Halide KAYA, A. Çetin TANRIKULU, Halil KÖMEK, Hatice ŞEN SELİMOĞLU, Vedat ERDEM, Abdurrahman ŞENYİĞİT, Cengizhan SEZGİ, Abdurrahman ABAKAY

Küçük hücreli dışı akciğer kanseri olan olgularda prognostik faktörler ve PET/BT’deki SUV max değerinin prognostik önemi

Giriş: Çalışma küçük hücreli dışı akciğer kanseri (KHDAK) olan olgularda, florodeoksiglukoz-pozitron emisyon tomogra- fi/bilgisayarlı tomografi (FDG-PET/BT)’de maksimum standart uptake değerinin (SUV max) sağkalım ile ilişkisini belirle- mek ve olguların demografik, klinik ve laboratuvar verilerinin sağkalıma etkilerini araştırmak amacıyla planlandı. Materyal ve Metod: Mayıs 2006-Mart 2011 tarihleri arasında merkezimize başvuran, kesin tanı almış ve evrelemesinde FDG-PET/BT kullanan 101 KHDAK’lı olgunun dosyaları retrospektif olarak incelendi. Başta kitlenin FDG-PET/BT’deki SUV max’ı olmak üzere, prognozu etkileyen klinik, histopatolojik, laboratuvar ve tedavi parametreleri kaydedilerek istatistiksel analiz yapıldı. Bulgular: Hastaların 88 (%87.1)’i erkek, 13 (%12.9)’ü kadındı. Ortalama sağkalım süresi 10.6 ± 8.5 (1- 49 ay) ay idi. Has- taların demografik, klinik, laboratuvar ve radyolojik parametreleri SUV max’ın medyan değeri (12.0) ile iki gruba ayrılarak karşılaştırıldı. İki grup arasında sağkalım açısından, anlamlı bir fark yoktu (p= 0.807). Çalışmada, ileri evre, metastaz var- lığı, yüksek laktat dehidrogenaz (LDH) düzeyi, yüksek lökosit düzeyi, kitlenin inoperabl olması, düşük albumin düzeyi ve düşük performans düzeyinin sağkalımı olumsuz etkilediği görüldü. Sonuç: Sonuçlar, KHDAK’lı olguların, sağkalım süresinde kitlenin FDG-PET/BT’deki SUV max değerinin önemli rolü olma- dığını düşündürtmüştür. Performans durumu, serum LDH, lökosit ve albumin değerlerinin bilinmesi daha iyi prognostik değerlendirme sağlayabilir.

Prognostic factors in non-small cell lung cancer patients and prognostic importance of PET/CT SUV max value

Introduction: This study planned to investigate the maximum standard uptake values (SUV max) at fluorodeoxyglucose- positron emission tomography/computed tomography (FDG-PET/CT) whether associated with survival or not and the ef- fect of demographic, clinical and laboratory data on survival in non-small cell lung cancer (NSCLC) patients. Materials and Methods: This study was created by examining retrospectively the records of 101 patients with NSCLC that received a definitive diagnosis and FDG-PET/CT used for staging in our center between May 2006-March 2011. Especially FDG-PET/CT, SUV max and the other clinical, histopathologic, laboratory and treatment parameters that effects prognosis were recorded and statistical analysis was performed. Results: Eighty eight (87.1%) of the patients were men and 13 (12.9%) were women. The average survival period was 10.6 ± 8.5 (1-49 months) months. The demographic, clinical, laboratory and radiological parameters were divided into two gro- ups with the median value of SUV max (12.0). There was not a significant difference in survival between the two groups (p= 0.807). The study showed that advanced stage, presence of metastasis, high lactate dehydrogenase (LDH) levels, high white blood cell levels, inoperability, low albumin levels and low performance effect negative on survival. Conclusion: It was considered that SUV max does not play an important role in the survival period of NSCLC patients. Knowledge of performance condition, serum LDH, leukocyte and albumin values may provide a better prognostic evalua- tion.

