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Wang K, Tu N, Feng H, Zhou Y, Bu L. Preoperative prognostic prediction for invasive pulmonary adenocarcinoma: Impact of 18F-FDG PET/CT semi-quantitative parameters associated with new histological subtype classification. Clin Radiol 2024:S0009-9260(24)00504-X. [PMID: 39341726 DOI: 10.1016/j.crad.2024.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/29/2024] [Accepted: 08/30/2024] [Indexed: 10/01/2024]
Abstract
AIMS To explore the preoperative predictive value of 18F-FDG PET/CT for poor prognostic histologic subtypes of invasive pulmonary adenocarcinoma (IPA) under new classification. MATERIALS AND METHODS This study included 316 patients. Histopathology of IPA was evaluated by recording the percentage of each histologic component. PET/CT parameters were compared among IPAs with different risks of recurrence. Optimum cutoff values of PET/CT parameters were calculated using ROC curve analysis. Overall survival (OS) and disease-free survival (DFS) were calculated using Kaplan-Meier method, and survival differences between groups were tested using log-rank test. Multivariate analysis for survival was performed using the Cox regression model. RESULTS Patients were divided into low (LRR), intermediate (IRR), and modified high (mHRR) risk of recurrence group incorporating typical (HRR-T) and nontypical (HRR-NT) subgroups based on histologic patterns. There were significant differences in SUVmax, SUVmean, SUVmin, SUVSD, TLG, and tumor size among three groups. HRR-NT had lower SUVmax, SUVmean, SUVmin, SUVSD and TLG than HRR-T subgroup, and higher SUVmax, SUVmean, SUVmin, SUVSD, MTV, TLG and tumor size than IRR group. ROC curve analysis showed that SUVmax had highest AUC (0.815) in distinguishing LRR and IRR. TLG had highest AUC (0.741) in distinguishing IRR and mHRR. Multivariable analysis showed that tumor size and SUVmax were independent predictors of DFS and OS. CONCLUSIONS High risk of recurrence of IPA exhibited higher 18F-FDG uptake and tumor size. Tumor size and SUVmax could be used as preoperative surrogates for the IASLC grading system. 18F-FDG PET/CT can improve the preoperative prognostic prediction for IPA patients.
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Affiliation(s)
- K Wang
- PET-CT/MRI and Molecular Imaging Center, Renmin Hospital of Wuhan University, Wuhan 430000, Hubei, China
| | - N Tu
- PET-CT/MRI and Molecular Imaging Center, Renmin Hospital of Wuhan University, Wuhan 430000, Hubei, China
| | - H Feng
- PET-CT/MRI and Molecular Imaging Center, Renmin Hospital of Wuhan University, Wuhan 430000, Hubei, China
| | - Y Zhou
- PET-CT/MRI and Molecular Imaging Center, Renmin Hospital of Wuhan University, Wuhan 430000, Hubei, China
| | - L Bu
- PET-CT/MRI and Molecular Imaging Center, Renmin Hospital of Wuhan University, Wuhan 430000, Hubei, China.
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Agüloğlu N, Aksu A, Unat DS, Selim Unat Ö. The value of PET/CT radiomic texture analysis of primary mass and mediastinal lymph node on survival in patients with non-small cell lung cancer. Rev Esp Med Nucl Imagen Mol 2024; 43:500027. [PMID: 39029620 DOI: 10.1016/j.remnie.2024.500027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 07/21/2024]
Abstract
OBJECTIVE This study was designed to determine the potential prognostic value of radiomic texture analysis and metabolic-volumetric parameters obtained from positron emission tomography (PET) in primary mass and metastatic hilar/mediastinal lymph nodes in stage 2-3 non-small cell lung cancer (NSCLC). METHODS Images of patients diagnosed with stage 2-3 NSCLC who underwent 18F-FDG PET/CT imaging for staging up to 4 weeks before the start of treatment were evaluated using LIFEx software. Volume of interest (VOI) was generated from the primary tumor and metastatic lymph node separately, and volumetric and textural features were obtained from these VOIs. The relationship between the parameters obtained from PET of primary mass and the metastatic hilar/mediastinal lymph nodes with overall survival (OS) and progression-free survival (PFS) was analyzed. RESULTS When radiomic features, gender and stage obtained from lymph nodes were evaluated by Cox regression analysis; GLCM_correlation (p: 0.033, HR: 4,559, 1.660-12.521, 95% CI), gender and stage were determined as prognostic factors predicting OS. In predicting PFS; stage, smoking and lymph node MTV (p: 0.033, HR: 1.008, 1.001-1.016, 95% CI) were determined as prognostic factors. However, the radiomic feature of the primary tumor could not show a significant relationship with either OS or PFS. CONCLUSIONS In a retrospective cohort of NSCLC patients with Stage 2 and 3 disease, volumetric and radiomic texture characteristics obtained from metastatic lymph nodes were associated with PFS and OS. Tumor heterogeneity, defined by radiomic texture features of 18 F-FDG PET/CT images, may provide complementary prognostic value in NSCLC.
