Sex and SUVmax: Sex-Dependent Prognostication in Early Non–Small Cell Lung Cancer

Abstract

The identification of robust prognostic factors for patients with early-stage non-small cell lung cancer (NSCLC) is clinically important. The International Association for the Study of Lung Cancer has identified both sex and the maximum standardized uptake value (SUVmax) of 18 F-FDG in the primary tumor as measured by PET as potential prognostic variables. We examined the prognostic value of SUVmax in a surgical cohort of patients with NSCLC and disaggregated the findings by sex. Methods: Patients who had undergone a preoperative PET/CT scan and surgical resection with curative intent from 2001 to 2009 were identified from a prospective database. An SUVmax cutoff was calculated using receiver-operating-characteristic curves. Overall survival was correlated with SUVmax for the whole cohort and disaggregated by sex. Results: Inclusion criteria were met by 189 patients: 127 (67%) men and 62 (33%) women. Five-year survival was 54.6% for the whole cohort, 47.7% for men, and 68.2% for women. SUVmax correlated negatively with survival in a univariate analysis for the whole cohort (hazard ratio [HR], 2.51; 95% confidence interval [CI], 1.54-4.09; P , 0.001) and men (HR, 3.42; 95% CI, 1.94-6.05; P , 0.001) but not for women (HR, 1.61; 95% CI, 0.43-3.12; P 5 0.77), using 8 as a cutoff. In multivariate analysis, SUVmax correlated with overall survival for the whole cohort (HR, 1.70; 95% CI, 1.05-2.99; P 5 0.05) and men (HR, 2.40; 95% CI, 1.32-4.37; P 5 0.004) but not for women (HR, 0.80; 95% CI,; P 5 0.80). Conclusion: SUVmax independently predicted overall survival for men but not for women in this surgical cohort. Our results suggest that SUVmax is an independent prognostic variable in men with surgically treated early NSCLC.

Sex-Dependent Staging in Non–Small-Cell Lung Cancer; Analysis of the Effect of Sex Differences in the Eighth Edition of the Tumor, Node, Metastases Staging System

“…that the maximum standardised uptake value of fluorodeoxyglucose on PET scan was prognostic in men and not women with NSCLC, demonstrating sex differences between the tumour cell metabolism of glucose, which correlated with survival. [58] These findings were further corroborated by Ippolito et al who found a higher glycolytic rate was associated with poorer survival in men but not in women with glioma, indicating sex differences at the tumor cell level. [59] Dougherty et al demonstrated that tumour cells have a sexual dimorphism in so far as in adenocarcinoma cell lines from men and women had similar numbers of oestrogen receptor alpha and beta, but the male cell lines were not oestrogen responsive.…”

Evaluation of fluorine-18-fluorodeoxyglucose PET/computed tomography and human epithelial growth factor receptor 2 expression in treatment-naive patients with lung adenocarcinoma

“…analysis. Previous studies [28][29][30][31][32] have reported the prognostic value of SUV max of 18 F-FDG PET/CT, HER2 expression, TNM stage, CYFRA211 and EGFR mutation in lung adenocarcinoma, respectively, which are in agreement with our present study.…”

Integrated analysis of long non-coding RNAs and mRNA profiles reveals potential sex-dependent biomarkers of bevacizumab/erlotinib response in advanced lung cancer

“…In females, these core genes were upregulated in BE-responsive patients, whereas in males all of these core genes other than SIX1 and SOX2 were downregulated in BE-responsive patients. These results are of interest as they highlight sex-dependent differences in patient tumor responses, consistent with previous work demonstrating sexual dimorphism with respect to cancer patient physiological, pathophysiological, and pharmacological outcomes [32]. Work from the Moffitt Cancer Center indicated that men were associated with worse lung cancer outcomes than women (HR, 1.24 [95% CI, 1.09-1.41]) [33], and sex-related differences in patient immunotherapy have also been observed [34].…”