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. 2022 Apr 25:10:e13352.
doi: 10.7717/peerj.13352. eCollection 2022.

Effects of cigarette smoking on metabolic activity of lung cancer on baseline 18F-FDG PET/CT

Maoqing Jiang  1   2 , Xiuyu Guo  1 , Xiaohui Zhang  1 , Qiaoling Gao  1 , Weiqi Mei  2 , Jingfeng Zhang  3 , Jianjun Zheng  1
Affiliations

Effects of cigarette smoking on metabolic activity of lung cancer on baseline 18F-FDG PET/CT

Maoqing Jiang et al. PeerJ. .

Abstract

Background: Never-smokers with lung cancer usually have a higher survival rate than that of smokers. The high metabolic activity of lung cancer on 18F-2-Fluoro-2-deoxyglucose (18F-FDG) PET/CT generally indicates a poor outcome. However, there is a lack of reports on the association between cigarette smoking and 18F-FDG metabolic activity in patients with lung cancer. In this study, we aimed to investigate the effects of cigarette smoking on metabolic activity of lung cancer on 18F-FDG PET/CT.

Materials and methods: A total of 338 patients (230 males, 108 females; mean age: 66.3, range 34-86) with pathologically diagnosed lung cancer were enrolled from September 2019 to April 2021. All patients underwent baseline 18F-FDG PET/CT and the maximum standard uptake value (SUVmax) of the primary tumor (pSUVmax), lymph node (nSUVmax) and distant metastasis (mSUVmax) were measured. The associations between cigarette smoking status, clinical stage, pathological subtypes and metabolic parameters on 18F-FDG PET/CT were analyzed.

Results: Of the 338 patients, cigarette smoking was identified in 153 patients (45.3%) and the remaining 185 (54.7%) were never-smokers. Smoking was found more frequently in males, squamous cell carcinoma (SCC) and stage III-IV diseases. The pSUVmax in smokers was significantly higher than that in never-smokers (t = 3.386, P < 0.001), but the nSUVmax and mSUVmax revealed no statistically significant differences (t = 0.399, P = 0.690 and t = 0.057, P = 0.955; respectively). With the increase of cumulative smoking dose, pSUVmax increased significantly (r = 0.217, P < 0.001). In addition, the pSUVmax in patients with stage III-IV was significantly higher than that in stage I-II (t = 8.509, P < 0.001). Smokers showed a higher pSUVmax than never-smokers for patients with stage I-II (t = 3.106, P = 0.002), but not in stage III-IV (t = 0.493, P = 0.622). The pSUVmax was significantly different among patients with different pathological subtypes of lung cancer (F = 11.45, P < 0.001), while only the adenocarcinoma (ADC) and SCC groups showed a difference in pSUVmax (t = 6.667, P < 0.001). Smokers with ADC showed a higher pSUVmax when compared to never-smokers, but not in SCC. There were no significant differences of pSUVmax between smokers and never-smokers at stage I-II ADC or SCC and stage III-IV ADC or SCC.

Conclusions: This study demonstrated a close association between cigarette smoking and the metabolic activity of lung cancer and suggests that smoking may be a potential risk factor of higher pSUVmax in early lung cancer on 18F-FDG PET/CT.

Keywords: 18F-FDG; Cigarette smoking; Lung cancer; Metabolic status; PET/CT.

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Conflict of interest statement

The authors declare there are no competing interests.