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Affiliation(s)
- N Agüloğlu
- Department of Nuclear Medicine, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, İzmir, Turkey.
| | - A Aksu
- Department of Nuclear Medicine, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey.
| | - D S Unat
- Giresun Dr. Ali Menekşe Chest Diseases Hospital, Giresun, Turkey.
| | - Ö Selim Unat
- Giresun Dr. Ali Menekşe Chest Diseases Hospital, Giresun, Turkey.
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Grimm F, Asuaje A, Jain A, Silva Dos Santos M, Kleinjung J, Nunes PM, Gehrig S, Fets L, Darici S, MacRae JI, Anastasiou D. Metabolic priming by multiple enzyme systems supports glycolysis, HIF1α stabilisation, and human cancer cell survival in early hypoxia. EMBO J 2024; 43:1545-1569. [PMID: 38485816 PMCID: PMC11021510 DOI: 10.1038/s44318-024-00065-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/08/2024] [Accepted: 02/15/2024] [Indexed: 04/18/2024] Open
Abstract
Adaptation to chronic hypoxia occurs through changes in protein expression, which are controlled by hypoxia-inducible factor 1α (HIF1α) and are necessary for cancer cell survival. However, the mechanisms that enable cancer cells to adapt in early hypoxia, before the HIF1α-mediated transcription programme is fully established, remain poorly understood. Here we show in human breast cancer cells, that within 3 h of hypoxia exposure, glycolytic flux increases in a HIF1α-independent manner but is limited by NAD+ availability. Glycolytic ATP maintenance and cell survival in early hypoxia rely on reserve lactate dehydrogenase A capacity as well as the activity of glutamate-oxoglutarate transaminase 1 (GOT1), an enzyme that fuels malate dehydrogenase 1 (MDH1)-derived NAD+. In addition, GOT1 maintains low α-ketoglutarate levels, thereby limiting prolyl hydroxylase activity to promote HIF1α stabilisation in early hypoxia and enable robust HIF1α target gene expression in later hypoxia. Our findings reveal that, in normoxia, multiple enzyme systems maintain cells in a primed state ready to support increased glycolysis and HIF1α stabilisation upon oxygen limitation, until other adaptive processes that require more time are fully established.
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Affiliation(s)
- Fiona Grimm
- Cancer Metabolism Laboratory, The Francis Crick Institute, 1 Midland Road, NW1 1AT, London, UK
| | - Agustín Asuaje
- Cancer Metabolism Laboratory, The Francis Crick Institute, 1 Midland Road, NW1 1AT, London, UK
| | - Aakriti Jain
- Cancer Metabolism Laboratory, The Francis Crick Institute, 1 Midland Road, NW1 1AT, London, UK
| | - Mariana Silva Dos Santos
- Metabolomics Science Technology Platform, The Francis Crick Institute, 1 Midland Road, NW1 1AT, London, UK
| | - Jens Kleinjung
- Computational Biology Science Technology Platform, The Francis Crick Institute, 1 Midland Road, NW1 1AT, London, UK
| | - Patrícia M Nunes
- Cancer Metabolism Laboratory, The Francis Crick Institute, 1 Midland Road, NW1 1AT, London, UK
| | - Stefanie Gehrig
- Cancer Metabolism Laboratory, The Francis Crick Institute, 1 Midland Road, NW1 1AT, London, UK
| | - Louise Fets
- Cancer Metabolism Laboratory, The Francis Crick Institute, 1 Midland Road, NW1 1AT, London, UK
| | - Salihanur Darici
- Cancer Metabolism Laboratory, The Francis Crick Institute, 1 Midland Road, NW1 1AT, London, UK
| | - James I MacRae
- Metabolomics Science Technology Platform, The Francis Crick Institute, 1 Midland Road, NW1 1AT, London, UK
| | - Dimitrios Anastasiou
- Cancer Metabolism Laboratory, The Francis Crick Institute, 1 Midland Road, NW1 1AT, London, UK.
