Prognostic role of preoperative fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography with an image-based harmonization technique: A multicenter retrospective studyCentral MessagePerspective
Akira Hamada, MD, PhD,
Kazuhiro Kitajima, MD, PhD,
Kenichi Suda, MD, PhD,
Takamasa Koga, MD, PhD,
Junichi Soh, MD, PhD,
Hayato Kaida, MD, PhD,
Kimiteru Ito, MD, PhD,
Tetsuro Sekine, MD, PhD,
Kyoshiro Takegahara, MD, PhD,
Hiromitsu Daisaki, PhD,
Masaki Hashimoto, MD, PhD,
Yukihiro Yoshida, MD, PhD,
Takanobu Kabasawa, MD, PhD,
Takashi Yamasaki, MD,
Seiichi Hirota, MD, PhD,
Jitsuo Usuda, MD, PhD,
Kazunari Ishii, MD, PhD,
Tetsuya Mitsudomi, MD, PhD
Affiliations
Akira Hamada, MD, PhD
Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
Kazuhiro Kitajima, MD, PhD
Department of Radiology, Hyogo Medical University School of Medicine, Hyogo, Japan
Kenichi Suda, MD, PhD
Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan; Address for reprints: Kenichi Suda, MD, PhD, Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
Takamasa Koga, MD, PhD
Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
Junichi Soh, MD, PhD
Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
Hayato Kaida, MD, PhD
Department of Radiology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
Kimiteru Ito, MD, PhD
Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
Tetsuro Sekine, MD, PhD
Department of Radiology, Nippon Medical School, Musashi Kosugi Hospital, Kawasaki, Japan
Kyoshiro Takegahara, MD, PhD
Department of Thoracic Surgery, Nippon Medical School Hospital, Tokyo, Japan
Hiromitsu Daisaki, PhD
Department of Radiological Technology, School of Radiological Technology, Gunma Prefectural College of Health Sciences, Maebashi, Japan
Masaki Hashimoto, MD, PhD
Departments of Thoracic Surgery and Orthopedic Surgery, Hyogo Medical University School of Medicine, Hyogo, Japan
Yukihiro Yoshida, MD, PhD
Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
Takanobu Kabasawa, MD, PhD
Department of Pathological Diagnostics, Faculty of Medicine, Yamagata University, Yamagata, Japan
Takashi Yamasaki, MD
Department of Surgical Pathology, Hyogo Medical University School of Medicine, Hyogo, Japan
Seiichi Hirota, MD, PhD
Department of Surgical Pathology, Hyogo Medical University School of Medicine, Hyogo, Japan
Jitsuo Usuda, MD, PhD
Department of Thoracic Surgery, Nippon Medical School Hospital, Tokyo, Japan
Kazunari Ishii, MD, PhD
Department of Radiology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
Tetsuya Mitsudomi, MD, PhD
Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
Objectives: Despite the prognostic impacts of preoperative fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography examination, fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography–based prognosis prediction has not been used clinically because of the disparity in data between institutions. By applying an image-based harmonized approach, we evaluated the prognostic roles of fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography parameters in clinical stage I non–small cell lung cancer. Methods: We retrospectively examined 495 patients with clinical stage I non–small cell lung cancer who underwent fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography examinations before pulmonary resection between 2013 and 2014 at 4 institutions. Three different harmonization techniques were applied, and an image-based harmonization, which showed the best-fit results, was used in the further analyses to evaluate the prognostic roles of fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography parameters. Results: Cutoff values of image-based harmonized fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography parameters, maximum standardized uptake, metabolic tumor volume, and total lesion glycolysis were determined using receiver operating characteristic curves that distinguish pathologic high invasiveness of tumors. Among these parameters, only the maximum standardized uptake was an independent prognostic factor in recurrence-free and overall survivals in univariate and multivariate analyses. High image-based maximum standardized uptake value was associated with squamous histology or lung adenocarcinomas with higher pathologic grades. In subgroup analyses defined by ground-glass opacity status and histology or by clinical stages, the prognostic impact of image-based maximum standardized uptake value was always the highest compared with other fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography parameters. Conclusions: The image-based fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography harmonization was the best fit, and the image-based maximum standardized uptake was the most important prognostic marker in all patients and in subgroups defined by ground-glass opacity status and histology in surgically resected clinical stage I non–small cell lung cancers.
