Prognostic Significance of the Standardized Uptake Value on Positron Emission Tomography in Patients with Multiple Clinical-N0 Lung Cancers

Abstract

Background While there have been many attempts to differentiate multiple lung cancers (MLCs) using the clinicopathological presentation and molecular profile, there are still some controversies regarding the prognostic factors for MLCs with clinical-N0 status.

Patients and Methods Between 1996 and 2012, 131 patients were diagnosed as MLCs pathologically. The main lesion of MLCs was defined as follows: (1) among synchronous lesions, the radiologically denser or larger tumor on thin-section computed tomography (CT) or (2) the second tumor among metachronous lesions. ¹⁸F-fluorodeoxyglucose uptake on positron emission tomography (PET) scan was examined to evaluate maximum standardized uptake value (SUVmax) of the main tumor.

Results Among 131 patients with clinical-N0 status, 66 were men and 65 were women and they had an average age of 67 years. One-hundred nine patients were diagnosed as MPLCs, and 22 were intrapulmonary metastases (PMs). Based on multivariate analyses, SUVmax was a significant prognostic factor in both synchronous and metachronous clinical-N0 MLCs (p = 0.0060, 0.0451, respectively). Among the overall patients, while pathological diagnosis, maximum tumor dimension, consolidation status, and SUVmax were all significant prognostic factors by a univariate analysis, SUVmax (p = 0.0016) was superior to pathological diagnosis based on the Martini and Melamed classification (p = 0.2258) based on a multivariate analysis. The 5-year survival rate of MPLCs (78.7%) was significantly greater than that of PMs (30.5%) (p = 0.0036). Furthermore, the 5-year survival rate in patients with low SUVmax (91.1%) was far better than that in patients with high SUVmax (17.9%) (p = 0.0001).

Conclusion SUVmax on PET was a significant clinical factor that more precisely reflected the prognosis of MLCs with clinical-N0 status, and could be superior to a pathological diagnosis based on the Martini and Melamed classification.

Keywords

multiple primary lung cancers - intrapulmonary metastases - positron emission tomography - prognosis

• References

• 1 Aberle DR, Adams AM, Berg CD , et al; National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011; 365 (5) 395-409
• 2 Gould MK, Fletcher J, Iannettoni MD , et al; American College of Chest Physicians. Evaluation of patients with pulmonary nodules: when is it lung cancer?: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007; 132 (3, Suppl): 108S-130S
• 3 Martini N, Melamed MR. Multiple primary lung cancers. J Thorac Cardiovasc Surg 1975; 70 (4) 606-612
• 4 Tanvetyanon T, Robinson L, Sommers KE , et al. Relationship between tumor size and survival among patients with resection of multiple synchronous lung cancers. J Thorac Oncol 2010; 5 (7) 1018-1024
• 5 Girard N, Deshpande C, Lau C , et al. Comprehensive histologic assessment helps to differentiate multiple lung primary nonsmall cell carcinomas from metastases. Am J Surg Pathol 2009; 33 (12) 1752-1764
• 6 Antakli T, Schaefer RF, Rutherford JE, Read RC. Second primary lung cancer. Ann Thorac Surg 1995; 59 (4) 863-866 , discussion 867
• 7 Shen KR, Meyers BF, Larner JM, Jones DR ; American College of Chest Physicians. Special treatment issues in lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007; 132 (3, Suppl): 290S-305S
• 8 Travis WD, Brambilla E, Noguchi M , et al. International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol 2011; 6 (2) 244-285
• 9 Suzuki K, Koike T, Asakawa T , et al; Japan Lung Cancer Surgical Study Group (JCOG LCSSG). A prospective radiological study of thin-section computed tomography to predict pathological noninvasiveness in peripheral clinical IA lung cancer (Japan Clinical Oncology Group 0201). J Thorac Oncol 2011; 6 (4) 751-756
• 10 Park CM, Goo JM, Kim TJ , et al. Pulmonary nodular ground-glass opacities in patients with extrapulmonary cancers: what is their clinical significance and how can we determine whether they are malignant or benign lesions?. Chest 2008; 133 (6) 1402-1409
• 11 Asamura H. Multiple primary cancers or multiple metastases, that is the question. J Thorac Oncol 2010; 5 (7) 930-931
• 12 Vazquez M, Carter D, Brambilla E , et al; International Early Lung Cancer Action Program Investigators. Solitary and multiple resected adenocarcinomas after CT screening for lung cancer: histopathologic features and their prognostic implications. Lung Cancer 2009; 64 (2) 148-154
• 13 Suzuki K, Kusumoto M, Watanabe S, Tsuchiya R, Asamura H. Radiologic classification of small adenocarcinoma of the lung: radiologic-pathologic correlation and its prognostic impact. Ann Thorac Surg 2006; 81 (2) 413-419
• 14 Hattori A, Suzuki K, Matsunaga T , et al. Is limited resection appropriate for radiologically “solid” tumors in small lung cancers?. Ann Thorac Surg 2012; 94 (1) 212-215
• 15 Hattori A, Suzuki K, Matsunaga T , et al. Tumour standardized uptake value on positron emission tomography is a novel predictor of adenocarcinoma in situ for c-Stage IA lung cancer patients with a part-solid nodule on thin-section CT scan. Interact Cardiovasc Thorac Surg 2014; 18 (3) 329-334
• 16 Okada M, Tauchi S, Iwanaga K , et al. Associations among bronchioloalveolar carcinoma components, positron emission tomographic and computed tomographic findings, and malignant behavior in small lung adenocarcinomas. J Thorac Cardiovasc Surg 2007; 133 (6) 1448-1454
• 17 Shah AA, Barfield ME, Kelsey CR , et al. Outcomes after surgical management of synchronous bilateral primary lung cancers. Ann Thorac Surg 2012; 93 (4) 1055-1060 , discussion 1060
• 18 Rea F, Zuin A, Callegaro D, Bortolotti L, Guanella G, Sartori F. Surgical results for multiple primary lung cancers. Eur J Cardiothorac Surg 2001; 20 (3) 489-495
• 19 Trousse D, Barlesi F, Loundou A , et al. Synchronous multiple primary lung cancer: an increasing clinical occurrence requiring multidisciplinary management. J Thorac Cardiovasc Surg 2007; 133 (5) 1193-1200
• 20 Zell JA, Ou SH, Ziogas A, Anton-Culver H. Survival improvements for advanced stage nonbronchioloalveolar carcinoma-type nonsmall cell lung cancer cases with ipsilateral intrapulmonary nodules. Cancer 2008; 112 (1) 136-143
• 21 Battafarano RJ, Meyers BF, Guthrie TJ, Cooper JD, Patterson GA. Surgical resection of multifocal non-small cell lung cancer is associated with prolonged survival. Ann Thorac Surg 2002; 74 (4) 988-993 , discussion 993–994
• 22 Kim TJ, Goo JM, Lee KW, Park CM, Lee HJ. Clinical, pathological and thin-section CT features of persistent multiple ground-glass opacity nodules: comparison with solitary ground-glass opacity nodule. Lung Cancer 2009; 64 (2) 171-178
• 23 Roberts PF, Straznicka M, Lara PN , et al. Resection of multifocal non-small cell lung cancer when the bronchioloalveolar subtype is involved. J Thorac Cardiovasc Surg 2003; 126 (5) 1597-1602
• 24 Zell JA, Ou SH, Ziogas A, Anton-Culver H. Long-term survival differences for bronchiolo-alveolar carcinoma patients with ipsilateral intrapulmonary metastasis at diagnosis. Ann Oncol 2006; 17 (8) 1255-1262