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. 2020 May 28;54(3):278-284.
doi: 10.2478/raon-2020-0034.

Prognostic role of positron emission tomography and computed tomography parameters in stage I lung adenocarcinoma

Angelo Carretta  1   2 , Alessandro Bandiera  1 , Piergiorgio Muriana  1 , Stefano Viscardi  1 , Paola Ciriaco  1 , Ana Maria Samanes Gajate  3 , Gianluigi Arrigoni  4 , Chiara Lazzari  5 , Vanesa Gregorc  5 , Giampiero Negri  1   2
Affiliations

Prognostic role of positron emission tomography and computed tomography parameters in stage I lung adenocarcinoma

Angelo Carretta et al. Radiol Oncol. .

Abstract

Background According to the current pathological classification, lung adenocarcinoma includes histological subtypes with significantly different prognoses, which may require specific surgical approaches. The aim of the study was to assess the role of CT and PET parameters in stratifying patients with stage I adenocarcinoma according to prognosis. Patients and methods Fifty-eight patients with pathological stage I lung adenocarcinoma who underwent surgical treatment were retrospectively reviewed. Adenocarcinoma in situ and minimally-invasive adenocarcinoma were grouped as non-invasive adenocarcinoma. Other histotypes were referred as invasive adenocarcinoma. CT scan assessed parameters were: ground glass opacity (GGO) ratio, tumour disappearance rate (TDR) and consolidation diameter. The prognostic role of the following PET parameters was also assessed: standardized uptake value (SUV) max, SUVindex (SUVmax to liver SUVratio), metabolic tumour volume (MTV), total lesion glycolysis (TLG). Results Seven patients had a non-invasive adenocarcinoma and 51 an invasive adenocarcinoma. Five-year disease-free survival (DFS) and cancer-specific survival (CSS) for non-invasive and invasive adenocarcinoma were 100% and 100%, 70% and 91%, respectively. Univariate analysis showed a significant difference in SUVmax, SUVindex, GGO ratio and TDR ratio values between non-invasive and invasive adenocarcinoma groups. Optimal SUVmax, SUVindex, GGO ratio and TDR cut-off ratios to predict invasive tumours were 2.6, 0.9, 40% and 56%, respectively. TLG, SUVmax, SUVindex significantly correlated with cancer specific survival. Conclusions CT and PET scan parameters may differentiate between non-invasive and invasive stage I adenocarcinomas. If these data are confirmed in larger series, surgical strategy may be selected on the basis of preoperative imaging.

Keywords: PET; adenocarcinoma; computed tomography; lung; surgery.

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Figures

Figure 1
Figure 1
Kaplan-Meier disease free survival (DFS) plot for non-invasive and invasive adenocarcinoma (Invasive adenocarcinoma). Five-year DFS (disease free survival) was 100% for non-invasive and 70% for invasive adenocarcinoma (p = 0.115).
Figure 2
Figure 2
Kaplan-Meier cancer specific survival (CSS) plot for non-invasive and invasive adenocarcinoma. Five-year CSS was 100% for non-invasive and 91% for invasive adenocarcinoma (p = 0.46).
Figure 3
Figure 3
Kaplan-Meier cancer specific survival curves according to SUVmax value. Five-year cancer specific survival (CSS) was 97% in patients with a SUVmax < 8.6 and 81% in patients with a SUVmax > 8.6 (p = 0.036).
Figure 4
Figure 4
Kaplan-Meier cancer specific survival curves (CSS) according to SUVindex value. Five-year CSS was 97% in patients with a SUVindex < 4.08 and 76% in patients with a SUVindex > 4.08 (p = 0.01).
Figure 5
Figure 5
Kaplan-Meier cancer specific survival curves (CSS) according to total lesion glycolysis (TLG) value. Five-year CSS was 100% in patients with a TLG < 9.38 and 82% in patients with a TLG > 9.38 (p = 0.02).
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