Ishida Yuriko, Watanabe Shiro, Sakakibara-Konishi Jun, Ikezawa Yasuyuki, Kikuchi Hajime, Kawai Yasutaka, Kimura Hirokazu, Nakakubo Sho, Hirata Kenji, Kudo Kohsuke, Konno Satoshi
Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan.
Department of Diagnostic Imaging, Graduate School of Medicine, Hokkaido University, Kita15, Nishi7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
Jpn J Radiol. 2025 Sep 12. doi: 10.1007/s11604-025-01869-4.
Interstitial pneumonia (IP) is associated with poor prognosis in lung cancer and increases the risk of acute exacerbation (AE). Few studies analyzed the relationship between fluorodeoxyglucose (FDG) accumulation in IP with lung cancer complicated with IP and the incidence of AE. This study investigates the association between FDG accumulation in the interstitial lesions and the AE incidence in patients with lung cancer complicated with IP.
This multicenter, retrospective study included patients with lung cancer complicated with IP who received chemotherapy. All CTs at baseline and the onset of AE were centrally adjudicated. The SUVpeak and FDGscore for interstitial lesions were calculated from FDG positron emission tomography images before chemotherapy, and these values were corrected using reference uptake. To determine the association with AE risk, clinical characteristics and imaging findings were compared between patients who developed AE and those who did not. Subsequently, logistic regression analysis was performed to identify risk factors for the development of AE.
One hundred and thirteen patients who met the eligibility criteria were enrolled from three centers. However, 9 patients with a clinical diagnosis of collagen-related interstitial pneumonia were excluded due to predominant FDG accumulation in the interstitial lesions, and 104 patients were analyzed. Of those patients, 31.7% (33/104) developed all grade AE and 18.3% (19/104) developed grade 3 or higher. There were no significant differences in patient characteristics and imaging patterns between those with and without AE. SUVpeak in the ipsilateral and contralateral interstitial lesions to the tumor and the FDGscore did not differ between those with or without AE.
No association was observed between FDG accumulation in interstitial lesions and AE in patients with lung cancer complicated with IP. We may have to remain cautious about the risk of AE in lung cancer complicated with IP, even when FDG accumulation in interstitial lesions is high or low.
间质性肺炎（IP）与肺癌预后不良相关，并增加急性加重（AE）风险。很少有研究分析合并IP的肺癌中IP的氟脱氧葡萄糖（FDG）蓄积与AE发生率之间的关系。本研究调查合并IP的肺癌患者间质病变中FDG蓄积与AE发生率之间的关联。
这项多中心回顾性研究纳入了接受化疗的合并IP的肺癌患者。对基线和AE发作时的所有CT进行集中判定。根据化疗前的FDG正电子发射断层扫描图像计算间质病变的SUVpeak和FDGscore，并使用参考摄取量对这些值进行校正。为确定与AE风险的关联，比较了发生AE的患者和未发生AE的患者的临床特征和影像学表现。随后，进行逻辑回归分析以确定AE发生的危险因素。
从三个中心招募了113名符合入选标准的患者。然而，9例临床诊断为胶原相关间质性肺炎的患者因间质病变中FDG蓄积占主导而被排除，共分析了104例患者。在这些患者中，31.7%（33/104）发生了所有级别的AE，18.3%（19/104）发生了3级或更高级别AE。发生AE和未发生AE的患者在患者特征和影像学模式上没有显著差异。肿瘤同侧和对侧间质病变的SUVpeak以及FDGscore在发生AE和未发生AE的患者之间没有差异。
在合并IP的肺癌患者中，未观察到间质病变中FDG蓄积与AE之间存在关联。即使间质病变中FDG蓄积高低不同，对于合并IP的肺癌患者的AE风险我们可能仍需谨慎。
