KÜÇÜK HÜCRELİ DIŞI AKCİĞER KANSERİ OLGULARINDA PET/BT'DEKİ PRİMER TÜMÖR SUVMAX DEĞERİNİN PROGNOSTİK DEĞERİ VE UZAK ORGAN, LENF NODU METASTAZI İLE İLİŞKİSİ

Öz

Amaç: Çalışmamızda Küçük hücreli dışı akciğer kanserli (KHDAK) olgularda, tedavi öncesi Floro deoksi glikoz-Pozitron Emisyon Tomografi ve Bilgisayarlı Tomografi'de (FDG-PET/BT) SUVmax (standart uptake value) değerinin; sağkalım ile korele olup olmadığını belirlemek ve primer tümör SUVmax değerinin uzak organ ya da lenf bezi metastazı ile ilişkisini araştırmayı amaçladık. Yöntem ve Gereç: Ocak 2010-Aralık 2013 tarihleri arasında İzmir Dr. Suat Seren Göğüs Hastalıkları ve Cerrahisi Eğitim Araştırma Hastanesi 2. serviste yeni tanı konulan ve evrelemesinde FDG-PET/BT kullanılan 208 KHDAK'li olgunun dosyaları retrospektif olarak incelendi. Olguların dosyalarından hastaların cinsiyet, yaş, sigara öyküsü, performans durumu, tanı tarihi, histolojik tipi, evresi, ilk progresyon tarihi, ölüm tarihi ve kitle, lenf nodu ve metastaz gelişmiş odağın FDG-PET/BT'deki SUVmax değerleri SPSS programına kaydedildi. Bulgular: T SUVmax ortalama değeri erkeklerde ve tümör çapı 5 cm üzerinde olanlarda anlamlı derecede yüksek bulundu (sırasıyla p:0,025 ve p:0,001). Tümör tipi adenokanser olanlarda T SUVmax değeri anlamlı düzeyde düşük saptandı (p:0,01).T SUVmax değeri ile evre ve tümörün yerleşim yeri olan periferik ya da santral olması arasında istatistiksel olarak anlamlı fark saptanmadı (sırasıyla p:0,0530, p: 0,0902).T SUVmax ortalaması T1 olanlarda istatistiksel olarak anlamlı düzeyde düşük (p:0,011)saptanırken, T4 olanlarda ise istatistiksel olarak anlamlı düzeyde yüksek bulundu (p:0,019). N ve M faktörü ile T SUVmax değeri arasında istatistiksel olarak anlamlı fark saptanmadı (p>0,05). Primer tümör T SUVmax değeri, sağ kalan hastalarda 15,03±6,07 iken ölen hastalarda ise 15,33±6,50 idi. Sağ kalan ve ölen hastalar ile primer tümör T SUVmax ortalama değeri arasında istatistiksel olarak anlamlı fark saptanmadı (p:0,74) Sonuç: Bu çalışma, KHDAK'lı olguların, sağkalım süresinde FDG-PET/BT'deki primer tümör SUVmax değerinin önemli rolü olmadığını düşündürtmüştür.

Anahtar Kelimeler

• Küçük hücreli dışı akciğer kanseri, prognostik faktörler, SUV max

PROGNOSTIC IMPORTANCE OF SUV MAX VALUE IN PET/CT AND CORRELATION SUV MAX VALUE BETWEEN LYMPH NODE, DISTANT METASTASIS IN NON SMALL CELL LUNG CANCER

