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. 2024 Feb 5;8(1):4.
doi: 10.1186/s41824-024-00190-z.

Association between PET-CT accumulation in the hypothalamic/pituitary regions and neuron-specific enolase/primary tumor in limited-stage small cell lung cancer: a case-controlled retrospective study

Yukinori Okada  1 , Tatsuhiko Zama  2 , Tomohiro Itonaga  2 , Ryuji Mikami  2 , Mitsuru Okubo  2 , Shinji Sugahara  2 , Motoki Nakai  2 , Koichiro Abe  2 , Mana Yoshimura  2 , Kazuhiro Saito  2
Affiliations

Association between PET-CT accumulation in the hypothalamic/pituitary regions and neuron-specific enolase/primary tumor in limited-stage small cell lung cancer: a case-controlled retrospective study

Yukinori Okada et al. EJNMMI Rep. .

Abstract

Background: Research on the relationship between neuron-specific enolase (NSE) levels and normal organs, particularly the central nervous system, in small cell lung cancer is limited. Therefore, this study aimed to investigate the relationship between positron emission tomography-computed tomography (PET-CT) accumulation at hypothalamic/pituitary regions, tumor activity, and NSE level in limited-stage small cell lung cancer. We retrospectively analyzed patients who were diagnosed with limited-stage small cell lung cancer at Tokyo Medical University Hospital between July 1, 2019, and May 31, 2023, and were treated with chemoradiotherapy or radiotherapy. Leukocytes, erythrocytes, hemoglobin, platelets, total protein, albumin, NSE, and carcinoembryonic antigen were measured in blood samples obtained before treatment initiation. The maximum standardized uptake value (SUVmax), volume, and total lesion glycolysis (TLG) of each hypothalamic /pituitary region, primary tumor, and lymph node metastases were extracted from PET-CT images. The total tumor volume (primary tumor volume plus lymph node metastases volume) and total TLG (primary tumor TLG plus lymph node metastases TLG) were calculated.

Results: This study included 19 patients (mean age, 70.1 ± 8.8 years; 13 men and 6 women); the pathology in all patients was small cell lung cancer. Patients were classified into two groups according to the NSE reference value (16.3 ng/mL): six patients having NSE level below the reference value and 13 having NSE level above the reference value. The SUVmax in the hypothalamic/pituitary region was 2.95 in the NSE < 16.3 ng/mL group and 4.10 in the NSE > 16.3 ng/mL group, with a statistically significant difference (p = 0.03). The total tumor volume was 17.8 mL in the NSE < 16.3 ng/mL group and 98.9 mL in the NSE > 16.3 ng/mL group, with a statistically significant difference (p < 0.01). A correlation coefficient of r = 0.458 (p = 0.0486) was observed between SUVmax in the hypothalamus/pituitary and NSE level. A correlation coefficient of r = 0.647 (p < 0.01) was also observed between total tumor volume and NSE level. Finally, a correlation coefficient of r = 0.53 (p = 0.01) was observed between hypothalamic/pituitary TLG and primary tumor TLG.

Conclusions: The findings demonstrated a correlation between hypothalamic/pituitary activity and tumor activity, suggesting the prognostic significance of NSE.

Keywords: Hypothalamus/pituitary; Neuron-specific enolase; Positron emission tomography–computed tomography; Small cell lung cancer; Standardized uptake value.

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Conflict of interest statement

All authors declare that they have no competing interests. Yukinori Okada is a board member of the EIIS (Expert Imaging and Interventional Support) Society, but this is an unpaid position. He has received lecture fees in the past that are unrelated to the content of this study.

Figures

Fig. 1
Fig. 1
The PET–CT images (hypothalamic/pituitary region and whole body) were shown
Fig. 2
Fig. 2
Comparison of the hypothalamus/pituitary SUVmax between the NSE < 16.3 ng/mL group and NSE > 16.3 ng/mL group
Fig. 3
Fig. 3
Correlation between SUVmax in the hypothalamus/pituitary and NSE level in all cases
Fig. 4
Fig. 4
ROC analysis of hypothalamic/pituitary SUVmax and NSE below/above 16.3 ng/mL
Fig. 5
Fig. 5
Correlation between the hypothalamus/pituitary TLG and primary tumor TLG
Fig. 6
Fig. 6
Correlation between the hypothalamus/pituitary TLG and primary tumor volume
See this image and copyright information in PMC

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