Prognostic impact of the integration of volumetric quantification of the solid part of the tumor on 3DCT and FDG-PET imaging in clinical stage IA adenocarcinoma of the lung

Hideyuki Furumoto; Yoshihisa Shimada; Kentaro Imai; Sachio Maehara; Junichi Maeda; Masaru Hagiwara; Tetsuya Okano; Ryuhei Masuno; Masatoshi Kakihana; Naohiro Kajiwara; Tatsuo Ohira; Norihiko Ikeda

doi:10.1016/j.lungcan.2018.05.001

Prognostic impact of the integration of volumetric quantification of the solid part of the tumor on 3DCT and FDG-PET imaging in clinical stage IA adenocarcinoma of the lung

Lung Cancer. 2018 Jul:121:91-96. doi: 10.1016/j.lungcan.2018.05.001. Epub 2018 May 4.

Affiliations

¹ Department of Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
² Department of Radiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
³ Department of Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan. Electronic address: zenkyu@za3.so-net.ne.jp.

PMID: 29858033
DOI: 10.1016/j.lungcan.2018.05.001

Abstract

Objectives: The aim of this study was to conduct comparative analyses of the biological malignant potential of clinical stage IA adenocarcinoma using positron emission tomography/computed tomography (PET/CT), high-resolution CT (HRCT), and three-dimensional CT (3DCT). The predictive performance of these parameters was evaluated in terms of clinical outcomes and pathological invasiveness (positive lymphatic permeation, blood-vessel invasion, pleural invasion, and lymph-node metastasis).

Materials and methods: We enrolled 170 patients with c-IA adenocarcinoma who underwent PET/CT, HRCT, and 3D reconstruction of lung structures using the Synapse Vincent system (Fujifilm Corporation, Tokyo, Japan) followed by complete resection. Maximum standardized uptake values (SUV_max) of F¹⁸-fluorodeoxyglucose and the size and volume of the solid part of the tumor were quantified and analyzed in relation to surgical outcomes.

Results: Univariate analysis demonstrated that all the three parameters and whole-tumor volume were associated with unfavorable disease-free survival (DFS), while the volume of the solid part was the independent predictor on multivariate analysis (p < .001). The receiver operating characteristic curves for pathological invasiveness, determined using the variables dichotomized at each cut-off level (SUV_max 2.4; solid-part size 1.23 cm; solid-part volume 779 mm³), showed that all were significantly correlated with pathological invasiveness and prognosis, whereas the combination of SUV_max and the solid-part volume was the most powerful predictor of survival and pathological invasiveness compared to any other parameters: the 4-year DFS and proportion of pathological invasiveness in patients with SUV_max > 2.4 and solid-part volume > 779 mm³ versus those with SUV_max ≤ 2.4 or solid-part volume ≤779 mm³ were 81.2% versus 98.3% (p < .001) and 84.3% versus 15.1% (p < .001), respectively.

Conclusion: In c-IA adenocarcinoma, the volume of the solid part of the tumor was the independent predictor for unfavorable DFS, and the integration of the volume of the solid part and SUV_max was highly beneficial for the prediction of survival and pathological invasiveness.

Keywords: Adenocarcinoma; PET/CT; Stage IA; Three-dimensional CT; Tumor volume.

MeSH terms

Adenocarcinoma / diagnosis*
Adenocarcinoma / mortality
Adult
Aged
Aged, 80 and over
Cone-Beam Computed Tomography / methods*
Female
Fluorodeoxyglucose F18
Humans
Lung / diagnostic imaging*
Lung / pathology
Lung Neoplasms / diagnosis*
Lung Neoplasms / mortality
Male
Middle Aged
Neoplasm Invasiveness
Neoplasm Staging
Pneumonectomy
Positron Emission Tomography Computed Tomography / methods*
Prognosis
Survival Analysis
Tumor Burden
Young Adult

Substances

Fluorodeoxyglucose F18