Abstract

Aim: In our study, we aimed to investigate the correlation between the SUVmax value of pretreatmentFDG- PET/CT and survival and to determine whether the SUVmax value of primary tumor correlates with distant organs or lymph node metastases in non-small cell lung cancer (NSCLC) patients. Material and Methods: Between January 2010- December 2013 newly diagnosed and scanned with FDG-PET/CT 208 NSCLC patients were analyzed retrospectively at İzmir Dr. Suat Seren Göğüs Hastalıkları Cerrahisi Eğitim Araştırma Hastanesi, 2nd chest diseases clinic. From the files of the cases patients's sex,age,smoking history, performance status,date of diagnosis, histological type,stage,first progression date, death date and FDG-PET/CT SUVmax values of the primary tumor,lymph node and metastases were recorded in the SPSS. Survival time was defined as;between the date of diagnosis and the date of death searched from Mernis System or the last application date to us whether patient is alive. Results: T SUVmax values were significantly higher in men and tumor size greater than 5 cm (p:0,025 and p: 0,001).T SUVmax value was significantly lower in Adenocarcinoma (p:0,01). There was no statistically significant difference between T SUVmax value and the stage and tumor localization (p:0,0530, p:0,0902) TSUVmax value were found statistically significantly lower in T1 patients (p =0.011) than in T4 patients (p=0.019). There was no statistically significant difference between N and M factor and T SUVmax values (p> 0.05).T SUVmax value was 15,03±6,07 and 15.33±6.50 in alive, death patients respectively. There was no difference between T SUVmax value and alive, death patients (p=0.74). Conclusion: It was considered that SUVmax does not play an important role in the survival period of NSCLC patients.

Keywords

• Non-small cell lung cancer, prognostic factor, SUV max

Kaynakça

1. 1. Shields TW. Surgical Treatment of nonsmall cell lung cancer. General Thoracic Surgery. Lippincott, Williams and Wilkins 2000:1311-41.
2. 2. Gail Darling, Carolyn M. Dresler. Clinical Presentation of Lung Cancer in Thoracic Surgery. Churchill Livingstone Inc. ed. F.G.Pearson; 96:1269-1271.
3. 3. Beckles MA, Spiro SG, Colice GL, Rudd RM. Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests and paraneoplastic syndromes. Chest 2003;123: 97-104.
4. 4. Brundage MD, Davies D. Mackillop WJ. Prognostic factors in non-small cell lung cancer: a decade of progress. Chest 2002;122:1037-57.
5. 5. Bury T, Dowlati A, Paulus P. Whole-body 18FDG positron emission tomography in the staging of non-small cell lung cancer. Eur Respir J 1997:10; 2529-34.
6. 6. Brink I, Reinhardt J, Hoegerle S, Altehoefer C, Ernst Moser, Egbert U. Increased metabolic activity in the thymus gland studied with 18F-FDG PET: Age dependency and frequency after chemotherapy. J Nucl Med 200;42: 591-5.
7. 7. Patz EF Jr, Connolly J, Herndon J. Prognostic value of thoracic FDG PET imaging after treatment for non-small cell lungcancer. Am J Roentgenol 2000; 174: 769-74.
8. 8. Hellwig D, Gröschel A, Graeter TP, Hellwig AP, Nestle U, SchafersHJ. Diagnostic performance and prognostic impact of FDG-PET in suspected recurrence of surgically treated nonsmall cell lung cancer. Eur J NuclMed Mol Imaging 2006; 33:13-21.

