Evaluation of the effect of PET/CT Fluorodeoxyglucose inclusion on mortality and survival in operated thymoma patients.

PURPOSE: In recent years, the use of fluorodeoxyglucose PET-computed tomography (PET-CT) has become widespread to evaluate the diagnosis, metabolism, stage and distant metastases of thymoma. In this study, it was aimed to investigate the connection of malignancy potential, survival and maximum standardized uptake value (SUV max ) measured by PET-CT before surgery according to the histological classification of the WHO in patients operated for thymoma. In addition, the predictive value of the Glasgow prognostic score (GPS) generated by C-reactive protein (CRP) and albumin values on recurrence and survival was investigated and its potential as a prognostic biomarker was evaluated. METHODS: Forty-five patients who underwent surgical resection for thymoma and were examined with PET-CT in the preoperative period between January 2010 and January 2022 were included in the study. The relationship between WHO histological classification, tumor size and SUV max values on PET-CT according to TNM classification of retrospectively analyzed corticoafferents were evaluated. Preoperative albumin and CRP values were used to determine GPS. RESULTS: The cutoff value for SUV max was found to be 5.65 in the patients and the overall survival rate of low-risk (<5.65) and high-risk (>5.65) patients was compared according to the SUV max threshold value (5.65) and found to be statistically significant. In addition, the power of PET/CT SUV max value to predict mortality (according to receiver operating characteristics analysis) was statistically significant ( P  = 0.048). Survival expectancy was 127.6 months in patients with mild GPS (O points), 96.7 months in patients with moderate GPS (1 point), and 25.9 months in patients with severe GPS (2 points). CONCLUSION: PET/CT SUV max values can be used to predict histological sub-type in thymoma patients, and preoperative SUV max and GPS are parameters that can provide information about survival times and mortality in thymoma patients.

The effect of platelet-to-lymphocyte ratio (PLR) and glasgow prognostic score (GPS) on recurrence, and survival in patients undergoing lobectomy for early-stage non-small cell lung cancer (NSCLC).

Tumor markers are indicators that can be used not only for cancer diagnosis but also for determining prognosis. Unfortunately, there is currently no tumor marker that reliably predicts the prognosis of lung cancer. In this study, we investigated the prognostic impact of the platelet-to-lymphocyte ratio (PLR) and Glasgow Prognostic Score (GPS), known as inflammation markers in peripheral blood, in patients who underwent resection for early-stage non-small cell lung cancer (NSCLC). We retrospectively analyzed the medical records of a total of 3300 patients who underwent surgery for NSCLC between 2010 and 2020. Among these patients, 250 met the inclusion criteria of lobectomy, pT1-T2N0 stage, and histology of adenocarcinoma or squamous cell carcinoma. Preoperative albumin, C-reactive protein (CRP), preoperative PLR, and postoperative 5th-day PLR values were determined from patient's peripheral blood data. The impact of these values on postoperative recurrence and survival was investigated. GPS was calculated based on preoperative CRP and albumin values, and patients were divided into 3 groups: 0 (mild), 1 (moderate), and 2 (severe). The relationship between preoperative GPS and survival was analysed. Among the included patients, 155 (62%) had adenocarcinoma and 95 (38%) had squamous cell carcinoma. A total of 185 (74%) patients had pT1 tumors, while 65 (26%) had pT2 tumors. During the postoperative follow-up period, local recurrence was observed in 28 (11.2%) patients and distant metastasis in 51 (20.4%) patients. The overall mortality rate was 19.6%. The 5-year survival rates for pT1 and pT2 tumors were 80.4% and 72.5%, respectively. Significant associations were found between preoperative PLR, postoperative PLR, and recurrence (p = 0.005 and p = 0.011). The expected overall survival (OS) was 103.4 months in the mild GPS group, 91.8 months in the moderate GPS group, and 50 months in the severe GPS group. The relationship between GPS groups and OS was statistically significant (p = 0.005). Preoperative analysis of PLR and GPS may provide prognostic value in NSCLC patients who undergo surgical resection. Our study provides a rationale for further investigation of peripheral blood immune markers for prognostic purposes.

Adjacent lobe invasion of T2 tumor in non-small cell lung cancer has T3 disease-like survival fissure invasion: T2 or T3?

