Preoperative PET-SUVmax and volume based PET parameters of the primary tumor fail to predict nodal upstaging in early-stage lung cancer

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Özlem Okumus - , University of Duisburg-Essen (Author)
  • Khaled Mardanzai - , University of Duisburg-Essen (Author)
  • Till Plönes - , University of Duisburg-Essen (Author)
  • Dirk Theegarten - , University of Duisburg-Essen (Author)
  • Kaid Darwiche - , University of Duisburg-Essen (Author)
  • Martin Schuler - , University of Duisburg-Essen (Author)
  • Felix Nensa - , University of Duisburg-Essen (Author)
  • Hubertus Hautzel - , University Hospital Essen (Author)
  • Ken Hermann - , University Hospital Essen (Author)
  • Martin Stuschke - , University of Duisburg-Essen (Author)
  • Balazs Hegedus - , University of Duisburg-Essen (Author)
  • Clemens Aigner - , University of Duisburg-Essen (Author)

Abstract

Objectives: Accurate nodal staging is of utmost importance in patients with lung cancer. FDG-PET/CT imaging is now part of the routine staging. Despite thorough preoperative staging nodal upstaging still occurs in early-stage lung cancer. However, the predictive value of preoperative PET metrics of the primary tumor on nodal upstaging remains to be unexplored. Our aim was to assess the association of these preoperative PET-parameters with nodal upstaging in histologically confirmed lung adenocarcinoma and squamous cell carcinoma. Methods: From January 2016 to November 2018, 500 patients with pT1-T2/cN0 lung cancer received an anatomical resection with curative intent. 171 patients with adenocarcinoma and squamous cell carcinoma and available PET-CTs were retrospectively included. We analyzed the the association of nodal upstaging with preoperative PET-SUVmax and metabolic PET metrics including total lesion glycolysis (TLG) and metabolic tumor volume (MTV) with different defined thresholds. Results: High values of preoperative PET-SUVmax of the primary tumor were associated with squamous cell carcinoma (p < 0.0001) and with larger tumors (p < 0.0001). Increased preoperative C-reactive protein levels (<1mg/dL) correlated significantly with high preoperative PET-SUVmax values (p < 0.0001). No significant relationship between PET-SUVmax and lactate dehydrogenase activity (p = 0.6818), white blood cell count (p = 0.7681), gender (p = 0.1115) or age (p = 0.9284) was observed. Nodal upstaging rate was 14.0 % with 8.8 % N1 and 5.3 % N2 upstaging. Tumor size (p = 0.0468) and number of removed lymph nodes (p = 0.0461) were significant predictors of nodal upstaging but no significant association was found with histology or PET parameters. Of note, increased MTV – regardless of the threshold – tended to associate with nodal upstaging. Conclusion: Early-stage lung cancer patients with squamous histology and T2 tumors presented increased preoperative PET-SUVmax values. Nevertheless, beyond tumor size and number of removed lymph nodes neither SUVmax nor metabolic PET parameters MTV and TLG were significant predictors of nodal upstaging.

Details

Original languageEnglish
Pages (from-to)82-88
Number of pages7
JournalLung cancer
Volume176
Publication statusPublished - Feb 2023
Peer-reviewedYes
Externally publishedYes

External IDs

PubMed 36623341

Keywords

Sustainable Development Goals

Keywords

  • CRP, Lung cancer, MTV, Nodal upstaging, PET-SUVmax, TLG