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Combining fluorine-18 fluorodeoxyglucose positron emission tomography and pathological risk factors to predict postoperative recurrence in stage I lung adenocarcinoma

Hsu, Chien-China; Ho, Kuo-Weib; Chang, Yen-Hsianga; Huang, Yung-Chenga

Nuclear Medicine Communications: June 2019 - Volume 40 - Issue 6 - p 632–638
doi: 10.1097/MNM.0000000000001006
ORIGINAL ARTICLES
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Objective The aim of this study was to investigate the predictive value of qualitative assessment of tumor fluorine-18 fluorodeoxyglucose (18F-FDG) uptake on PET and pathological risk factors for postoperative tumor recurrence in patients with stage I lung adenocarcinoma.

Patients and methods Eighty-seven patients with stage I lung adenocarcinoma who had undergone 18F-FDG-PET and sequential surgical treatment without adjuvant chemotherapy were enrolled into this retrospective study. Qualitative assessment visually compared tumor 18F-FDG uptake with liver uptake. Tumors with one or more risk factors of tumor size of at least 4 cm, poorly differentiated, visceral pleural invasion, and lymphovascular invasion were defined as pathological high-risk tumors.

Results Patients with pathological high-risk tumors had a significantly (P=0.015) higher standardized uptake value. A multivariable Cox’s proportional hazard analysis showed that tumor 18F-FDG uptake>liver uptake (adjusted hazard ratio: 3.54; 95% confidence interval: 1.36–9.21, P=0.010) and pathological high-risk tumors (adjusted hazard ratio: 2.34; 95% confidence interval: 1.13–4.87, P=0.023) were significant independent predictors of postoperative tumor recurrence. Patients with tumor 18F-FDG uptake>liver uptake and pathological high-risk tumors had significantly (P=0.001) worse 5-year disease-free survival (38.8%) and significantly (P=0.011) worse overall survival (68.5%).

Conclusion Tumor 18F-FDG uptake>liver uptake and pathological high-risk tumors were significant independent predictors of postoperative tumor recurrence in stage I lung adenocarcinoma. Combining the two factors improves the prediction of disease-free and overall survivals, which could offer a feasible prediction model for clinically recommending adjuvant chemotherapy.

aDepartment of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung

bDepartment of Nuclear Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan

Correspondence to Yung-Cheng Huang, MD, Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niaosong District, Kaohsiung 83301, Taiwan Tel: +886 773 171 233 061; fax: +886 773 171 232 631; e-mail: ychbibi@gmail.com

Received December 6, 2018

Received in revised form February 12, 2019

Accepted February 13, 2019

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