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Objective: This study aimed to investigate the relationship between 18Fluorine-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) parameters and hematological parameters in squamous cell lung cancer without distant metastasis and to investigate the prognostic value of these parameters.
Patients and Methods: This study included 155 patients who underwent 18F-FDG PET/CT imaging for squamous cell lung cancer. Metabolic and hematological parameters were analyzed. Metabolic parameters included maximum and mean standardized uptake values (SUVmax and SUVmean), metabolic tumor volume (MTV), total lesional glycolysis (TLG), and maximum tumor-to-blood SUV ratio (SURmax). Hematological parameters included neutrophil, lymphocyte, platelet, neutrophil/lymphocyte count ratio (NLR), and platelet/lymphocyte count ratio (PLR)
Results: Overall survival was significantly shorter in patients with TLG > 194, NLR > 3.3, and PLR > 157.2 (p < 0.001, p = 0.001, and p = 0.001, respectively). There was a poor correlation between TLG and NLR (p < 0.001, r = 0.302), TLG and PLR (p < 0.001, r = 0.304). TLG (> 194; hazard ratio 1.704, 95% CI 1.056–2.751, p = 0.027) and Tumor-Node-Metastasis (TNM)-based staging (stage II; hazard ratio 1.965, 95% CI 0.739–5.227, p = 0.019) were independent prognostic factors for overall survival.
Conclusion: While PET/CT metabolic parameters had both predictive and independent prognostic values in squamous cell lung cancers, PLR and NLR had only predictive values. It shows that PET/CT metabolic parameters related to the course of the disease are more valuable than hematological parameters in squamous cell lung cancer.
2. Thakur MK, Gadgeel SM. Predictive and prognostic biomarkers in non-small cell lung cancer. Semin Respir Crit Care Med 2016; 37: 760–70.
3. Vansteenkiste J, Crinò L, Dooms C, Douillard J, Faivre-Finn C, Lim E et al. 2nd ESMO Consensus Conference on Lung Cancer: early-stage non-small-cell lung cancer consensus on diagnosis, treatment and follow-up. Ann Oncol, 2014;25(8):1462–1474.
4. Im HJ, Pak K, Cheon GJ, Kang KW, Kim SJ, Kim IJ et al. Prognostic value of volumetric parameters of 18F-FDG PET in non-small-cell lung cancer: a meta-analysis. Eur J Nucl Med Mol Imaging, September 6, 2014 [Epub ahead of print].
5. Khiewvan B, Ziai P, Houshmand S, Salavati A, Ziai P, Alavi A. The role of PET/CT as a prognosticator and outcome predictor in lung cancer. Expert Rev Respir Med. 2016;10(3):317–30.
6. Lee JW, Lee SM, Yun M, Cho A. Prognostic value of volumetric parameters on staging and posttreatment FDG PET/CT in patients with stage IV non–small cell lung cancer. Clin Nucl Med 2016; 41:347–53
7. Peng B, Wang YH, Liu YM, Ma LX. Prognostic significance of the neutrophil to lymphocyte ratio in patients with non‐small cell lung cancer: a systemic review and meta‐analysis. Int J Clin Exp Med 2015; 8: 3098–106.
8. Deng M, Ma X, Liang X, Zhu C, Wang M. Are pretreatment neutrophil-lymphocyte ratio and platelet-lymphocyte ratio useful in predicting the outcomes of patients with smallcell lung cancer? Oncotarget. 2017; 8:37200–07. https://doi. org/10.18632/oncotarget.16553.
9. Yuan C, Li N, Mao X, Liu Z, Ou W, Wang SY. Elevated pretreatment neutrophil/white blood cell ratio and monocyte/lymphocyte ratio predict poor survival in patients with curatively resected non‐small cell lung cancer: Results from a large cohort. Thorac Cancer 2017;8:350–8.
10. Bar-Ad V., Palmer J., Li L. Neutrophil to lymphocyte ratio associated with prognosis of lung cancer. Clin Transl Oncol. 2017; 19(6): 711–717.
