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Prognostic Value and Clinical Impact of Pretreatment FDG PET in Pulmonary Lymphoepithelioma-Like Carcinoma

Su, Tzu-Pei, MD*; Ho, Kung-Chu, MD, PhD*†; Wang, Chih-Wei, MD; Lin, Chun-Yu, MD§; Liu, Chien-Ying, MD; Yang, Cheng-Ta, MD; Yen, Tzu-Chen, MD, PhD

doi: 10.1097/RLU.0000000000002371
Original Articles
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Purpose Compared with other forms of non–small cell lung cancer, pulmonary lymphoepithelioma-like carcinoma (LELC) is rarer and portends better outcomes. We sought to investigate the prognostic role and clinical impact of pretreatment 18F-FDG PET in pulmonary LELC.

Methods A total of 71 patients with pulmonary LELC were identified through a retrospective review of clinical records. Of them, 41 underwent 18F-FDG PET for primary staging. Outcomes were assessed using the Kaplan-Meier method and Cox regression models with a forward stepwise selection procedure. Staging changes served as the main outcome measure for assessing the impact of 18F-FDG PET. For the purpose of analyses, all patients were restaged according the American Joint Committee on Cancer Staging Manual eighth edition.

Results Stage and pretreatment 18F-FDG PET were significantly independent predictors of overall survival (OS) on multivariate analysis. Five-year OS rates for patients with stages I–II, III–IVA, and IVB were 92.3%, 70.4%, and 20.0%, respectively. The use of 18F-FDG PET for staging purposes was associated with a better OS (P = 0.003). Specifically, the 5-year OS rates for patients who were staged with and without 18F-FDG PET were 85.4% and 49.7%, respectively (P = 0.012). 18F-FDG PET resulted in a disease upstage in 28.6% of patients with CT-defined stages III–IVA; of them, 14.3% were upstaged to IVB disease.

Conclusions The American Joint Committee on Cancer eighth edition stage and pretreatment 18F-FDG PET were independent prognostic factors for OS in patients with pulmonary LELC. 18F-FDG PET imaging resulted in a better disease staging with a corresponding optimization of therapeutic interventions, which ultimately improved survival outcomes.

From the *Department of Nuclear Medicine, Keelung Chang Gung Memorial Hospital, and

Department of Medical Imaging and Radiological Sciences, Chang Gung University and

Departments of Anatomic Pathology,

§General Medicine & Geriatrics,

Thoracic Medicine, and

Nuclear Medicine and Center for Advanced Molecular Imaging and Translation, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.

Received for publication August 30, 2018; revision accepted September 30, 2018.

T.-P.S. and K.-C.H. contributed equally to this work.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent was waived because of the retrospective nature of this study.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflicts of interest and sources of funding: none declared.

Correspondence to: Tzu-Chen Yen, MD, PhD, Department of Nuclear Medicine and Center for Advanced Molecular Imaging and Translation, Chang Gung Memorial Hospital, Linkou, and Chang Gung University, 5 Fu-Shin St, Kueishan, Taoyuan 333, Taiwan. E-mail: yen1110@adm.cgmh.org.tw.

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