Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, 325, Section 2, Cheng-Kung Road, Taipei, 114, Taiwan.
Department of Nuclear Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Eur Radiol. 2021 Oct;31(10):8021-8029. doi: 10.1007/s00330-021-07801-4. Epub 2021 Mar 25.
To investigate the role of PET in predicting the prognosis of resected stage IA non-small cell lung cancer (NSCLC) and planning individualized therapeutic strategies.
We retrospectively reviewed the data of patients who underwent surgical resection for lung cancer between January 2004 and December 2014. The clinical data, imaging characteristics of nodules, surgical approaches, and outcomes were analyzed.
We evaluated 998 cases; 637 patients with pathological stage I disease were categorized as follows: stage IA1 (251 cases), stage IA2 (250 cases), and stage IA3 (136 cases). The mean follow-up period was 109 months. Significant differences were observed in sex, tumor differentiation, epidermal growth factor receptor mutation, smoking habits, lymphovascular space invasion, tumor size, maximum standard uptake value (SUVmax), and carcinoembryonic antigen level among the groups. Multivariable Cox regression revealed that ground-glass opacity ratio (hazard ratio (HR) = 0.001) and tumor SUVmax independently predicted the postoperative risk of relapse for stage IA3 NSCLC. The HR for SUVmax > 4 was 8.986 (p < 0.001). The 5-year overall survival (OS) rates were 87.2%, 92.9%, and 82.7%, and the 5-year disease-free survival (DFS) rates were 93.2%, 84.2%, and 70.51% for stage IA1, IA2, and IA3 NSCLC, respectively (both p < 0.001). OS and DFS rates were poor in stage IA3 NSCLC patients with an SUVmax uptake > 4 (OS, 71.0% and 92.2%; DFS, 50.2% and 87.3%, for SUVmax > 4 and ≤ 4, respectively; both p = 0.001).
SUVmax was a prognostic factor for resected stage IA NSCLC. Postoperative treatment may be considered for IA3 NSCLC with SUVmax > 4.
• PET helps surgeons to assess patients with early-stage lung cancer. • This retrospective study revealed that PET plays an influential role in predicting the prognosis of resected lung cancer. • Better prognostication aids better planning of therapeutic strategies with diversification.
探讨 PET 在预测可切除ⅠA 期非小细胞肺癌（NSCLC）患者预后及规划个体化治疗策略中的作用。
回顾性分析 2004 年 1 月至 2014 年 12 月接受肺癌切除术的患者数据。分析患者的临床资料、结节的影像学特征、手术方式和治疗结果。
共评估了 998 例患者，其中 637 例患者病理分期为ⅠA 期：IA1 期（251 例）、IA2 期（250 例）和 IA3 期（136 例）。平均随访时间为 109 个月。各组间的性别、肿瘤分化程度、表皮生长因子受体突变、吸烟习惯、脉管侵犯、肿瘤大小、最大标准摄取值（SUVmax）和癌胚抗原水平存在显著差异。多变量 Cox 回归分析显示，磨玻璃影比例（危险比（HR）=0.001）和肿瘤 SUVmax 可独立预测 IA3 期 NSCLC 术后复发风险。SUVmax＞4 的 HR 为 8.986（p＜0.001）。IA1、IA2 和 IA3 期 NSCLC 患者的 5 年总生存率（OS）分别为 87.2%、92.9%和 82.7%，5 年无病生存率（DFS）分别为 93.2%、84.2%和 70.51%（均 p＜0.001）。SUVmax 摄取值＞4 的 IA3 期 NSCLC 患者 OS 和 DFS 率较差（OS，71.0%和 92.2%；DFS，50.2%和 87.3%，SUVmax＞4 和 SUVmax≤4 分别）（均 p=0.001）。
SUVmax 是可切除ⅠA 期 NSCLC 的预后因素。对于 SUVmax＞4 的 IA3 期 NSCLC，术后治疗可能需要考虑。
PET 有助于外科医生评估早期肺癌患者。
这项回顾性研究表明，PET 在预测可切除肺癌的预后方面具有重要作用。
更好的预后有助于更好地规划多样化的治疗策略。
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