Figures

Figure 1
Figure 1. Flowchart of patient selection.
Figure 2
Figure 2. Metabolic activity of lung cancer on 18F-FDG PET/CT.
The levels of pSUVmax (A), nSUVmax (B) and mSUVmax (C) on 18F-FDG PET/CT were compared according to cigarette smoking history of patients with lung cancer (never-smokers vs. smokers).
Figure 3
Figure 3. Correlation between cumulative smoking dose and pSUVmax.
A significant correlation was observed between cumulative smoking dose (pack-years) and pSUVmax on 18F-FDG PET/CT in patients with lung cancer (r = 0.217, P < 0.001).
Figure 4
Figure 4. Comparative analysis of pSUVmax in clinical stage and cigarette smoking history.
The pSUVmax was significantly higher in patients with stage III–IV than those in stage I–II (A). The pSUVmax in stage I–II smokers was significantly higher than that in never-smokers (B), but not in stage III–IV smokers (C).
Figure 5
Figure 5. Comparative analysis of pSUVmax among different pathological subtypes.
ADC, adenocarcinoma; SCC, squamous cell carcinoma; LCC, large cell carcinoma; SCLC, small cell lung cancer.
Figure 6
Figure 6. Comparative analysis of pSUVmax in adenocarcinoma with different cigarette smoking history and clinical stage.
The pSUVmax of smokers with adenocarcinoma was higher than that of never-smokers (A). Stage III–IV adenocarcinoma had a higher pSUVmax than that in stage I–II adenocarcinoma (B). No significant differences of pSUVmax were observed between stage I–II smokers and never smokers (C), and between stage III–IV smokers and never smokers (D).
Figure 7
Figure 7. Comparative analysis of pSUVmax in squamous cell carcinoma with different cigarette smoking history and clinical stage.
The pSUVmax of smokers with squamous cell carcinoma showed no significant difference compared to never-smokers (A). Stage III–IV squamous cell carcinoma had a higher pSUVmax than that in stage I–II squamous cell carcinoma (B). No significant differences of pSUVmax were observed between stage I–II smokers and never smokers (C), and between stage III–IV smokers and never smokers (D).
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References

    1. Alberg AJ, Ford JG, Samet JM, American College of Chest P Epidemiology of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition) Chest. 2007;132(3 Suppl):29S–55S. doi: 10.1378/chest.07-1347. - DOI - PubMed
    1. Berghmans T, Dusart M, Paesmans M, Hossein-Foucher C, Buvat I, Castaigne C, Scherpereel A, Mascaux C, Moreau M, Roelandts M, Alard S, Meert AP, Patz Jr EF, Lafitte JJ, Sculier JP, European Lung Cancer Working Party for the ILCSP Primary tumor standardized uptake value (SUVmax) measured on fluorodeoxyglucose positron emission tomography (FDG-PET) is of prognostic value for survival in non-small cell lung cancer (NSCLC): a systematic review and meta-analysis (MA) by the European Lung Cancer Working Party for the IASLC Lung Cancer Staging Project. Journal of Thoracic Oncology. 2008;3(1):6–12. doi: 10.1097/JTO.0b013e31815e6d6. - DOI - PubMed
    1. Boellaard R, O’Doherty MJ, Weber WA, Mottaghy FM, Lonsdale MN, Stroobants SG, Oyen WJ, Kotzerke J, Hoekstra OS, Pruim J, Marsden PK, Tatsch K, Hoekstra CJ, Visser EP, Arends B, Verzijlbergen FJ, Zijlstra JM, Comans EF, Lammertsma AA, Paans AM, Willemsen AT, Beyer T, Bockisch A, Schaefer-Prokop C, Delbeke D, Baum RP, Chiti A, Krause BJ. FDG PET and PET/CT: EANM procedure guidelines for tumour PET imaging: version 1.0. European Journal of Nuclear Medicine and Molecular Imaging. 2010;37(1):181–200. doi: 10.1007/s00259-009-1297-4. - DOI - PMC - PubMed
    1. Centers for Disease Control and Prevention Annual smoking-attributable mortality, years of potential life lost, and productivity losses–United States, 1997-2001. MMWR. Morbidity and Mortality Weekly Report. 2005;54(25):625–628. - PubMed
    1. Doll R, Hill AB. Smoking and carcinoma of the lung; preliminary report. British Medical Journal. 1950;2(4682):739–748. doi: 10.1136/bmj.2.4682.739. - DOI - PMC - PubMed

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