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F. Lococo
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MA10 - Facing the Real World: New Staging System and Response Evaluation in Immunotherapy (ID 393)
- Event: WCLC 2016
- Type: Mini Oral Session
- Track: Radiology/Staging/Screening
- Presentations: 1
- Moderators:P. Kosmidis
- Coordinates: 12/06/2016, 14:20 - 15:50, Stolz 2
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MA10.07 - 18F-Fluorodeoxyglucose Positron Emission Tomography Scan in Solid-Type Stage-I Pulmonary Adenocarcinomas: What Cause False-Negative Cases? (ID 4018)
15:02 - 15:08 | Author(s): F. Lococo
- Abstract
- Presentation
Background:
False-negative 18F-fluorodeoxyglucose (FDG) uptake can be divided into those cases related to technological limitations of positron-emission tomography (PET) and others related to inherent properties of neoplasms. We aim to clarify possible factors causing false-negative (FN) PET results in solid-type pulmonary adenocarcinomas (PAs).
Methods:
From 01/2007 to 12/2014, among 255 Stage-I NSCLCs we retrospectively review PET/CT-records, clinical information, preoperative thin-section CT-images, and pathological features (classified by the IASLC/ATS/ERS subtyping criteria) of 94 consecutive solid-type Stage-I PA undergone surgical resection at Our Institution. Univariate and multivariate logistic analysis were used to identify and weigh the independent predictors of PET-findings: body weight, blood glucose level, tumor-size, and histological classification.
Results:
There were 58 males and 36 females (mean age= 68.7 yrs, range 42-85). Seventeen lesions (18.1%) were judged as PET-negative and 77 lesions (81.9%) as PET-positive. Overall, mean SUVmax was 8.0 (range 0-35) with higher SUVmax-values (p<0.001) in PA>2cm (mean SUVmax=10.6) than PA<2cm (mean SUVmax=4.8). PET false-negative (FN) results were also differently distributed (27.9% in PA <2cm vs 9.8% in PA>2 cm, p=0.023). When clustering the PA in 2 histological classes (Class-A [“colloid/mucinous/lepidic”] vs Class-B [“micropapillary/solid/acinar/papillary”]), the radiometabolic patterns were significantly different [mean SUVmax 3.8 in Class-A vs 9.9 in Class-B, p<0.001], as reported in Figure 1. Similarly, a different distribution of PET FN-cases was observed (38.7% FN in Class-A vs 7.9% FN in Class-B, p=0.001). Table 1 shows the results of multivariate logistic analysis. Both the tumor-size (cut-off=2cm) and IASLC/ATS/ERS aggregated clusters were clinically relevant factors for determining whether PET results were negative or positive, but only histology was statistically significant (OR:6.1, 95%CI: 1.85-20.15, p=0.003). Figure 1
Conclusion:
Among solid-type lung adenocarcinoma, tumor-size and histopathological findings were significantly associated with FDG-uptake. In particular, it warrants attention that lesions ≤2cm and “colloid/mucinous/lepidic” adenocarcinomas have a tendency for negative PET-findings.
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P1.05 - Poster Session with Presenters Present (ID 457)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Early Stage NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.05-050 - External Validation of a Prognostic Model for Squamous-Cell Lung Cancer and Impact of Adjuvant Treatment in >1,300 Patients (ID 5297)
14:30 - 14:30 | Author(s): F. Lococo
- Abstract
Background:
A risk classification model able to powerfully discriminate the prognosis of resected squamous-cell lung cancer (R-SqCLC) patients (pts) was developed (Pilotto JTO 2015). Herein, we validate the model in a larger multicenter series of >1,300 R-SqCLC pts (AIRC project 14282).
Methods:
R-SqCLC pts in 6 different institutions (01/2002 - 12/2012) were considered eligible. Each patient was assigned with a prognostic score to identify the individual risk of recurrence, on the basis of the clinico-pathological data according to the develop model (age, T-descriptor according to TNM 7th edition, nodes, and grading). Kaplan-Meier analysis for disease-free/cancer-specific/overall survival (DFS/CSS/OS) was performed according to the published 3-class risk model (Low: score 0-2; Intermediate: score 3-4; High: score 5-6). Harrell’s C-statistics was adopted for model validation. The effect of adjuvant chemotherapy (ACT) was adjusted with the Propensity Score (PS).
Results:
Data from 1,375 pts from 6 institutions were gathered (median age: 68 years; male/female: 86.8%/13.2%; T-descriptor 1–2/3–4: 73.3%/26.7%; nodes 0/>0: 53.4%/46.6%; stages I-II/III-IV: 71.7%/28.3%); 384 pts (34.5%) underwent ACT. With a median follow-up of 55 months (95% CI 51-59), pts at Low-Risk had a significantly longer DFS in comparison with Intermediate- (HR 1.67, 95% CI 1.40-2.01) and High-Risk (HR 2.46, 95% CI 1.90-3.19) pts, as well as for CSS (HR 1.79, 95% CI 1.48-2.17; HR 2.33, 95% CI 1.76-3.07) and OS (HR 2.46, 95% CI 1.80-3.36; HR 4.30, 95% CI 2.92-6.33). C-statistics was 68.3 (95% CI 63.5-73.1), 68.0 (95% CI 63.2-72.9), and 66.0 (95% CI 61.6-71.1), for DFS, CSS and OS, respectively. 60-months DFS for Low-, Intermediate- and High-Risk pts was 51.0%, 33.5% and 25.8%, respectively (p<0.0001). 60-months CSS for Low-, Intermediate- and High-Risk pts was 82.7%, 64.7% and 53.3%, respectively (p<0.0001). 60-months OS for Low-, Intermediate- and High-Risk pts was 56.7%, 37.9% and 30.9%, respectively (p<0.0001). A significant benefit in DFS was found in favor of ACT (p=0.005), with no difference in CSS (p=0.57), although a trend in OS (p=0.16). Overall, no significant differences for ACT were found in DFS, CSS and OS when survival was corrected with PS analysis, although CSS and OS curves visually separate with a trend for ACT in Intermediate- and High-Risk pts.
Conclusion:
The prognostic performance of the previously developed model was validated in a larger R-SqCLC pts’ series. Considering the overall dismal prognosis of such disease, the efficacy of ACT requires to be clearly established for Intermediate- and High-Risk pts, as well as that should be questioned for Low-Risk pts.
