Metabolic tumor volume predicts overall survival in patients with primary pulmonary lymphoepithelioma-like carcinoma

Chun-Yu Lin; Yu-Chuan Chang; I-Ting Wang; Meng-Heng Hsieh; Chih-Wei Wang; Shu-Min Lin; Ching-Yang Wu; Yueh-Fu Fang

doi:10.3892/ol.2019.10954

Metabolic tumor volume predicts overall survival in patients with primary pulmonary lymphoepithelioma-like carcinoma

Oncol Lett. 2019 Dec;18(6):6143-6149. doi: 10.3892/ol.2019.10954. Epub 2019 Oct 2.

Authors

Chun-Yu Lin^{1

2}, Yu-Chuan Chang^{3

4}, I-Ting Wang⁵, Meng-Heng Hsieh¹, Chih-Wei Wang⁶, Shu-Min Lin¹, Ching-Yang Wu⁷, Yueh-Fu Fang¹

Affiliations

¹ Department of Thoracic Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan, R.O.C.
² Department of Pulmonary and Critical Care, Saint Paul's Hospital, Taoyuan 33069, Taiwan, R.O.C.
³ Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan, R.O.C.
⁴ Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33305, Taiwan, R.O.C.
⁵ Department of Pulmonary and Critical Care, Mackay Memorial Hospital, Taipei 10491, Taiwan, R.O.C.
⁶ Department of Pathology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan 33305, Taiwan, R.O.C.
⁷ Department of Surgery, Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan 33305, Taiwan, R.O.C.

Abstract

Pretreatment tumor metabolic burden, measured using fluorine-18 fluorodeoxyglucose positron emission tomography/computerized tomography (¹⁸F-FDG PET/CT), has been demonstrated to predict outcomes in various types of malignancies. Additionally, Epstein-Barr virus (EBV) serum titer is associated with stages of pulmonary lymphoepithelioma-like carcinoma (LELC). The present study aimed to investigate the prognostic value of the functional parameters of ¹⁸F-FDG PET/CT in pulmonary LELC and their association with serum EBV DNA. The present retrospective study analyzed data from 71 patients with pulmonary LELC; among these, 32 patients with pulmonary LELC underwent pretreatment ¹⁸F-FDG PET/CT staging between January 2008 and December 2016. EBV viral load and functional parameters of ¹⁸F-FDG PET/CT were used for survival analysis. Multivariate analysis identified tumor stage IV as a significant predictor of poor progression-free survival [hazard ratio (HR), 4.85; P=0.049], whereas elevated total metabolic tumor volume (MTV ≥72.6 ml) independently predicted worse overall survival (OS; HR, 12.59; P=0.024). Pretreatment serum EBV DNA titer was significantly positively associated with total MTV (P=0.0337) and total lesion glycolysis (TLG; P=0.0093), but could not predict outcomes. Total MTV was an independent predictor of OS, and may guide clinical management for pulmonary LELC.

Keywords: Epstein-Barr virus DNA; fluorodeoxyglucose positron emission tomography/computerized tomography; metabolic tumor volume; prognosis; pulmonary lymphoepithelioma-like carcinoma.