma in 2011 [10,11,12], which divided adenocarcinoma into four types: preinvasive lesions, microinvasive adenocarcinoma (MIA), invasive adenocarcinoma and invasive adenocarcinoma variants. Invasive adenocarcinoma (IAC) was divided into lepidic predominant adenocarcinoma (LPA), papillary predominant adenocarcinoma (PPA), and acinar predominant adenocarcinoma (APA), in addition to solid predominant adenocarcinoma (SPA), and micropapillary predominant adenocarcinoma (MPA)
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