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Del M, Illac C, Morisseau M, Angeles MA, Ducassou A, Betrian S, Bataillon G, Ferron G, Chantalat E, Gabiache E, Martinez A. Intraepithelial tumor-infiltrating lymphocytes shape loco-regional PET/CT spread of locally advanced cervical cancer. Int J Gynecol Cancer 2024; 34:490-496. [PMID: 38471676 DOI: 10.1136/ijgc-2023-004677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Data suggest an association between positron emission tomography/CT (PET/CT) metabolic metrics and tumor microenvironment in several malignancies, and a potential role of PET/CT to monitor response to immunotherapy. OBJECTIVE To evaluate the correlation between tumor loco-regional extension and tumor-infiltrating lymphocyte infiltration in locally advanced cervical cancer prior to concurrent chemo-radiotherapy.The secondary objective was to assess the association between tumor-infiltrating lymphocytes and PET/CT metabolic metrics. METHODS Patients with locally advanced cervical cancer and negative para-aortic extensions on PET/CT were included. Two senior nuclear medicine physicians specializing in gynecologic oncology reviewed all PET/CT exams, and extracted tumor maximum standardized uptake value, metabolic tumor volume, and total lesion glycolysis, as well as pelvic lymph node involvement. One senior gynecologic oncology pathologist assessed intraepithelial tumor-infiltrating lymphocytes and stromal tumor-infiltrating lymphocytes. Intraepithelial tumor-infiltrating lymphocytes were categorized following previous studies as <1% and >1%. The cut-off for stromal tumor-infiltrating lymphocytes was chosen empirically: intermediate <60% and high >60%. RESULTS 86 patients were included. Intraepithelial tumor-infiltrating lymphocytes were not significantly associated with tumor metabolic metrics. Intraepithelial tumor-infiltrating lymphocytes were not significantly associated with maximum standard uptake value (p=0.16), or metabolic tumor volume (p=0.19). Tumors with <1% intraepithelial tumor-infiltrating lymphocytes score were associated with a higher MRI tumor size (≥ median) (63.3% vs 39.3%, p=0.04). Patients with pelvic lymph node uptake were significantly more frequent in patients with high stromal tumor-infiltrating lymphocytes score (≥60%) (61.5% vs 31.7%, p=0.009). CONCLUSIONS Poor or absent intraepithelial tumor-infiltrating lymphocytes were associated with more advanced disease at diagnosis and larger tumor size. Tumor-infiltrating lymphocytes were not associated with tumor metabolic activity. Intraepithelial and stroma tumor-infiltrating lymphocytes are not redundant and should be assessed separately. Further work is needed to evaluate the association between tumor metabolic profile and immune populations, including different T-cell subtypes for patient selection for immunotherapy strategies.
