Novel PET imaging biomarkers as predictors of postoperative recurrence in lung adenocarcinoma

The exploration of biomarkers is of crucial importance for the prognosis of cancer patients. The objective of this study was to ascertain the predictive value of positron emission tomography (PET) image-derived biomarkers, specifically the normalized distances from the hot spot of radiotracer uptake to the tumor centroid (NHOC) and the tumor perimeter (NHOP), in forecasting the recurrence risk and disease-free survival (DFS) in patients with operable stage IA-IIIA lung adenocarcinoma (LUAD).

A retrospective analysis was conducted on 164 patients with surgically treated pathologically confirmed stage IA-IIIA LUAD, all of whom had prior ¹⁸F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (¹⁸F-FDG PET/CT) scans. In addition to conventional PET/CT parameters, we assessed the normalized distances from the maximum SUV to both the tumor centroid (NHOCmax) and the tumor perimeter (NHOPmax) as observed in the PET/CT images.

A total of 164 patients were included, with a median age of 65 years. NHOPmax exhibited the highest AUC of 0.682 (95% CI: 0.578-0.785), with a sensitivity of 78.8%. Correlation analysis showed that NHOPmax had low correlations with other metabolic parameters such as SUVmax, TLG, and MTV. In both univariate and multivariate analyses, NHOPmax was significantly associated with postoperative outcomes (P < 0.001, odds ratio 0.033). Survival analysis indicated that NHOPmax was an independent predictor of DFS (HR = 0.399, P < 0.05), with higher NHOPmax (> 0.43) associated with significantly better survival (P < 0.0001).

NHOPmax quantified from ¹⁸F-FDG PET/CT scans, could be a promising predictor of postoperative recurrence in patients with resectable LUAD.