Glucose Uptake Values in Positron Emission Tomography Are Useful to Predict Survival after Sublobar Resection for Lung Cancer

Abstract

Background To assess the reliability of maximum standardized uptake values (SUVmax) at the primary lesion in 18-fluorodeoxyglucose positron emission tomography combined with computed tomography (¹⁸FDG-PET/CT) for identifying patients with lung cancer who were most likely to be cured by sublobar resection (SR).

Methods We retrospectively reviewed the medical records of 120 patients who underwent SR for clinical (c)-stage IA + IB lung cancer after ¹⁸FDG-PET/CT. Various factors, including tumor size, SUVmax at the primary site, and microscopic tumor invasion, were examined to identify their association with postsurgical survival. Prognoses of patients undergoing SR were compared with those of 272 patients undergoing lobectomy and lymphadenectomy during the same period.

Results The 5-year recurrence-free survival (RFS) and overall survival (OS) rates in all patients undergoing SR for c-stage IA + IB disease were 79.5% and 82.2%, respectively. In multivariate analysis, a lack of microscopic pleural invasion and SUVmax ≤ 3.0 significantly correlated with better RFS and OS in patients undergoing SR. Though there were no significant differences in RFS and OS following SR and lobectomy for c-stage IA + IB or IA disease, RFS was significantly inferior in nonintentional SR (NISR) than in lobectomy in c-stage IA disease (p < 0.01). However, in NISR identified based on SUVmax ≤ 2.0, RFS was comparable to those in lobectomy (p = 0.5371).

Conclusion When certain subgroups of patients are accurately identified based on preoperative SUVmax, SR can be a highly curative surgical method for lung cancer.

