Abstract
The study objective was to retrospectively analyze the metabolic variables derived from 18 F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) as predictors of progression-free survival (PFS) and overall survival (OS) in advanced lung adenocarcinoma stratified by epidermal growth factor receptor (EGFR) mutation status. A total of 176 patients (91, EGFR mutation; 85, wild-type EGFR) who underwent 18F-FDG PET/CT before treatment were enrolled. The main 18F-FDG PET/CT-derived variables: primary tumor maximum standardized uptake value (SUVmaxT), primary tumor total lesion glycolysis (TLGT), the maximum SUVmax of all selected lesions in whole body determined using the Response Evaluation Criteria In Solid Tumors (RECIST) 1.1 criteria (SUVmaxWBR), and whole-body total TLG determined using the RECIST 1.1 criteria (TLGWBR) were measured. Survival analysis regarding TLGWBR, and other factors in advanced lung adenocarcinoma patients stratified using EGFR mutation status, were evaluated. The results indicated that high TLGWBR (≥259.85), EGFR wild-type, and high serum LDH were independent predictors of worse PFS and OS in all patients with advanced lung adenocarcinoma. Among patients with wild-type EGFR, only TLGWBR retained significance as an independent predictor of both PFS and OS. Among patients with the EGFR mutation, high serum LDH level was an independent predictor of worse PFS and OS, and high TLGWBR (≥259.85) was an independent predictor of worse PFS but not worse OS. In conclusion, TLGWBR is a promising parameter for prognostic stratification of patients with advanced lung adenocarcinoma and EGFR status; however, it cannot be used to further stratify the risk of worse OS for patients with the EGFR mutation. Further prospective studies are needed to validate our findings.
Highlights
Lung cancer is the most common cancer and the leading cause of malignant diseases worldwide
The variation in the survival of patients with advanced lung adenocarcinoma is associated with multiple factors (EGFR mutation status, Eastern Cooperative Oncology Group (ECOG) performance status, metabolism variables, serum markers, and sex). 18 F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) is a promising method and provides parameters for the selection of patients who have a better prognosis
To the best of our knowledge, the current study involves the largest number of cases of any clinical study date, regarding the analysis of the prognostic significance of metabolic and volumetric parameters derived from 18F-FDG PET/CT in advanced lung adenocarcinoma patients with the epidermal growth factor receptor (EGFR) mutation
Summary
Lung cancer is the most common cancer and the leading cause of malignant diseases worldwide. Non-small-cell lung cancer (NSCLC) accounts for 80–85% of lung cancer cases [1]. Adenocarcinoma is the most frequently diagnosed histological subtype of primary lung cancer in most countries, accounting for almost half of all lung cancers. Most patients with lung adenocarcinomas are diagnosed with advanced disease, which is clinically aggressive and has high metastatic potential [2]. Despite remarkable advances in surgical resections and targeted therapies, the prognosis of lung adenocarcinoma patients remains poor [3]. Identifying novel prognostic methods is very important in improving the predictive ability of outcomes for patients with lung adenocarcinoma
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