周一“星”视角|PET/CT和颅脑MRI对临床T1期肺癌患者转移检测的影响：一项大规模队列研究；Ⅰ期肺腺癌复发相关的高危因素

01

Yi Feng1,2, Bo Cheng1,2, Shuting Zhan1,2, Haiping Liu3, Jianfu Li1,2, PeilingChen1,2, Zixun Wang1,2,4, Xiaoyan Huang5, Xiuxia Fu1,2,4, Wenjun Ye1,2, Runchen Wang1,2, Qixia Wang1,2, Yang Xiang1,2, Huiting Wang1,2, Feng Zhu6, Xin Zheng1,2, Wenhai Fu1,2, Guodong Hu7, Zhuxing Chen1,2,8, Jianxing He1,2, Wenhua Liang1,2

1 Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.

2 Guangzhou Institute of Respiratory Health, Guangzhou, 510120, China.

3 PET/CT Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.

4 Nanshan School, Guangzhou Medical University, Jingxiu Road, Panyu District, Guangzhou, 511436, China.

5 The Radiology Department of the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.

6 Detroit Medical Center Sinai-Grace Hospital, Internal Medicine Department, 6071 Outer Dr W, Detroit, MI, 48235, USA.

7 Department of Respiratory and Critical Care Medicine, The Tenth Affiliated Hospital of Southern Medical University, Dongguan, Guangdong, 523108, China.

8 Pulmonary Nodule Surgical Department, The First People's Hospital of Foshan, Foshan, 528000, China.

Objective: 

[18F]-FDG PET/CT and brain MRI are common approaches to detect metastasis in patients of lung cancer. Current guidelines for the use of PET/CT and MRI in clinical T1-category lung cancer lack risk-based stratification and require optimization. This study stratified patients based on metastatic risk in terms of the lesions' size and morphological characteristics.

Methods:

The detection rate of metastasis was measured in different sizes and morphological characteristics (solid and sub-solid) of tumors. To confirm the cut-off value for discriminating metastasis and overall survival (OS) prediction, the receiver operating characteristic (ROC) analysis was performed based on PET/CT metabolic parameters (SUVmax/SUVmean/SULpeak/MTV/TLG), followed by Kaplan-Meier analysis for survival in post-operation patients with and without PET/CT plus MRI.

Results: 

2,298 patients were included. No metastasis was observed in patients with solid nodules < 8.0 mm and sub-solid nodules < 10.0 mm. The cut-off of PET/CT metabolic parameters on discriminating metastasis were 1.09 (SUVmax), 0.26 (SUVmean), 0.31 (SULpeak), 0.55 (MTV), and 0.81 (TLG), respectively. Patients undergoing PET/CT plus MRI exhibited longer OS compared to those who did not receive it in solid nodules ≥ 8.0 mm & sub-solid nodules ≥ 10.0 mm (HR, 0.44; P < 0.001); in solid nodules ≥ 8.0 mm (HR, 0.12; P < 0.001) and in sub-solid nodules ≥ 10.0 mm (HR; 0.61; P = 0.075), respectively. Compared to patients with metabolic parameters lower than cut-off values, patients with higher metabolic parameters displayed shorter OS: SUVmax (HR, 12.94; P < 0.001), SUVmean (HR, 11.33; P < 0.001), SULpeak (HR, 9.65; P < 0.001), MTV (HR, 9.16; P = 0.031), and TLG (HR, 12.06; P < 0.001).

Conclusion: 

The necessity of PET/CT and MRI should be cautiously evaluated in patients with solid nodules < 8.0 mm and sub-solid nodules < 10.0 mm, however, these examinations remained essential and beneficial for patients with solid nodules ≥ 8.0 mm and sub-solid nodules ≥ 10.0 mm.

[CITATION]: Feng Y, Cheng B, Zhan S, et al. The impact of PET/CT and brain MRI for metastasis detection among patients with clinical T1-category lung cancer: Findings from a large-scale cohort study. Eur J Nucl Med Mol Imaging. 2024 May 9.

[DOI]:10.1007/s00259-024-06740-8.

[IF]: 9.1

02

Cameron N Fick1, Elizabeth G Dunne1, Stijn Vanstraelen1, Nicolas Toumbacaris2, Kay See Tan2, Gaetano Rocco3, Daniela Molena3, James Huang3, Bernard J Park3, Natasha Rekhtman4, William D Travis4, Jamie E Chaft5, Matthew J Bott3, Valerie W Rusch3, Prasad S Adusumilli3, Smita Sihag3, James M Isbell3, David R Jones3

1 Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center (MSK), New York, NY.

2 Department of Epidemiology and Biostatistics, MSK, New York, NY.

3 Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center (MSK), New York, NY; Druckenmiller Center for Lung Cancer Research, MSK, New York, NY.

4 Department of Pathology and Laboratory Medicine, MSK, New York, NY.

5 Department of Medicine, MSK and Weill Cornell Medical College, New York, NY.

Objective: 

There is a lack of knowledge regarding the use of prognostic features in stage I lung adenocarcinoma (LUAD). Thus, we investigated clinicopathologic features associated with recurrence after complete resection for stage I LUAD.

Methods: 

We performed a retrospective analysis of patients with pathologic stage I LUAD who underwent R0 resection from 2010 to 2020. Exclusion criteria included history of lung cancer, induction or adjuvant therapy, noninvasive or mucinous LUAD, and death within 90 days of surgery. Fine and Gray competing-risk regression assessed associations between clinicopathologic features and disease recurrence.

Results: 

In total, 1912 patients met inclusion criteria. Most patients (1565 [82%]) had stage IA LUAD, and 250 developed recurrence: 141 (56%) distant and 109 (44%) locoregional only. The 5-year cumulative incidence of recurrence was 12% (95% confidence interval, 11%-14%). Higher maximum standardized uptake value of the primary tumor (hazard ratio [HR]=1.04), sublobar resection (HR=2.04), higher IASLC grade (HR=5.32 [grade 2]; HR=7.93 [grade 3]), lymphovascular invasion (HR=1.70), visceral pleural invasion (HR=1.54), and tumor size (HR=1.30) were independently associated with hazard of recurrence. Tumors with 3-4 high-risk features had a higher cumulative incidence of recurrence at 5 years than tumors without these features (30% vs. 4%; P < 0.001).

Conclusions: 

Recurrence after resection for stage I LUAD remains an issue for select patients. Commonly reported clinicopathologic features can be used to define patients at high risk of recurrence and should be considered when assessing the prognosis of patients with stage I disease.

[CITATION]: Fick CN, Dunne EG, Vanstraelen S, et al. High-Risk Features Associated with Recurrence in Stage I Lung Adenocarcinoma. J Thorac Cardiovasc Surg. 2024 May 22:S0022-5223(24)00440-9.

[DOI]: 10.1016/j.jtcvs.2024.05.009.

[IF]: 6.0