11. Cremonesi M, Gilardi L, Ferrari ME, Piperno G, Travaini LL, Timmerman R et al. Role of interim (18)F-FDG-PET/CT for the early prediction of clinical outcomes of Non-Small Cell Lung Cancer (NSCLC) during radiotherapy or chemo-radiotherapy. A systematic review. Eur J Nucl Med Mol Imaging 2017; 44: 1915-1927.
12. Dong M, Liu J, Sun X and Xing L. Prognositc significance of SUVmax on pretreatment 18 F-FDG PET/CT in early-stage non-small cell lung cancer treated with stereotactic body radiotherapy: A meta-analysis. J Med Imaging Radiat Oncol. 2017;61(5):652-659.
13. Liu, J., M. Dong , X. Sun , W. Li , L. Xing and J. Yu . Prognostic Value of 18F-FDG PET/CT in Surgical Non-Small Cell Lung Cancer: A Meta-Analysis. PLoS One. 2016; 11: e0146195. https://doi.org/10.1371/journal.pone.0146195.
14. Zhang M, Wang D, Sun Q, Pu H, Wang Y, Zhao S et al. Prognostic significance of PD-L1 expression and 18F-FDG PET/CT in surgical pulmonary squamous cell carcinoma. Oncotarget. 2017;8(31):51630–51640.
15. Ito R, Iwano S, Kishimoto M, Ito S, Kato K, Naganawa S. Correlation between FDG-PET/CT findings and solid type non-small cell cancer prognostic factors: are there differences between adenocarcinoma and squamous cell carcinoma?. Ann Nucl Med. 2015;29(10):897–905.
16. Wang Z, Zhan P, Lv Y. Prognostic role of pretreatment neutrophil-to-lymphocyte ratio in non-small cell lung cancer patients treated with systemic therapy: a meta-analysis. Transl Lung Cancer Res. 2019;8(3):214–26.
17. Mizuguchi S, Izumi N, Tsukioka T, Komatsu H, Nishiyama N. Neutrophil-lymphocyte ratio predicts recurrence in patients with resected stage 1 non-small cell lung cancer. J Cardiothorac Surg. 2018, 27;13(1):78.
18. Yin Y, Wang J, Wang X, Gu L, Pei H, Kuai S, et al. Prognostic value of the neutrophil to lymphocyte ratio in lung cancer: a meta-analysis. Clinics (2015) 70(7):524–30.
19. Yu Y, Qian L, Cui J. Value of neutrophil-to-lymphocyte ratio for predicting lung cancer prognosis: a meta-analysis of 7,219 patients. Mol Clin Oncol 2017; 7:498–506.
20. Gu XB, Tian T, Tian XJ, Zhang XJ. Prognostic significance of neutrophil-to-lymphocyte ratio in non-small cell lung cancer: a meta-analysis. Sci Rep. 2015, 24;5:12493.
21. Minami S, Ihara S, Komuta K. Pretreatment Lymphocyte to Monocyte Ratio as a Prognostic Marker for Advanced Pulmonary Squamous Cell Carcinoma Treated With Chemotherapy. J Clin Med Res. 2018;10(8):657–664.
22. Jadvar H and Parker JA. Clinical PET and PET/CT. Springer Verlag (2005): 45-69.
23. Rahman WT, Wale DJ, Viglianti BL, Townsend DM, Manganaro MS, Gross MD et al. The impact of infection and inflammation in oncologic 18F-FDG PET/CT imaging. Biomed Pharmacother. 2019; 117:109168.
24. Jeong E, Hyun SH, Moon SH, Cho YS, Kim BT, Lee KH. Relation between tumor FDG uptake and hematologic prognostic indicators in stage I lung cancer patients following curative resection. Medicine (Baltimore). 2017;96(5):5935.
25. Mirili C, Guney IB, Paydas S, Seydaoglu G, Kapukaya TK, Ogul A et al. Prognostic significance of neutrophil/lymphocyte ratio (NLR) and correlation with PET-CT metabolic parameters in small cell lung cancer (SCLC). Int J Clin Oncol. 2019 Feb;24(2):168-178.