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Tumor FDG-avidity on PET scan predicts long-term survival in patients with stage I bronchioloalveolar carcinoma
D. J. Raz, A. Y. Odisho, D. M. Jablons*. University of California San Francisco, San Francisco, CA,
BACKGROUND: Bronchioloalveolar carcinoma (BAC) is a clinically heterogeneous subtype of non-small cell lung carcinoma that frequently has low 2-[18F]fluoro-D-glucose (FDG) uptake on positron emission tomography (PET) scanning. We investigated whether FDG-avid tumors were associated with worse survival in patients who had completely resected BAC.
METHODS: We performed a cohort study of thirty-three patients who had completely resected BAC between 1998 and 2004, who had no hilar or mediastinal lymph node metastases, and who had undergone a preoperative PET scan. Tumor FDG-avidity was defined as a standardized uptake value (SUV) of 2.5 or greater. Survival analysis was performed using a Cox proportional hazard model. We recorded and adjusted for tumor size, whether the patient had multi-focal BAC, and whether the tumor was histologically pure BAC or was mixed with invasive adenocarcinoma.
RESULTS: Of thirty-three patients studied, twenty-three patients (70%) were alive and ten patients (30%) were dead after a mean follow-up of 34.7+17.6 months (range: 11-87 months). The median tumor SUV was 2.2 (range:0-9). Fifteen patients (45%) had FDG-avid tumors, and 18 patients (55%) had non-avid tumors. Three-year survival was 49% in the FDG-avid group and 94% in the non-avid group. Using a proportional hazard model, FDG avidity had a hazard ratio (HR) of death of 9.2 (95%CI 1.1-75.0, p=0.039) after adjusting for tumor size, the presence of multi-focal BAC, and the presence of histologically mixed BAC.
CONCLUSIONS: Preoperative tumor FDG-PET SUV of 2.5 or greater predicts a higher risk of mortality in patients with node negative BAC undergoing lung resection.
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