Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan.
Cancer. 2010 Jul 1;116(13):3170-7. doi: 10.1002/cncr.25244.
The malignant biological behavior of small-sized lung adenocarcinomas remains obscure, although understanding this feature is important for selecting appropriate treatment. In the current study, the authors evaluated malignancy grades of small adenocarcinomas using fluorodeoxyglucose-positron emission tomography/computed tomography (PET/CT) in addition to high-resolution CT (HRCT) and pathological analysis in a multicenter setting.
A total of 201 patients with clinical T1N0M0 adenocarcinoma underwent PET/CT and HRCT followed by complete surgical resection. Associations between components of bronchioloalveolar carcinoma (BAC) in specimens and maximum standardized uptake values (maxSUV) on PET/CT and ground-glass opacity (GGO) ratios and tumor disappearance rate (TDR) on HRCT were analyzed, as well as associations between these findings and pathological features of the tumors. Variations in maxSUV among institutions and the underestimations derived from small tumors, which are limitations of PET performed in multicenter studies, were adjusted using a phantom study.
The maxSUV, BAC ratio, TDR, and GGO ratio (in that order) reflected the grade of tumor invasiveness and lymph node metastasis. The maxSUV and BAC ratio were found to be significant prognostic predictors derived from disease-free survival curves. Although the BAC ratio was found to be significantly associated with preoperative radiographic parameters, the maxSUV, GGO ratio, and TDR (all P < .0001), the degree of correlation with maxSUV (correlation coefficient [R(2)] = 0.1699) was much weaker than that reported with the GGO ratio (R(2) = 0.5860) or TDR (R(2) = 0.5082).
Phantom studies can overcome the difficulties of multicenter studies using PET. A higher maxSUV appears to reflect aggressive malignant behavior in clinical T1N0M0 adenocarcinomas, independent of BAC components. Preoperative PET/CT assessment in addition to HRCT could be used to construct hypotheses for a future clinical study of strategies for the treatment of patients with small lung adenocarcinoma.
尽管了解小尺寸肺腺癌的恶性生物学行为很重要，但这种特征仍然不明确，这对选择适当的治疗方法很重要。在这项多中心研究中，作者使用氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（PET/CT），结合高分辨率 CT（HRCT）和病理分析，评估了小腺癌的恶性程度。
201 例临床 T1N0M0 腺癌患者接受了 PET/CT 和 HRCT 检查，随后进行了完全手术切除。分析了标本中细支气管肺泡癌（BAC）成分与 PET/CT 上的最大标准化摄取值（maxSUV）、HRCT 上的磨玻璃密度（GGO）比值和肿瘤消失率（TDR）之间的关系，以及这些发现与肿瘤病理特征之间的关系。使用体模研究调整了机构间 maxSUV 的变化以及由于多中心研究中进行的 PET 存在的小肿瘤的低估。
maxSUV、BAC 比值、TDR 和 GGO 比值（依次）反映了肿瘤侵袭性和淋巴结转移程度。maxSUV 和 BAC 比值是从无病生存曲线中得出的重要预后预测因子。虽然 BAC 比值与术前影像学参数显著相关，但 maxSUV、GGO 比值和 TDR（均 P<0.0001）与 maxSUV 的相关性更强（相关系数 [R2] = 0.1699），而与 GGO 比值（R2 = 0.5860）或 TDR（R2 = 0.5082）的相关性要弱得多。
体模研究可以克服使用 PET 进行多中心研究的困难。较高的 maxSUV 似乎反映了临床 T1N0M0 腺癌中侵袭性恶性行为，与 BAC 成分无关。术前 PET/CT 评估结合 HRCT 可用于构建未来对小肺癌腺癌治疗策略的临床研究假设。