Keywords

imaging - lung cancer treatment - positron emission tomography

• References

• 1 Ginsberg RJ, Rubinstein LV ; Lung Cancer Study Group. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Ann Thorac Surg 1995; 60 (3) 615-622 , discussion 622–623
• 2 Whitson BA, Groth SS, Andrade RS, Maddaus MA, Habermann EB, D'Cunha J. Survival after lobectomy versus segmentectomy for stage I non-small cell lung cancer: a population-based analysis. Ann Thorac Surg 2011; 92 (6) 1943-1950
• 3 Kim D, Ferraris VA, Davenport D, Saha S. Outcomes of lobar and sublobar resections for non-small-cell lung cancer: a single-center experience. South Med J 2015; 108 (4) 230-234
• 4 Liu Y, Huang C, Liu H, Chen Y, Li S. Sublobectomy versus lobectomy for stage IA (T1a) non-small-cell lung cancer: a meta-analysis study. World J Surg Oncol 2014; 12: 138
• 5 Wisnivesky JP, Henschke CI, Swanson S , et al. Limited resection for the treatment of patients with stage IA lung cancer. Ann Surg 2010; 251 (3) 550-554
• 6 Okada M, Mimae T, Tsutani Y , et al. Segmentectomy versus lobectomy for clinical stage IA lung adenocarcinoma. Ann Cardiothorac Surg 2014; 3 (2) 153-159
• 7 Nakamura H, Kawasaki N, Taguchi M, Kabasawa K. Survival following lobectomy vs limited resection for stage I lung cancer: a meta-analysis. Br J Cancer 2005; 92 (6) 1033-1037
• 8 Zhang Y, Sun Y, Wang R, Ye T, Zhang Y, Chen H. Meta-analysis of lobectomy, segmentectomy, and wedge resection for stage I non-small cell lung cancer. J Surg Oncol 2015; 111 (3) 334-340
• 9 Port JL, Kent MS, Korst RJ, Libby D, Pasmantier M, Altorki NK. Tumor size predicts survival within stage IA non-small cell lung cancer. Chest 2003; 124 (5) 1828-1833
• 10 Yoshikawa K, Tsubota N, Kodama K, Ayabe H, Taki T, Mori T. Prospective study of extended segmentectomy for small lung tumors: the final report. Ann Thorac Surg 2002; 73 (4) 1055-1058 , discussion 1058–1059
• 11 Nonaka M, Kadokura M, Yamamoto S , et al. Tumor dimension and prognosis in surgically treated lung cancer: for intentional limited resection. Am J Clin Oncol 2003; 26 (5) 499-503
• 12 Nakamura H, Kazuyuki S, Kawasaki N, Taguchi M, Kato H. History of limited resection for non-small cell lung cancer. Ann Thorac Cardiovasc Surg 2005; 11 (6) 356-362
• 13 Nakamura H, Saji H, Ogata A, Saijo T, Okada S, Kato H. Lung cancer patients showing pure ground-glass opacity on computed tomography are good candidates for wedge resection. Lung Cancer 2004; 44 (1) 61-68
• 14 Yoshida J, Nagai K, Yokose T , et al. Limited resection trial for pulmonary ground-glass opacity nodules: fifty-case experience. J Thorac Cardiovasc Surg 2005; 129 (5) 991-996
• 15 Nishio R, Akata S, Saito K , et al. The ratio of the maximum high attenuation area dimension to the maximum tumor dimension may be an index of the presence of lymph node metastasis in lung adenocarcinomas 3 cm or smaller on high-resolution computed tomography. J Thorac Oncol 2007; 2 (1) 29-33
• 16 Nakamura H, Saji H, Shinmyo T , et al. Close association of IASLC/ATS/ERS lung adenocarcinoma subtypes with glucose-uptake in positron emission tomography. Lung Cancer 2015; 87 (1) 28-33
• 17 Nakamura H, Saji H, Marushima H , et al. Standardized uptake values in the primary lesions of non-small-cell lung cancer in FDG-PET/CT can predict regional lymph node metastases. Ann Surg Oncol 2015; 22 (Suppl. 03) 1388-1393
• 18 Travis WD, Giroux DJ, Chansky K , et al; International Staging Committee and Participating Institutions. The IASLC Lung Cancer Staging Project: proposals for the inclusion of broncho-pulmonary carcinoid tumors in the forthcoming (seventh) edition of the TNM Classification for Lung Cancer. J Thorac Oncol 2008; 3 (11) 1213-1223
• 19 Miyoshi K, Toyooka S, Gobara H , et al. Clinical outcomes of short hook wire and suture marking system in thoracoscopic resection for pulmonary nodules. Eur J Cardiothorac Surg 2009; 36 (2) 378-382
• 20 Goldstraw P. New TNM classifications for testing. In: Staging Manual in Thoracic Oncology. Orange Park, FL: Editorial Rx Press; 2009: 85-90
• 21 Travis WD, Brambilla E, Burke AP , et al. Tumours of the lung. In: WHO Classification of Tumours of the Lung, Pleura, Thymus and Heart. Lyon, France: International Agency for Research on Cancer (IARC); 2015: 26-50
• 22 Lakha S, Gomez JE, Flores RM, Wisnivesky JP. Prognostic significance of visceral pleural involvement in early-stage lung cancer. Chest 2014; 146 (6) 1619-1626
• 23 Huang H, Wang T, Hu B, Pan C. Visceral pleural invasion remains a size-independent prognostic factor in stage I non-small cell lung cancer. Ann Thorac Surg 2015; 99 (4) 1130-1139
• 24 Russell PA, Wainer Z, Wright GM, Daniels M, Conron M, Williams RA. Does lung adenocarcinoma subtype predict patient survival? A clinicopathologic study based on the new International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society international multidisciplinary lung adenocarcinoma classification. J Thorac Oncol 2011; 6 (9) 1496-1504
• 25 Woo T, Okudela K, Mitsui H , et al. Prognostic value of the IASLC/ATS/ERS classification of lung adenocarcinoma in stage I disease of Japanese cases. Pathol Int 2012; 62 (12) 785-791
• 26 Hung JJ, Jeng WJ, Chou TY , et al. Prognostic value of the new International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society lung adenocarcinoma classification on death and recurrence in completely resected stage I lung adenocarcinoma. Ann Surg 2013; 258 (6) 1079-1086
• 27 Mansuet-Lupo A, Bobbio A, Blons H , et al. The new histologic classification of lung primary adenocarcinoma subtypes is a reliable prognostic marker and identifies tumors with different mutation status: the experience of a French cohort. Chest 2014; 146 (3) 633-643
• 28 Nakamura H, Saji H, Shinmyo T , et al. Association of IASLC/ATS/ERS histologic subtypes of lung adenocarcinoma with epidermal growth factor receptor mutations in 320 resected cases. Clin Lung Cancer 2015; 16 (3) 209-215
• 29 Goldstraw P, Crowley J, Chansky K , et al. International Association for the Study of Lung Cancer International Staging Committee; Participating Institutions. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours. J Thorac Oncol 2007; 2 (8) 706-714
• 30 Asamura H, Goya T, Koshiishi Y , et al; Japanese Joint Committee of Lung Cancer Registry. A Japanese Lung Cancer Registry study: prognosis of 13,010 resected lung cancers. J Thorac Oncol 2008; 3 (1) 46-52