Primary tumor standardized uptake value (SUVmax) measured on 18F-FDG PET/CT and mixed NSCLC components predict survival in surgical-resected combined small-cell lung cancer

Abstract

Purpose The combined small-cell lung cancer (c-SCLC) is rare and has unique clinicopathological futures. The aim of this study is to investigate 18 F-FDG PET/CT parameters and clinicopathological factors that influence the prognosis of c-SCLC. Methods Between November 2005 and October 2014, surgical-resected tumor samples from c-SCLC patients who received preoperative 18 F-FDG PET/CT examination were retrospectively reviewed. The maximum standardized uptake value (SUV max), 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. Results Thirty-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). SUV max , 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 SUV max 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. Conclusion Surgical-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.

Construction and Validation of a Novel Nomogram to Predict the Overall Survival of Patients With Combined Small Cell Lung Cancer: A Surveillance, Epidemiology, and End Results Population-Based Study

“…Previous studies had proposed some factors that were potentially correlated with OS of C-SCLC, including smoking history, 10 extensive-stage disease, 11 lymph node metastasis, 2 , 8 adjuvant treatment, 2 , 10 , 11 and pathologically combined LCNEC 10 and SCC. 17 Lei et al reported that lymph node metastasis was significantly correlated with decreased disease-free survival (DFS) and OS in surgically resected C-SCLC, consistent with our finding. 9 In addition, in a previously published study, Men et al observed that positive lymph nodes ratio >10% was an independent risk factor of OS for these patients.…”

“…1 Numerous studies also explored the effect of postoperative radiotherapy on the OS of C-SCLC. 2,8,11,17,24 In a study conducted by Men et al, they indicated that postoperative chemotherapy was not significantly correlated with improved OS of C-SCLC. 24 However, subgroup analysis revealed that postoperative chemotherapy significantly improved the survivals of patients with stage III or N2 disease.…”

“…In most retrospective studies, researchers revealed that surgery was not significantly correlated with the prognosis of C-SCLC, no matter what type of resection was adopted. 2,8,10,17 On the contrary, Guo et al indicated that receiving sublobectomy was correlated with decreased OS for patients with C-SCLC. 11 Besides, in a similar populationbased study, He et al investigated the treatment options for C-SCLC.…”