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Affiliation(s)
- Mathilde Del
- Department of Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Claire Illac
- Department of Pathology, Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Mathilde Morisseau
- Department of Biostatistics, Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Martina Aida Angeles
- Department of Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Anne Ducassou
- Radiation Oncology and Brachytherapy Department, Institut Universitaire du Cancer de Toulouse - Oncopole, Institut Claudius Regaud, Toulouse, France
| | - Sarah Betrian
- Department of Medical Oncology, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Guillaume Bataillon
- Department of Anatomopathology, Toulouse University Cancer Institute, Toulouse, France
| | - Gwenael Ferron
- Department of Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
- Team 19, ONCOSARC - Oncogenesis of Sarcomas, Cancer Research Center of Toulouse (CRCT) - INSERM UMR 1037, Toulouse, France
| | - Elodie Chantalat
- Department of Surgical Oncology, University Hospital Centre Toulouse IUC Oncopole CHU Division, Toulouse, France
| | - Erwan Gabiache
- Department of Nuclear Medicine, Cancer University Institute Toulouse Oncopole, Toulouse, France
| | - Alejandra Martinez
- Department of Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
- Team 1, Tumor Immunology and Immunotherapy, Cancer Research Center of Toulouse (CRCT) - INSERM UMR 1037, Toulouse, France
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Lin Fracp P, Holloway L, Min Franzcr M, Lee Franzcr M, Fowler Franzcr A. Prognostic and predictive values of baseline and mid-treatment FDG-PET in oropharyngeal carcinoma treated with primary definitive (chemo)radiation and impact of HPV status: review of current literature and emerging roles. Radiother Oncol 2023; 184:109686. [PMID: 37142128 DOI: 10.1016/j.radonc.2023.109686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 04/16/2023] [Accepted: 04/24/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND AND PURPOSE This study provides a review of the literature assessing whether semiquantitative PET parameters acquired at baseline and/or during definitive (chemo)radiotherapy ("prePET" and "iPET") can predict survival outcomes in patients with oropharyngeal squamous cell carcinoma (OPC), and the impact of human papilloma virus (HPV) status. MATERIAL AND METHODS A literature search was carried out using PubMed and Embase between 2001 to 2021 in accordance with PRISMA. RESULTS The analysis included 22 FDG-PET/CT studies1-22, 19 pre-PET and 3 both pre-PET and iPET14,18,20,. The analysis involved 2646 patients, of which 1483 are HPV-positive (17 studies: 10 mixed and 7 HPV-positive only), 589 are HPV-negative, and 574 have unknown HPV status. Eighteen studies found significant correlations of survival outcomes with pre-PET parameters, most commonly primary or "Total" (combined primary and nodal) metabolic tumour volume and/or total lesional glycolysis. Two studies could not establish significant correlations and both employed SUVmax only. Two studies also could not establish significant correlations when taking into account of the HPV-positive population only. Because of the heterogeneity and lack of standardized methodology, no conclusions on optimal cut-off values can be drawn. Ten studies specifically evaluated HPV-positive patients: five showed positive correlation of pre-PET parameters and survival outcomes, but four of these studies did not include advanced T or N staging in multivariate analysis1,6,15,22, and two studies only showed positive correlations after excluding high risk patients with smoking history7 or adverse CT features22. Two studies found that prePET parameters predicted treatment outcomes only in HPV-negative but not HPV-positive patients10,16. Two studies found that iPET parameters could predict outcomes in HPV-positive patients but not prePET parameters14,18. CONCLUSION The current literature supports high pre-treatment metabolic burden prior to definitive (chemo)radiotherapy can predict poor treatment outcomes for HPV-negative OPC patients. Evidence is conflicting and currently does not support correlation in HPV-positive patients.
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Affiliation(s)
- Peter Lin Fracp
- Department of Nuclear Medicine and PET, Liverpool Hospital, Liverpool, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, NSW, Australia; School of Medicine, Western Sydney University, NSW, Australia.
| | - Lois Holloway
- South Western Sydney Clinical School, University of New South Wales, NSW, Australia; School of Medicine, Western Sydney University, NSW, Australia; Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia; Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Myo Min Franzcr
- Department of Radiation Oncology, Sunshine Coast University Hospital, Queensland, Australia; Faculty of Science, Health, Education and Engineering, University of Sunshine Coast, Queensland, Australia
| | - Mark Lee Franzcr
- South Western Sydney Clinical School, University of New South Wales, NSW, Australia; Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia
