Predictive value of preoperative Metabolic Tumor Volume in Patients with Resectable Lung adenocarcinoma

초록

Aim: Predictive value of preoperative Metabolic Tumor Volume in Patients with Resectable Lung adenocarcinoma. Objectives: We explore the relationships between PET parameter (SUVmax, MTV and TLG) of the primary tumor and the recurrence in patients with surgically resectable lung adenocarcinoma on preoperative 18F-FDG PET/CT. Methods: From January 2010 to December 2015, 149 patients with lung adenocarcinoma who under went 18F-FDG PET/CT for initial diagnosis were retrospectively selected from database of our hospital. PET parameters (SUVmax, MTV and TLG of the primary tumor) were calculated. MTV and TLG with threshold of SUVmax 30%, 40% and 50% were calculated, respectively. And age, gender, smoking history, primary tumor size, lymph nodes stage and recurrence were recorded. A receiver operator characteristic (ROC) curve analysis, univariate and multivariate analysis were performed to identify the potential value of 18F-FDG PET/CT for predicting the recurrence. Results: There were 70 males and 79 females with an average of 65.8 years. Sixty-six (44.2%) of the 149 patients had the adjuvant treatment (chemo or radiation therapy) after the tumor resection and 53 (35.6%) had the recurrence. There were 94 (stage I ), 27 (stage II) and 28 (stage III) patients. The difference in the average of SUVmax (mean ± SD, 5.47 ± 3.01 vs. 4.36 ± 2.82; p=0.027), MTV30% (23.81 ± 22.42 vs 15.65 ± 24.90, p= 0.043) and the tumor size (3.40 ± 1.67 vs 2.67 ± 1.37, P=0.007) between the cases with and without the recurrence was statistically significant. MTV 40% and MTV 50% had no statistically significant difference between the case with and without the recurrence. Univariate analysis identified SUVmax (>4.22, P=0.049), MTV30% (≥11.09, p=0.010), lymph node metastasis ( N stage ≥1, p=0.005), lymphatic invasion (p=0.002). and high stage (≥ III, p=0.010) as significant predictors of recurrence. Multivariate analysis identified only MTV30% ( ≥11.09, relative risk = 1.77, p=0.021) showed statistical significance. Other factors (age, gender, smoking history, primary tumor size, visceral invasion) was not statistically significant. Conclusions: : MTV30% appears to be a statistically significant independent predictive marker of the recurrence in patients after the tumor resection. Therefore, lung adenocarcinoma patients with MTV30% may need a close follow-up because of the recurrence potential.