Clinical impact of SUVmax of interstitial lesions in lung cancer patients with interstitial lung disease who underwent pulmonary resection

Kimitaka Akaike; Koichi Saruwatari; Ryohei Matsushima; Kosuke Fujino; Jun Morinaga; Seitaro Oda; Hiroshi Takahashi; Shinya Shiraishi; Hiroko Okabayashi; Shohei Hamada; Yusuke Tomita; Aiko Masunaga; Sho Saeki; Koei Ikeda; Hidenori Ichiyasu; Makoto Suzuki; Takuro Sakagami

doi:10.21037/jtd-22-604

Clinical impact of SUV_max of interstitial lesions in lung cancer patients with interstitial lung disease who underwent pulmonary resection

J Thorac Dis. 2022 Oct;14(10):3801-3810. doi: 10.21037/jtd-22-604.

Authors

Kimitaka Akaike¹, Koichi Saruwatari¹, Ryohei Matsushima², Kosuke Fujino², Jun Morinaga³, Seitaro Oda⁴, Hiroshi Takahashi¹, Shinya Shiraishi⁴, Hiroko Okabayashi¹, Shohei Hamada¹, Yusuke Tomita¹, Aiko Masunaga¹, Sho Saeki¹, Koei Ikeda², Hidenori Ichiyasu¹, Makoto Suzuki², Takuro Sakagami¹

Affiliations

¹ Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
² Department of Thoracic Surgery, Kumamoto University Hospital, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
³ Department of Clinical Investigation, Kumamoto University Hospital, Kumamoto, Japan.
⁴ Department of Diagnostic Radiology, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.

Abstract

Background: Acute exacerbation of interstitial lung disease often causes fatal respiratory deterioration in lung cancer patients with interstitial lung disease. Here, we examined whether the maximum standardized uptake value of a contralateral interstitial lesion was a predictive factor of acute exacerbation of interstitial lung disease within 30 days postoperatively in lung cancer patients with interstitial lung disease who underwent pulmonary resection.

Methods: Overall, 117 consecutive lung cancer patients with interstitial lung disease who underwent pulmonary resection between August 2010 and April 2019 at the Kumamoto University Hospital were retrospectively analysed for the association between the maximum standardized uptake value of the contralateral interstitial lesions and interstitial lung disease parameters.

Results: The median maximum standardized uptake value of contralateral interstitial lesions was 1.61, which was regarded as the cut-off point predictive of the incidence of acute exacerbation of interstitial lung disease. Eight patients developed postoperative acute exacerbation of interstitial lung disease. There was no significant association between the maximum standardized uptake value of the contralateral interstitial lesions and postoperative acute exacerbation of interstitial lung disease. The maximum standardized uptake value was weakly but significantly associated with lactate dehydrogenase levels (r=0.211, P=0.022), Krebs von den Lungen-6 (r=0.208, P=0.028), and % diffusing capacity for carbon monoxide (r=-0.290, P=0.002). Moreover, seven patients developed acute exacerbation of the interstitial lung disease during the clinical course after 30 postoperative days, and the incidence rate of acute exacerbation of interstitial lung disease was significantly higher in the high maximum standardized uptake value group (≥1.61) than in the low maximum standardised uptake value group (<1.61) (12.7% vs. 0%, P=0.002, Gray's test).

Conclusions: Maximum standardized uptake value was not a predictor of postoperative acute exacerbation of interstitial lung disease in lung cancer patients with interstitial lung disease after pulmonary resection, but could be a predictive tool of an association with interstitial lung disease severity and activity markers.

Keywords: Acute exacerbation of interstitial lung disease; fluorine-18 2-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography; interstitial lung disease; lung cancer; pulmonary resection.