Verma Shipra, Chan Justin, Chew Chong, Schultz Christopher
Department of Nuclear Medicine, PET & Bone Densitometry, Royal Adelaide Hospital, Adelaide, SA, Australia.
D'Arcy Sutherland Cardiothoracic Surgery Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.
Heart Lung Circ. 2019 Mar;28(3):436-442. doi: 10.1016/j.hlc.2017.12.011. Epub 2018 Jan 31.
Lung cancers managed surgically with curative intent are sometimes upstaged postoperatively. The potential contributions from surgical waiting time and primary tumour F-FDG avidity on positron emission tomography (PET)/computed tomography (CT) are unknown.
We reviewed the records of 153 Royal Adelaide Hospital surgical patients with primary lung cancers from 2013 to 2016 who had preoperative staging combining CT, F-FDG PET/CT and biopsy. Subjects were divided into two cohorts: postoperative Tumour, Node, Metastases (TNM) upstaged (US) and not upstaged (UN). The parameters of standardised uptake value (SUV max), pre-scan blood glucose level (BGL), the time interval between staging and surgery were analysed using a two-tailed Mann-Whitney U test.
Subjects were aged 31 to 85 years; 75 were male. Ninety-three had adenocarcinoma (AC), 42 had squamous cell carcinoma (SCC). Sixty-four were upstaged after surgery, 40 AC and 18 SCC. For AC, US SUV max was significantly higher (mean US 6.4 (SD 4.6) vs. UN 4.6 (SD 3.4), p=0.03) but not time to surgery (mean US 55 (SEM 7.1) vs. UN 71 (SEM 14.8) days p=0.74). Upstaged were mainly T (imaging and histopathology discordance) and N (unexpected mediastinal or hilar nodal metastases). For SCC, US vs. UN SUV max (mean US 12.0 (SD 5.6) vs. UN 9.4 (SD 5.6), p=0.08) and time to surgery (mean US 48 (SEM 5.3) vs. UN 47 (SEM 5.0) days p=0.66) were not significantly different. Standardised uptake value max and surgical waiting time were not analysed for other tumour types due to small numbers. Pre-PET BGL US vs. UN was not significantly different for all (p=0.52), AC (p=0.32) and SCC (p=0.37) subjects, thus not a confounding factor.
For lung cancers assigned to curative surgery, high primary tumour SUV max of AC but not SCC may predict surgical upstaging with implications for F-FDG PET/CT nodal assessments. Surgical waiting time appears not to be a predictor for both tumour types.
以治愈为目的接受手术治疗的肺癌患者有时会在术后出现分期上调。手术等待时间和正电子发射断层扫描（PET）/计算机断层扫描（CT）上原发性肿瘤的F-FDG摄取度的潜在影响尚不清楚。
我们回顾了2013年至2016年在皇家阿德莱德医院接受手术的153例原发性肺癌患者的记录，这些患者术前进行了CT、F-FDG PET/CT和活检联合分期。研究对象分为两组：术后肿瘤、淋巴结、转移（TNM）分期上调（US）组和未上调（UN）组。使用双尾曼-惠特尼U检验分析标准化摄取值（SUV max）、扫描前血糖水平（BGL）、分期与手术之间的时间间隔等参数。
研究对象年龄在31至85岁之间；75例为男性。93例为腺癌（AC），42例为鳞状细胞癌（SCC）。64例患者术后分期上调，其中40例AC和18例SCC。对于AC，上调组的SUV max显著更高（上调组平均为6.4（标准差4.6），未上调组为4.6（标准差3.4），p = 0.03），但手术时间无显著差异（上调组平均为55（标准误7.1）天，未上调组为71（标准误14.8）天，p = 0.74）。分期上调主要是T（影像与组织病理学不一致）和N（意外的纵隔或肺门淋巴结转移）。对于SCC，上调组与未上调组的SUV max（上调组平均为12.0（标准差5.6），未上调组为9.4（标准差5.6），p = 0.08）和手术时间（上调组平均为48（标准误5.3）天，未上调组为47（标准误5.0）天，p = 0.66）无显著差异。由于其他肿瘤类型数量较少，未对其SUV max和手术等待时间进行分析。所有患者（p = 0.52）、AC患者（p = 0.32）和SCC患者（p = 0.37）的PET前BGL上调组与未上调组无显著差异，因此不是混杂因素。
对于计划进行根治性手术的肺癌患者，AC而非SCC的原发性肿瘤SUV max较高可能预示手术分期上调，这对F-FDG PET/CT淋巴结评估有影响。手术等待时间似乎不是这两种肿瘤类型的预测因素。
