Standardized uptake valuemax of the primary lesion combined with tumor markers for clinically predicting distant metastasis in de novo lung adenocarcinoma.

BACKGROUND: To examine standardized uptake valuemax of the primary lesion (pSUVmax) and tumor markers (TMs) for clinically predicting distant metastasis in novo lung adenocarcinoma. METHODS: The current retrospective observational study examined individuals diagnosed with de novo lung adenocarcinoma at Shanxi Cancer Hospital between February 2015 and December 2019. RESULTS: Totally, 532 de novo lung adenocarcinoma cases were included. They were aged 60.8 ± 9.7 years and comprised 224 women and 268 patients with distant metastasis. The areas under the curves (AUCs) of pSUVmax, lactate dehydrogenase (LDH), carcinoembryonic antigen (CEA), cytokeratin-19 fragment (CYFRA21-1), carbohydrate antigen 125 (CA125), and Grade of TMs for predicting distant metastasis were 0.742, 0.601, 0.671, 0.700, 0.736, and 0.745, respectively. The combination of pSUVmax, LDH, CEA, CYFRA21-1, CA125, and grade of TMs in predicting distant metastasis had an AUC value of 0.816 (95%CI: 0.781-0.851), with sensitivity of 89.2%, specificity of 58.7%, positive predictive value of 73.7%, and negative predictive value of 79.7%, respectively. CONCLUSIONS: pSUVmax combined with serum levels of LDH, CEA, CYFRA21-1, CA125, and the grade of TMs may have good performance in predicting distant metastasis of de novo lung adenocarcinoma.

Significance of thyroid transcription factor 1 and Napsin A for prompting the status of EGFR mutations in lung adenocarcinoma patients.

Background: To evaluate the prompting value of thyroid transcription factor 1 (TTF-1) and Napsin A for the status of epidermal growth factor receptor (EGFR) mutations in an independent cohort of lung adenocarcinomas (LUADs) when genetic testing is unavailable. Methods: In this study, 976 untreated primary LUADs were retrospectively reviewed. The clinical and pathological data, including age, gender, smoking history, predictive values of TTF-1 and Napsin A, EGFR status, and tumor-node-metastasis (TNM) stage were obtained through medical records available in Shanxi Province Cancer Hospital. All patients were divided into 2 groups, a mutant group (n=362) and wild-type group (n=614), according to their EGFR status. The clinical data and the expression of TTF-1 and Napsin A were compared between the 2 groups. TTF-1 and Napsin A are detected by fully automated IHC.PCR was carried out to detect the EGFR mutation. Univariate and multivariate logistic regression analyses were undertaken to distinguish independent factors of EGFR mutations. Results: A total of 362 cases (37.1%) of EGFR mutations were detected, which were more frequent in females, never smokers, lymphatic metastasis, distant metastasis, and the positive expression of TTF-1 and Napsin A. Multivariate analysis indicated that females [odds ratio (OR), 1.950; 95% confidence interval (CI): 1.2958 to 2.938; P=0.001], never smokers (OR, 2.040; 95% CI: 1.345 to 3.094; P=0.001), and the positive expression of TTF-1 (OR, 2.366; 95% CI: 1.440 to 3.887; P=0.001) and Napsin A (OR, 2.295; 95% CI: 1.448 to 3.638; P<0.001) were effective prompting for EGFR mutations. Conclusions: The positive expression of TTF-1 and Napsin A had the prompting value for EGFR mutations in patients with LUAD, and the indicators could be combined with other clinical characteristics to enhance the prediction of the EGFR status in LUAD.

The predictive value of 18F-FDG PET/CT in an EGFR-mutated lung adenocarcinoma population.

Background: A non-invasive, simple, and convenient method to evaluate the presence of epidermal growth factor receptor (EGFR) mutations is important for initial treatment decisions in lung adenocarcinoma. Methods: We retrospectively reviewed 297 untreated primary lung adenocarcinoma patients with exact EGFR status. Based on their EGFR status, the patients were divided into a mutant-type group (138 patients) and wild-type group (159 patients). General patient characteristics and possible factors reflecting the status of EGFR were also evaluated. Results: Of the 297 lung adenocarcinoma patients analyzed for EGFR status who underwent positron emission tomography (PET)/computed tomography (CT) between January 2013 and December 2017, mutations in the EGFR gene were detected in 138 patients (46.5%). EGFR mutations were more frequently associated with women, never smokers, and low 18F-fluoro-2-deoxy-glucose (18F-FDG) PET/CT maximal standard uptake value of the primary tumor (pSUVmax). Multivariate analysis indicated that women [odds ratio (OR) =2.853; 95% confidence interval (CI): 1.451-5.611; P=0.002], never smokers (OR =2.414; 95% CI: 1.217-4.789; P=0.012), tumor size <3.5 cm (OR, 2.170; 95% CI: 1.205-3.908; P=0.010), and pSUVmax <8.2 (OR =1.904; 95% CI: 1.098-3.302; P=0.022) were effective predictors of EGFR mutation. In addition, the area under the curve (AUC) of pSUVmax and tumor size was 0.623 and 0.600, respectively. Combined with clinical characteristics, including sex and smoking status, the AUC of the 4 predictors was 0.770. Conclusions: These indicators could be helpful for enhancing predictive accuracy of EGFR mutations in lung adenocarcinoma patients, especially in those for whom EGFR detection is unavailable.