9. 9. Vesselle H, Freeman JD, Wiens L, Stern J, Nguyen HQ, HawesSE. Fluorodeoxy glucose uptake of primary non-smallcell lung cancer at positron emission tomography: new contrary data on prognostic role. Clin Cancer Res 2007; 13: 3255-63.
10. 10. 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, andsurvival. J Thorac Cardio vasc Surg 2005; 130: 151-9.
11. 11. Downey RJ, Akhurst T, Gonen M, Park B, Rusch V. Fluorine-18 fluorodeoxy glucose positron emission tomographic maximalstandardized uptake value predicts survival independen tof clinical but not pathologic TNM staging of resected nonsmallcell lung cancer. J Thorac Cardiovasc Surg 2007; 133:1419- 1427, doi: 10.1016/j.jtcvs.2007.01.041
12. 12. 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.
13. 13. Chen JC, Huang TW, Cheng YL, Chang H, Tzao C, Huang WS, et al. Prognostic value of 18-FDG uptake in early stage NSCLC. Thorac Cardiovasc Surg 2009; 57: 413- 416, doi: 10.1055/s-0029-1185733.
14. 14. Lu P, Yu L, Li Y, Sun Y. A correlation study between maximum standardized uptake values and pathology and clinical staging in nonsmall cell lung cancer. Nucl Med Commun 2010; 31: 646-651.
15. 15. Berghmans T, Dusart M, Paesmans M. Primarytumorstandardizeduptakevalue (SUVmax) measured on fluorodeoxyglucose positron emission tomography (FDG-PET) is of prognostic value for survival innon-small cell lung cancer: a systematic review and metaanalysis by the European Lung Cancer Working Party for the IASLC Lung Cancer Staging Project. J Thorac Oncol 2008; 3: 6–12.
16. 16. 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.
17. 17. Sugawara Y, Quint LE, Iannettoni MD, Orringer MB, Russo JE, Recker BE, Saran PA, Wahl RL. Does the FDG uptake of primary non-small cell lung cancer predict prognosis? A work in progress. Clin Positron Imag 1999; 2(2):111-8.
18. 18. Erdem V, Selimoğlu Şen H, Kömek H, Tanrıkulu ÇA, Abakay A, Sezgi C, Kaya H, Şenyiğit A. Küçük hücreli dışı akciğer kanseri olan olgularda prognostik faktörler ve PET/BT’deki SUVmax değerinin prognostik önemi. Tuberk Toraks 2012; 60(3): 207-217.
19. 19. Paesmans M, Berghmans T, Dusart M, Garcia C, Hossein-Foucher C, Lafitte JJ. 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.
20. 20. Nael S, Kathy G, Julie L, Rashid A, Kishore D, Lorraine W, Eillish M, Vincent Y. Clinical implication and prognostic significance of standardised uptake value of primary non-small cell lung cancer on positron emissıon tomography: analysis of 176 case .European Journal of Cardiothoracic Surgery 2008; 34 : 892—897.
21. 21. Ahuja V, Coleman RE, Herndon J, Patz EF Jr. The prognostic significance of fluorodeoxyglucose PET imaging for patients with nonsmall cell lung carcinoma. Cancer 1998; 83: 918-24.
22. 22. Mery CM, Pappas AN, Burt BM, Bueno R, Linden PA, Sugarbaker DJ. Diameter of non-small cell lung cancer correlates with long-term survival: implications for T stage. Chest 2005; 128: 3255-60.
23. 23. 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.
24. 24. Dooms C, van Baardwijk A, Verbeken E, van Suylen RJ, Stroobants S, De Ruysscher D. Association between 18Ffluoro-2-deoxy-D-glucose uptake values and tumor vitality: prognostic value of positron emission tomography in earlystage non-small cell lung cancer. J Thorac Oncol 2009; 4: 822-8.
25. 5. Li M, Liu N, Hu M, Shi F, Yuan S, Zhang P. 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.
26. 26. Peio Lu, Yajuan Sun ,Yanqin Sun, Lijuan Yu. The role of FDG-PET/CT for evoluation of metastatic mediastinal lymph nodes in patient with lung squamous –cell carcinoma or adenocarsinoma. Lung Cancer 2014; 85 (2): 53-58.
27. 27. Özgül MA, Kırkıl G, Ekrem Cengiz Seyhan, Çetinkaya E,Özgül G, Yüksel M. The maximum standardized FDG uptake on PET CT In patients with non-small cell lung cancer. Multidisciplinary Respiratory Medicine 2013; 8: 69.
28. 28. Soret M, Bacharach SL, Buvat I. PartialVolume Effect in PET Tumor Imaging. J Nucl Med 2007; 48: 932-45.
29. 29. 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.
30. 30. Eschmann SM, Friedel G, Paulsen F, Reimold M, Hehr T, Budach W. 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.
31. 31. Chong S, Lee KS, Kim BT, Choi JY, Yi CA, Chung MJ. Integrated PET/CT of pulmonary neuroendocrine tumors: diagnostic and prognostic implications. Am J Roentgenol 2007; 188: 1223-31.