Preoperative Consolidation-to-Tumor Ratio and SUVmax Stratify the Risk of Recurrence in Patients Undergoing Limited Resection for Lung Adenocarcinoma ≤2 cm
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Limited resection is an increasingly utilized option for treatment of clinical stage IA lung adenocarcinoma (ADC) ≤2 cm (T1aN0M0), yet there are no validated predictive factors for postoperative recurrence. We investigated the prognostic value of preoperative consolidation/tumor (C/T) ratio [on computed tomography (CT) scan] and maximum standardized uptake value (SUVmax) on 18F-fluorodeoxyglucose-positron emission tomography (PET) scan.
We retrospectively reviewed 962 consecutive patients who underwent limited resection for lung cancer at Memorial Sloan-Kettering between 2000 and 2008. Patients with available CT and PET scans were included in the analysis. C/T ratio of 25 % (in accordance with the Japan Clinical Oncology Group 0201) and SUVmax of 2.2 (cohort median) were used as cutoffs. Cumulative incidence of recurrence (CIR) was assessed.
A total of 181 patients met the study inclusion criteria. Patients with a low C/T ratio (n = 15) had a significantly lower 5-year recurrence rate compared with patients with a high C/T ratio (n = 166) (5-year CIR, 0 vs. 33 %; p = 0.015), as did patients with low SUVmax (n = 86) compared with patients with high SUVmax (n = 95; 5-year CIR, 18 vs. 40 %; p = 0.002). Furthermore, within the high C/T ratio group, SUVmax further stratified risk of recurrence [5-year CIR, 22 % (low) vs. 40 % (high); p = 0.018].
With the expected increase in diagnoses of small lung ADC as a result of more widespread use of CT screening, C/T ratio and SUVmax are widely available markers that can be used to stratify the risk of recurrence among cT1aN0M0 patients after limited resection.
KeywordsSmall lung adenocarcinoma Limited resection Positron emission tomography SUVmax Consolidation/tumor ratio
The authors thank Joe Dycoco for his help with the lung adenocarcinoma database at the Division of Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, and David Sewell, for his editorial assistance.
This work was supported, in part, by the International Association for the Study of Lung Cancer Young Investigator Award; National Lung Cancer Partnership/LUNGevity Foundation Research Grant; American Association for Thoracic Surgery Third Edward D. Churchill Research Scholarship; William H. Goodwin and Alice Goodwin, the Commonwealth Foundation for Cancer Research and the Experimental Therapeutics Center; the National Cancer Institute (Grants U54CA137788 and U54CA132378); and the U.S. Department of Defense (Grant LC110202).
The authors declare no conflicts of interest.
- 3.Curado MP, Edwards B, Shin HR. Cancer Incidence in Five Continents. Vol. IX. IARC Scientific Publications No. 160. Lyon: IARC; 2007.Google Scholar
- 14.Dong B, Sato M, Sakurada A, et al. Computed tomographic images reflect the biologic behavior of small lung adenocarcinoma: they correlate with cell proliferation, microvascularization, cell adhesion, degradation of extracellular matrix, and K-ras mutation. J Thorac Cardiovasc Surg. 2005;130:733–9.PubMedCrossRefGoogle Scholar
- 23.Travis WD, Brambilla E, Muller-Hermelink HK, Harris CC. World Health Organization classification of tumors: pathology and genetics of tumors of the lung, pleura, thymus and heart. Lyon: IARC Press; 2004.Google Scholar