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Impact of preoperative [18F]FDG PET/CT vs. contrast-enhanced CT in the staging and survival of patients with clinical stage I and II non-small cell lung cancer: a 10-year follow-up study

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Abstract

Objectives

To elucidate the impact of [18F]FDG positron emission tomography/computed tomography (PET/CT) vs. CT workup on staging and prognostic evaluation of clinical stage (c) I-II NSCLC.

Methods

We retrospectively identified 659 cI-II NSCLC who underwent CT (267 patients) or preoperative CT followed by PET/CT (392 patients), followed by curative-intended complete resection in our hospital from January 2008 to December 2013. Differences were assessed between preoperative and postoperative stage. Five-year disease-free survival (DFS) and overall survival (OS) rates were calculated using the Kaplan–Meier approach and compared with log-rank test. Impact of preoperative PET/CT on survival was assessed by Cox regression analysis.

Results

The study included 659 patients [mean age, 59.5 years ± 10.8 (standard deviation); 379 men]. The PET/CT group was superior over CT group in DFS [12.6 vs. 6.9 years, HR 0.67 (95% CI 0.53–0.84), p < 0.001] and OS [13.9 vs. 10.5 years, HR 0.64 (95% CI 0.50–0.81), p < 0.001]. In CT group, more patients thought to have cN0 migrated to pN1/2 disease as compared with PET/CT group [26.4% (66/250) vs. 19.2% (67/349), p < 0.001], resulting in more stage cI cases being upstaged to pII–IV [24.7% (49/198) vs. 16.1% (47/292), p = 0.02], yet this was not found in cII NSCLC [27.5% (19/69) vs. 27.0% (27/100), p = 0.94]. Cox regression analysis identified preoperative PET/CT as an independent prognostic factor of OS and DFS (p = 0.002, HR = 0.69, 95% CI 0.54–0.88; p = 0.004, HR = 0.72, 95% CI 0.58–0.90).

Conclusion

Addition of preoperative [18F]FDG PET/CT was associated with superior DFS and OS in resectable cI–II NSCLC, which may result from accurate staging and stage-appropriate therapy.

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Data availability

The data of this study is available upon request and discussion with corresponding author.

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Funding

This study was supported by the following grants: Guangdong Provincial People's Hospital Startup Fund for Project of National Natural Science Foundation (Grant No.KY012020419 and KY012021920, to Jun-Tao Lin); Guangzhou Municipal Science and Technology Bureau (grant No. 202201011664 to Yang Xue-Ning); Key Lab System Project of Guangdong Science and Technology Department-Guangdong Provincial Key Lab of Translational Medicine in Lung Cancer (Grant No. 2017B030314120, to Yi-Long Wu); Guangdong Provincial People’s Hospital Scientific Research Funds for Leading Medical Talents in Guangdong Province (KJ012019426, Yi-Long Wu).

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Author notes

  1. Jun-Tao Lin and Xiang-Meng Li contributed equally to this article.

Authors and Affiliations

  1. Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan 2nd Road, Guangzhou, 510080, People’s Republic of China

    Jun-Tao Lin, Wen-Zhao Zhong, Xin-Yue Yu, Kai-Yan Ye, Yi-Lu Cheng, Jia-Yu Du, Yun-Qing Sun, Fu-Gui Zhang, Hong-Hong Yan, Ri-Qiang Liao, Song Dong, Ben-Yuan Jiang, Si-Yang Liu, Yi-Long Wu & Xue-Ning Yang

  2. Cancer Institute, Southern Medical University, Guangzhou, China

    Xiang-Meng Li

  3. Department of PET Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China

    Qing-Yi Hou

  4. Department of Radiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China

    Chun-Ling Liu

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  1. Jun-Tao Lin
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Correspondence to Yi-Long Wu or Xue-Ning Yang.

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Lin, JT., Li, XM., Zhong, WZ. et al. Impact of preoperative [18F]FDG PET/CT vs. contrast-enhanced CT in the staging and survival of patients with clinical stage I and II non-small cell lung cancer: a 10-year follow-up study. Ann Nucl Med 38, 188–198 (2024). https://doi.org/10.1007/s12149-023-01888-z

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