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Tumor glycolytic heterogeneity improves detection of regional nodal metastasis in patients with lung adenocarcinoma

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Abstract

Objective

The diagnostic performance of 18F-FDG PET for detecting regional lymph node metastasis in resectable lung cancer is variable, and its sensitivity for adenocarcinoma is even lower. We aimed to evaluate the value of 18F-FDG PET-derived features in predicting pathological lymph node metastasis in patients with lung adenocarcinoma.

Methods

We retrospectively analyzed pretreatment 18F-FDG PET-derived features of 126 lung adenocarcinoma patients who underwent curative surgery. A logistic regression model was used to analyze the association between study variables and pathological regional lymph node status obtained from the curative surgery. Furthermore, Cox regression analysis was used to test the effect of the study variables on survival outcomes, including disease-free survival (DFS) and overall survival (OS).

Results

The primary tumor entropy (OR = 1.7, p = 0.014) and visual interpretation of regional nodes via 18F-FDG PET (OR = 2.5, p = 0.026) independently predicted pathological regional lymph node metastasis. The areas under the receiver-operating-characteristic curves were 0.631, 0.671, and 0.711 for visual interpretation, primary tumor entropy, and their combination, respectively. Based on visual interpretation, a primary tumor entropy ≥ 3.0 improved the positive predictive value of positive visual interpretation from 51.2% to 63.0%, whereas an entropy < 3.0 improved the negative predictive value of negative visual interpretation from 75.3% to 82.6%. In cases with positive visual interpretation and low entropy, or negative visual interpretation and high entropy, the nodal metastasis rates were approximately 30%. In the survival analyses, the primary tumor entropy was also independently associated with DFS (HR = 2.7, p = 0.001) and OS (HR = 4.8, p = 0.001).

Conclusions

Our preliminary results show that the primary tumor entropy may improve 18F-FDG PET visual interpretation in predicting pathological nodal metastasis in lung adenocarcinoma, and may also show a survival prognostic value. This versatile biomarker may facilitate tailored therapeutic strategies for patients with resectable lung adenocarcinoma.

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Acknowledgements

We would like to express our deepest and sincere appreciation to staff from the Cancer Center of Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation for their kind assistance in retrieving the data of patients with lung cancer.

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Authors and Affiliations

  1. Department of Medical Imaging and Radiological Sciences, Tzu Chi University of Science and Technology, Hualien, Taiwan

    Kun-Han Lue & Shu-Hsin Liu

  2. School of Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan

    Sung-Chao Chu, Yen-Chang Chen, Sheng-Chieh Chan, Yu-Hung Chen & Chih-Bin Lin

  3. Department of Hematology and Oncology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan

    Sung-Chao Chu

  4. Epidemiology and Biostatistics Consulting Center, Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan

    Ling-Yi Wang

  5. Department of Anatomical Pathology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan

    Yen-Chang Chen & Ming-Hsun Li

  6. Department of Cardiothoracic Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan

    Bee-Song Chang

  7. Department of Nuclear Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan

    Sheng-Chieh Chan, Yu-Hung Chen & Shu-Hsin Liu

  8. Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan

    Chih-Bin Lin

  9. Department of Pharmacy, School of Medicine, Tzu Chi University, Hualien, Taiwan

    Ling-Yi Wang

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  1. Kun-Han Lue
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Correspondence to Yu-Hung Chen.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The requirement of informed consent for this study was waived due to its retrospective nature.

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Lue, KH., Chu, SC., Wang, LY. et al. Tumor glycolytic heterogeneity improves detection of regional nodal metastasis in patients with lung adenocarcinoma. Ann Nucl Med 36, 256–266 (2022). https://doi.org/10.1007/s12149-021-01698-1

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