SUVmax and Tumor Size Predict Surgical Outcome of Synchronous Multiple Primary Lung Cancers

Abstract

To assess surgical outcomes in synchronous multiple primary lung cancer (SMPLC) and correlations with clinicopathological features and prognostic/predictive factors.We retrospectively reviewed patients diagnosed with early-stage nonsmall cell lung cancer (NSCLC) between January 2006 and June 2012. In total, 564 patients with resectable NSCLC underwent a preoperative positron emission tomography-computed tomography scan followed by anatomic resection. We reviewed the clinical features of 35 SMPLC patients. Surgical outcomes, prognosis, and tumor imaging features were evaluated (median follow-up = 44 months).In total, 35 eligible SMPLC patients (6.21%) were identified (11 men [31%], 24 women [69%], mean age = 65 years]). The tumors were bilateral in 17 patients (49%) and in different lobes of the ipsilateral lung in 18 patients (51%). Most patients (26/35, 74%) had 2 primary tumors, and 26% (9/35) had more than 2 tumors (6 with 3 tumors; 3 with 4 tumors). The median size of the most advanced tumor was 3.0 cm (range 0.9–54). The median standard uptake value (SUV) of the largest tumor was 3.1 (range 1.0–13.3). The patients were treated as follows: 30 lobectomies, 2 sublobar resections, 2 sequential bilateral lobectomies, and 1 bi-lobectomy. Twenty-four patients (69%) received adjuvant therapy. The overall cumulative 5-year survival was 91.5% (median overall survival = 45.5 months). Patients with a reference tumor ≤ 3 cm and SUV ≤ 3.1 had an expected 5-year survival of 100%. Patients with a reference tumor > 3 cm and SUV > 3.1 had an expected 5-year survival rate of 53.3%.SMPLC patients can benefit from aggressive surgery. The size and SUVmax of the reference tumor may predict postoperative outcomes.

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

“…The National Comprehensive Cancer Network guidelines have recommended the application of 18 F-FDG PET/CT for SCLC patients (Johnson 2001 ). SUVmax measured on 18 F-FDG PET/CT is used to quantify FDG uptake of tumor cells; the degree of tumor uptake of 18 F-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 ).…”

Correlation of quantified metabolic activity in nonsmall cell lung cancer with tumor size and tumor pathological characteristics

“…Özgül et al [ 26 ] concluded that SUV max was significantly associated with tumor size. Hsu et al [ 27 ] demonstrated that patients with a reference tumor ≤ 3 cm and SUV ≤ 3.1 had an expected 5-year survival of 100%. Patients with a reference tumor > 3 cm and SUV > 3.1 had an expected 5-year survival rate of 53.3%.…”

Potential Utility of FDG PET-CT as a Non-invasive Tool for Monitoring Local Immune Responses

“…Standard uptake value is the ratio between 18 F-FDG concentrations in a tumor and those throughout the entire body, and SUV max is the maximum concentration of 18 F-FDG in an organ of interest. High SUV max generally indicates increased cancer metabolism, and has been shown to be associated with aggressive behavior, advanced disease status, and poor oncologic outcomes [ 5 11 31 32 ]. In the present study, we identified associations among tumor size, SUV max , and regulatory T lymphocytes.…”