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1. Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, et al. Cancer statistics, 2006. CA Cancer J Clin 2006; 56: 106-30.
2. Mountain CF. Revisions in the International System for Staging Lung Cancer. Chest 1997; 111: 1710-7.
3. Volm M, Koomagi R. Relevance of proliferative and pro-apoptotic factors in non-small-cell lung cancer for patient survival. Br J Cancer 2000; 82: 1747-54.
4. Wigren T. Confirmation of a prognostic index for patients with inoperable non-small cell lung cancer. Radiother Oncol 1997; 44: 9-15.
5. Patz EF Jr, Connolly J, Herndon J. Prognostic value of thoracic FDG PET imaging after treatment for non-small cell lung cancer. Am J Roentgenol 2000; 174: 769-74.
6. Hellwig D, Gröschel A, Graeter TP, Hellwig AP, Nestle U, Schafers HJ, et al. Diagnostic performance and prognostic impact of FDG-PET in suspected recurrence of surgically treated nonsmall cell lung cancer. Eur J Nucl Med Mol Imaging 2006; 33: 13-21.
7. Vesselle H, Freeman JD, Wiens L, Stern J, Nguyen HQ, Hawes SE, et al. Fluorodeoxyglucose uptake of primary non-small cell lung cancer at positron emission tomography: new contrary data on prognostic role. Clin Cancer Res 2007; 13: 3255- 63.
8. Cerfolio RJ, Bryant AS, Ohja B, Bartolucci AA. The maximum standardized uptake values on positron emission tomography of a non-small cell lung cancer predict stage, recurrence, and survival. J Thorac Cardiovasc Surg 2005; 130: 151-9.
9. Mor V, Laliberte L, Morris JN, Wiemann M. The Karnofsky performance status scale. An examination of its reliability and validity in a research setting. Cancer 1984; 53: 2002-7.
10. Berger KL, Nicholson SA, Dehdashti F, Siegel BA. FDG PET evaluation of mucinous neoplasms: correlation of FDG uptake with histopathologic features. Am J Roengenol 2000; 174: 1005-8.
11. Berghmans T, Dusart M, Paesmans M, Hossein-Foucher C, Buvat I, Castaigne C, et al. Primary tumor standardized uptake value (SUVmax) measured on fluorodeoxyglucose positron emission tomography (FDG-PET) is of prognostic value for survival in non-small cell lung cancer (NSCLC): a systematic review and meta-analysis (MA) by the European Lung Cancer Working Party for the IASLC Lung Cancer Staging Project. Thorac Oncol 2008; 3: 6-12.
12. Hoang JK, Hoagland LF, Coleman RE, Coan AD, Herndon JE II, Patz EF Jr. Prognostic value of fluorine-18 fluorodeoxyglucose positron emission tomography imaging in patients with advanced- stage non-small cell lung carcinoma. J Clin Oncol 2008; 26: 1459-64.
13. Paesmans M, Berghmans T, Dusart M, Garcia C, Hossein-Foucher C, Lafitte JJ, et al. Primary tumor standardized uptake value measured on fluorodeoxyglucose positron emission tomography is of prognostic value for survival in non-small cell lung cancer: Update of a Systematic Review and Meta-Analysis by the European Lung Cancer Working Party for the International Association for the Study of Lung Cancer Staging Project. J Thorac Oncol 2010; 5: 612-9.
14. Mery CM, Pappas AN, Burt BM, Bueno R, Linden PA, Sugarbaker DJ, et al. Diameter of non-small cell lung cancer correlates with long-term survival: implications for T stage. Chest 2005; 128: 3255-60.
15. Brown RS, Leung JY, Kison PV, Zasadny KR, Flint A, Wahl RL. Glucose transporters and FDG uptake in untreated primary human non-small cell lung cancer. J Nucl Med 1999; 40: 556- 65.
16. Dooms C, van Baardwijk A, Verbeken E, van Suylen RJ, Stroobants S, De Ruysscher D, et al. Association between 18F-fluoro- 2-deoxy-D-glucose uptake values and tumor vitality: prognostic value of positron emission tomography in early-stage non-small cell lung cancer. J Thorac Oncol 2009; 4: 822-8.
17. Li M, Liu N, Hu M, Shi F, Yuan S, Zhang P, et al. Relationship between primary tumor fluorodeoxyglucose uptake and nodal or distant metastases at presentation in T1 stage nonsmall cell lung cancer. Lung Cancer 2009; 63: 383-6.
18. Soret M, Bacharach SL, Buvat I. Partial-Volume Effect in PET Tumor Imaging. J Nucl Med 2007; 48: 932-45.
19. Eschmann SM, Friedel G, Paulsen F, Reimold M, Hehr T, Budach W, et al. Is standardised (18)F-FDG uptake value an outcome predictor in patients with stage III non-small cell lung cancer? Eur J Nucl Med Mol Imaging 2006; 33: 263-9.
20. Chong S, Lee KS, Kim BT, Choi JY, Yi CA, Chung MJ, et al. Integrated PET/CT of pulmonary neuroendocrine tumors: diagnostic and prognostic implications. Am J Roentgenol 2007; 188: 1223-31.
21. Aquino SL, Halpern EF, Kuester LB, Fischman AJ. FDG-PET and CT features of non-small cell lung cancer based on tumor type. Int J Mol Med 2007; 19: 495-9.
22. Kanters SD, Lammers JW, Voest EE. Molecular and biological factors in the prognosis of non-small cell lung cancer. Eur Respir J 1995; 8: 1389-97.
23. Goldstraw P. Manual in Thoracic Oncology. International Association for the Study of Lung Cancer Staging Orange Park, FL, USA. 2009.
24. Tsai CM, Perng RP, Huang WL. Lung cancer in young Chinese. Cancer Detect Prev 1988; 11: 235-8.
25. Nugent WC, Edney MT, Hammerness PG, Dain BJ, Maurer LH, Rigas JR. Non-small cell lung cancer at the extremes of age: impact on diagnosis and treatment. Ann Thorac Surg 1997; 63: 193-7.
26. Ferguson MK, Skosey C, Hoffman PC, Golomb HM. Sex-associated differences in presentation and survival in patients with lung cancer. J Clin Oncol 1990; 8: 1402-7.
27. Charloux A, Hedelin G, Dietemann A, Ifoundza T, Roeslin N, Pauli G, et al. Prognostic value of histology in patients with non-small cell lung cancer. Lung Cancer 1997; 17: 123-34.
28. Takigawa N, Segawa Y, Okahara M, Maeda Y, Takata I, Kataoka M, et al. Prognostic factors for patients with advanced non-small cell lung cancer: univariate and multivariate analyses including recursive partitioning and amalgamation. Lung Cancer 1996; 15: 67-77.