Controversy still exists regarding the staging of non-small cell lung cancer (NSCLC) with adjacent lobe invasion (T-ALI) according to the TNM system in terms of T factor and the appropriate surgical resection method. We performed an analysis to compare the prognosis of T-ALI with T2 and T3 disease and to see the effect of our surgical method for these tumors. Two hundred consecutive patients between January 2012 and November 2020, with anatomical lobectomy for T2 or T3 tumor (Group-1) and non-anatomical lobectomy resection (lobectomy plus wedge resection [LWR]) (Group-2) for T-ALI (T2-ALI and T3-ALI) due to primary NSCLC, who did not have lymph node metastases were analyzed retrospectively. All surgeries were performed by two experienced surgeons who adopted the same surgical technique. Those who underwent additional segmentectomy and bilobectomy due to fissure invasion were excluded from the study. Overall survival rates of all patients were determined and factors affecting survival were evaluated by performing univariate and multivariate analyses. Of the patients with a mean age of 62.2 ± 7.8 years, 175 (87.5%) were male and 25 (12.5%) were female. There were 137 (68.5%) patients in Group 1 and 63 (31.5%) patients in Group 2. The mean tumor size in Group 1 (4.4 ± 1.4 cm) was significantly smaller than that in Group 2 (4.9 ± 1.4 cm) (p = 0.014). When T distribution within the groups was considered, the rate of pathological T3 in Group 1 (33.6%) was significantly lower than that in Group 2 (55.6%) (p = 0.005). While the 5-year overall survival rate was 70.1% in Group 1, it was 50.6% in Group 2 (p = 0.022). When tumors were grouped as T2, T2-ALI, T3, and T3-ALI according to T factor, the 5-year overall survival rates were 71.4% and 67.8% in T2 and T3 tumors, respectively, and 49.2% and 51.5% in T2-ALI and T3-ALI tumors, respectively. In the multivariate analysis of these four groups, the overall survival rates for T2-ALI and T3-ALI were significantly lower than those of T2 tumors (p = 0.046 and p = 0.025, respectively). In the analysis made between the T2 tumor group and the new T3 group (T2-ALI, T3, T3-ALI), which was formed by upgrading T2-ALI tumors to the T3 group, T2 tumors were found to have a significantly better survival rate (p = 0.019). The disease-free survival of pT2 patients and new T3 group patients was statistically significant, 63.7% and 45.7%, respectively (p = 0.050). Our results suggest that LWR for T-ALI can be performed with acceptable oncologic outcomes when compared to anatomical lobectomy. T2-ALI has a worse overall survival than T2 tumor and offers a similar prognosis to T3. Given this situation, it is more appropriate to classify T2-ALI as T3. Further studies based on larger series are needed to confirm these preliminary data.

Positron emission tomography/computed tomography findings of lung invasive adenocarcinoma subgroups and comparison of their short-term survivals.

BACKGROUND: The aim of this study was to compare the maximum standardized uptake values on positron emission tomography/ computed tomography and survival of lung invasive adenocarcinoma subgroups. METHODS: Between January 2010 and January 2016, a total of 152 patients (112 males, 40 females; mean age: 64.2±8.6 years; range, 41 to 88 years) who underwent lung resection for an invasive adenocarcinoma were retrospectively analyzed. The patients were divided into subgroups as follows: acinar, lepidic, micropapillary, papillary, and solid. The maximum standardized uptake values in the imaging study and their relationship with survival were examined. RESULTS: There were 84 acinar (55%), 31 solid (20%), 23 lepidic (15%), nine papillary (5%), and five micropapillary (3%) cases. The positron emission tomography/computed tomography enhancement showed a statistically significant difference among the subgroups (p=0.004). The solid subgroup was the most involved (9.76), followed by micropapillary (8.98), acinar (8.06), papillary (5.82), and lepidic (4.23) subgroups, respectively. According to Tumor, Node, Metastasis staging, Stage I was present in 48.68% (n=74) of the cases, Stage II in 25.0% (n=38), Stage III in 25.0% (n=38), and Stage IV in 1.31% (n=2). The one-year, three-year, and five-year survival rates were significantly different among the disease stages (p=0.01). The longest survival duration was in the lepidic subgroup, although it did not reach statistical significance among the subgroups (p=0.587). CONCLUSION: The evaluation of invasive adenocarcinomas based on maximum standardized uptake values provides valuable information and may guide neoadjuvant and adjuvant therapies in the future.