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Impact of 18F-FDG PET on TNM Staging and Prognosis in Thymic Epithelial Tumors

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Preoperative fluorine-18-fluorodeoxyglucose positron emission tomography (18F-FDG PET) of thymic epithelial tumors (TETs) is well known for identifying malignant-grade TETs; however, its predictive power for determining locally advanced tumors, lymph node (LN) metastasis, and prognosis remains unknown.

Patients and Methods

We retrospectively evaluated patients with resectable TETs who were preoperatively assessed using 18F-FDG PET from January 2012 to January 2023. The receiver operating characteristic curve was used to evaluate the cutoff value of the maximum standardized uptake value (SUVmax) to predict advanced-stage disease. Recurrence/progression-free survival (RFS/PFS) was analyzed using the Kaplan–Meier method. The staging was classified according to the tumor–node–metastasis system.

Results

Our study included 177 patients; 145 (81.9%) had pathological early-stage TET (stage I or II), and 32 (19.1%) had advanced stage (stage III or IV). The area under the curve value for predicting the advanced stage was 0.903, and the cutoff value was 5.6 (sensitivity 81.3%, specificity 84.8%). SUVmax > 5.6 was associated with worse prognosis for RFS/PFS. LN metastasis was preoperatively detected by FDG uptake in 30.8% of patients with pathological LN positivity, whereas LN metastasis was not pathologically detected in patients with SUVmax < 5.9. In patients with advanced-stage TETs, LN recurrence was more frequent in patients who were preoperatively detected by 18F-FDG PET than those who were not (75.0% versus 7.1%).

Conclusions

18F-FDG PET is a potentially valuable tool for predicting advanced stage and poor prognosis of recurrence in patients with TETs. SUVmax can help thoracic surgeons to guide them in selecting appropriate therapeutic strategies for TETs.

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Acknowledgement

We thank Editage (www.editage.cn) for English language editing.

Funding

This work was not supported by any funding sources.

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Authors and Affiliations

  1. Departments of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan

    Takaki Akamine MD, Kazuo Nakagawa MD, Masaya Yotsukura MD, Yukihiro Yoshida MD & Shun-ichi Watanabe MD

  2. Departments of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan

    Kimiteru Ito MD, Hirokazu Watanabe MD & Masahiko Kusumoto MD

  3. Departments of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan

    Yasushi Yatabe MD

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  1. Takaki Akamine MD
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  2. Kazuo Nakagawa MD
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  3. Kimiteru Ito MD
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  4. Hirokazu Watanabe MD
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  5. Masaya Yotsukura MD
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  6. Yukihiro Yoshida MD
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  8. Masahiko Kusumoto MD
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  9. Shun-ichi Watanabe MD
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Corresponding author

Correspondence to Kazuo Nakagawa MD.

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Disclosue

Masahiko Kusumoto received honoraria for lecture fees from AstraZeneca K.K., Daiichi-Sankyo Inc., and Daiichi-Sankyo Co., Ltd. and a research grant from Canon medical systems corporation. The other authors declare no conflicts of interest associated with this study.

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Supplementary Information

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Supplementary FIG. 1. Flowchart of patients’ selection

10434_2023_14328_MOESM2_ESM.tif

Supplementary FIG. 2. Sankey diagram of the clinical and pathological TNM staging. Twelve patients were pathologically upstaged to an advanced stage from clinical stage I. Nine patients with cN0 disease had pathological lymph node metastasis

10434_2023_14328_MOESM3_ESM.tif

Supplementary FIG. 3. Kaplan–Meier curves of recurrence/progression-free survival according to SUVmax in patients with pathologically early-stage (A) and advanced-stage (B) thymic epithelial tumors

10434_2023_14328_MOESM4_ESM.tif

Supplementary FIG. 4. Kaplan–Meier curves of recurrence/progression-free survival according to pathological tumor-node-metastasis staging

10434_2023_14328_MOESM5_ESM.tif

Supplementary FIG. 5. Kaplan–Meier curves of recurrence/progression-free survival in patients with pN positive according to cN0 and cN1 determined by 18F-FDG PET

10434_2023_14328_MOESM6_ESM.tif

Supplementary FIG. 6. Receiver operating characteristic curve of SUVmax in predicting advanced-stage disease in PET/CT and PET/MRI

Supplementary FIG. 7. Box plots of SUVmax according to WHO histological classification

Supplementary file8 (DOCX 17 kb)

Supplementary file9 (DOCX 21 kb)

Supplementary file10 (DOCX 19 kb)

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Akamine, T., Nakagawa, K., Ito, K. et al. Impact of 18F-FDG PET on TNM Staging and Prognosis in Thymic Epithelial Tumors. Ann Surg Oncol 31, 192–200 (2024). https://doi.org/10.1245/s10434-023-14328-z

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  • DOI: https://doi.org/10.1245/s10434-023-14328-z

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