Role of CT and PET Imaging in Predicting Tumor Recurrence and Survival in Patients with Lung Adenocarcinoma A Comparison with the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society Classification of Lung Adenocarcinoma
Role of CT and PET Imaging in Predicting Tumor Recurrence and Survival in Patients with Lung Adenocarcinoma A Comparison with the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society Classification of Lung Adenocarcinoma
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DOI：
10.1097/jto.0000000000000689
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发表时间：
2015-12-01
影响因子：
20.4
通讯作者：
Shim, Young Mog
中科院分区：
文献类型：
--
作者：
Lee, Ho Yun;Lee, So Won;Shim, Young Mog
简介：近日，新的肺腺癌分类方案发布。这一新分类的预后价值尚未与包括计算机断层扫描 (CT) 和正电子发射断层扫描 (PET) 在内的影像学生物标志物的价值一起详细阐述。 方法：我们回顾了 723 名接受肺腺癌手术切除的连续患者的原发肿瘤的病理标本和影像学特征。在病理学上，对主要的组织学亚型和模式组进行了量化。评估 CT 上的肿瘤阴影消失率 (TDR) 和 PET 上的最大标准化摄取值 (SUVmax)。使用Kaplan-Meier曲线和Cox回归分析来分析这些变量与生存率（总生存率[OS]和无病生存率）之间的关系。结果：中位随访期为3.8年。手术切除后有137名患者（19%）复发，167名患者（23%）发生转移。 723例患者中，原位腺癌35例（4.8%），微浸润腺癌34例（4.7%），鳞屑为主125例（17.3%），腺泡为主314例（43.4%），乳头状为主65例（9.0%），乳头状为主23例。 (3.2%) 以微乳头状为主，113 名患者 (15.6%) 以实性为主，14 名患者 (1.9%) 以变异型腺癌为主。根据 CT 上的 TDR 和 PET 上的 SUVmax、主要亚型和模式组，OS 和无病生存率存在显着差异。在多变量分析中，SUVmax (p < 0.001)、TDR (p = 0.038) 和模式组 (p = 0.015) 是 OS 的独立预测因子。结论：CT 上的 TDR、PET 上的 SUVmax 以及新的组织学分类方案似乎是肺腺癌患者预后分层的有希望的参数，从而可以对需要进一步治疗的患者进行分类分期检查和辅助治疗。
Introduction: Recently, a new lung adenocarcinoma classification scheme was published. The prognostic value of this new classification has not been elaborated together with the value of imaging biomarkers including computed tomography (CT) and positron emission tomography (PET).Methods: We reviewed pathologic specimens and imaging characteristics of primary tumors from 723 consecutive patients who underwent surgical resection for lung adenocarcinoma. On pathology, the predominant histologic subtype and pattern group were quantified. Tumor-shadow disappearance ratio (TDR) on CT and maximum standardized uptake value (SUVmax) on PET were assessed. The relationships between those variables and survival (overall survival [OS] and disease-free survival) were analyzed by using Kaplan-Meier curves and Cox regression analyses.Results: The median follow-up period was 3.8 years. There were 137 patients (19%) with recurrence and 167 patients (23%) with metastasis after surgical resection. Among 723 patients, 35 patients (4.8%) had adenocarcinoma in situ, 34 patients (4.7%) had minimally invasive adenocarcinoma, 125 patients (17.3%) had lepidic predominant, 314 patients (43.4%) had acinar predominant, 65 patients (9.0%) had papillary predominant, 23 patients (3.2%) had micropapillary predominant, 113 patients (15.6%) had solid predominant, and 14 patients (1.9%) had variant adenocarcinomas. OS and disease-free survival rates were significantly different according to TDR on CT and SUVmax on PET, predominant subtypes, and pattern groups. On multivariate analysis, the SUVmax (p < 0.001), TDR (p = 0.038), and pattern group (p = 0.015) were independent predictors of OS.Conclusions: TDR on CT, SUVmax on PET, and the new histologic classification schemes appear to be promising parameters for the prognostic stratification of patients with lung adenocarcinomas, allowing for the triage of patients who necessitate further staging workup and adjuvant therapy.