Abstract
PurposeThe combined small-cell lung cancer (c-SCLC) is rare and has unique clinicopathological futures. The aim of this study is to investigate 18F-FDG PET/CT parameters and clinicopathological factors that influence the prognosis of c-SCLC.MethodsBetween November 2005 and October 2014, surgical-resected tumor samples from c-SCLC patients who received preoperative 18F-FDG PET/CT examination were retrospectively reviewed. The maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were used to evaluate metabolic parameters in primary tumors. The survivals were evaluated with the Kaplan–Meier method. Univariate and multivariate analyses were used to evaluate potential prognostic factors.ResultsThirty-one patients were enrolled, with a median age of 62 (range: 35 − 79) years. The most common mixed component was squamous cell carcinoma (SCC, n = 12), followed by large-cell carcinoma (LCC, n = 7), adenocarcinoma (AC, n = 6), spindle cell carcinoma (n = 4), adenosquamous carcinoma (n = 1) and atypical carcinoid (n = 1). The median follow-up period was 53.0 (11.0–142.0) months; the 5-year overall survival (OS) and progression-free survival(PFS) rate were 48.4% and 35.5%, respectively. Univariate survival analysis showed that gender, smoking history, tumor location were associated with PFS (P = 0.036, P = 0.043, P = 0.048), SUVmax and TNM stage were closely related to PFS in both Mixed SCC and non-SCC component groups (P = 0.007, P = 0.048). SUVmax, smoking history, tumor size and mixed SCC component were influencing factors of OS in patients (P = 0.040, P = 0.041, P = 0.046, P = 0.029). Multivariate survival analysis confirmed that TNM stage (HR = 2.885, 95%CI: 1.323–6.289, P = 0.008) was the most significantly influential factor for PFS. High SUVmax value (HR = 9.338, 95%CI: 2.426–35.938, P = 0.001) and mixed SCC component (HR = 0.155, 95%CI: 0.045–0.530, P = 0.003) were poor predictors for OS.ConclusionSurgical-resected c-SCLCs have a relatively good prognosis. TNM stage is the most significant factor influencing disease progression in surgical-resected c-SCLCs. SUVmax and mixed NSCLC components within c-SCLCs had a considerable influence on the survival. Both high SUVmax and mixed SCC component are poor predictors for patients with c-SCLCs.
Highlights
Combined small-cell lung carcinoma (c-SCLC) is defined as small-cell lung cancer (SCLC) combined with an additional component that consists of any of the histological types of non-small-cell lung cancer (NSCLC), including adenocarcinoma (AC), squamous cell carcinoma (SCC), large-cell carcinoma (LCC), or spindle cell, carcinoid and other rare types (Travis 2014)
A total of 31 patients diagnosed with c-SCLC were included in the present study
Primary tumor SUVmax measured on 18F-FDG PET/CT has no significant correlation with clinicopathological factors
Summary
Combined small-cell lung carcinoma (c-SCLC) is defined as small-cell lung cancer (SCLC) combined with an additional component that consists of any of the histological types of non-small-cell lung cancer (NSCLC), including adenocarcinoma (AC), squamous cell carcinoma (SCC), large-cell carcinoma (LCC), or spindle cell, carcinoid and other rare types (Travis 2014). SUVmax measured on 18F-FDG PET/CT is used to quantify FDG uptake of tumor cells; the degree of tumor uptake of 18F-FDG on PET/CT is shown to be an valuable prognostic gauge in malignant tumors (Bai et al 2017; Hsieh et al 2018; Hsu et al 2016; Kwon et al 2016; Lee et al 2015, 2018; Park et al 2014, 2016; Zhu et al 2018) While, volumetric parameters such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG) are investigated for independent prognostic parameters in NSCLC and some other cancers (Albano et al 2018; Burger et al 2016; Hasbek et al 2019; Lemarignier et al 2017; Tsujikawa et al 2017). Influence of primary tumor metabolic parameters and mixed NSCLC components on survival of c-SCLC, and whether they are associated with prognosis are unclear
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