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Zhuang F, Haoran E, Huang J, Wu J, Xu L, Zhang L, Li Q, Li C, Zhao Y, Yang M, Ma M, She Y, Chen H, Luo Q, Zhao D, Chen C. Utility of 18F-FDG PET/CT uptake values in predicting response to neoadjuvant chemoimmunotherapy in resectable non-small cell lung cancer. Lung Cancer 2023; 178:20-27. [PMID: 36764154 DOI: 10.1016/j.lungcan.2023.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/19/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Reliable predictive markers are lacking for resectable non-small cell lung cancer (NSCLC) patients treated with neoadjuvant chemoimmunotherapy. The present study investigated the utility of SUVmax values acquired from PET/CT to predict the response to neoadjuvant chemoimmunotherapy for resectable NSCLC. MATERAL AND METHODS SUVmax, clinical and pathological outcomes, were collected from patients in 5 hospitals. Patients who received dynamic PET/CT surveillance were divided into cohorts A (chemoimmunotherapy) and B (chemotherapy), respectively, while cohort C (chemoimmunotherapy) comprised patients undergoing post-therapy PET/CT. Associations between SUVmax and major pathologic response (MPR) were evaluated through receiver operating characteristic (ROC) curves. RESULTS A total of 129 cases with an MPR rate of 46.5 % was identified. In neoadjuvant chemoimmunotherapy, ΔSUVmax% (AUC: 0.890, 95 % CI: 0.761-0.949) and post-therapy SUVmax (AUC: 0.933, 95 % CI: 0.802-0.959) could accurately predict MPR. On the contrary, the baseline SUVmax was not associated with MPR (p = 0.184). Furthermore, an independent cohort C proved that post-therapy SUVmax could serve as an independent predictor (AUC: 0.928, 95 % CI: 0.823-0.958). In addition, robust predictive performance could be observed when we use the optimal cut-off point of both ΔSUVmax% (54.4 %, AUC: 0.912, 95 % CI: 0.824-0.994) and post-therapy SUVmax (3.565, AUC: 0.912, 95 % CI: 0.824-0.994) in neoadjuvant chemoimmunotherapy. The RNA data revealed that the expression of PFKFB4, a key enzyme in glycolysis, was positively correlated with SUVmax value and tumor cell proliferation after neoadjuvant chemoimmunotherapy. CONCLUSION These findings highlighted that the ΔSUVmax% and remained SUVmax were accurate and non-invasive tests for the prediction of MPR after neoadjuvant chemoimmunotherapy.
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Affiliation(s)
- Fenghui Zhuang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - E Haoran
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - Jia Huang
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Junqi Wu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - Long Xu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - Lei Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - Qiang Li
- Department of Nuclear Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - Chongwu Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - Yue Zhao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - Minglei Yang
- Department of Thoracic Surgery, Ningbo No. 2 Hospital, Chinese Academy of Sciences, Zhejiang, People's Republic of China
| | - Minjie Ma
- Department of Thoracic Surgery, The First Hospital of Lanzhou University, Gansu, People's Republic of China
| | - Yunlang She
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - Hezhong Chen
- Department of Thoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Qingquan Luo
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Deping Zhao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China.
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China; Department of Thoracic Surgery, The First Hospital of Lanzhou University, Gansu, People's Republic of China; Linhai First People's Hospital, Taizhou, Zhejiang Province, China.
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Keyhanian K, Sekhon HS. Do fine needle aspirate cytomorphological features correlate with positron emission tomography findings of metastatic non-small cell lung carcinoma in lymph nodes? Cancer Med 2023; 12:8218-8227. [PMID: 36691354 PMCID: PMC10134311 DOI: 10.1002/cam4.5629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/05/2023] [Accepted: 01/05/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Our objective was to correlate cytomorphological features of metastatic non-small cell lung carcinoma (mNSCLC) with maximal standardized uptake value (mSUV) of positron emission tomography (PET) in Lymph nodes (LNs). METHODS Positive cytology slides of 114 LNs were reviewed from 100 patients with mNSCLC who had undergone PET study. Student's t-test was used for statistical comparisons. RESULTS Mean patients' age: 68.5, 54% male. LNs locations were: mediastinum: 99, lung hilum: 13, peribronchial: 1, axilla: 1. Final diagnoses were: Adenocarcinoma: 86, squamous cell carcinoma: 28 LNs. Within the adenocarcinoma subgroup, histological patterns correlate with mSUV. Acinar and papillary patterns were associated with significantly lower mSUVs (mean ± standard error (SE): 7.9 ± 0.9 and 9.2 ± 0.8, respectively) than solid pattern (13.0 ± 1.2; p values: 0.001 and 0.009, respectively). Similar difference exists between patterns associated with low- and high-grade adenocarcinoma (Mean ± SE: 9.2 ± 0.8 and 12.0 ± 1.0, respectively. p value: 0.02). Interestingly, micropapillary pattern was associated with the lowest mSUV amongst all patterns (Mean ± SE: 5.4 ± 1.1). Other features that correlated with higher mSUV were necrosis, moderate/severe nuclear atypia, lower lymphoid tissue yield, and contralateral LN involvement. CONCLUSIONS In LNs with mNSCLC, certain cytomorphological features are associated with higher mSUV. Micropapillary, a pattern considered as high-grade, is associated with lower SUV values; hence, a lower SUV threshold may raise concern for metastasis. Although high SUV is associated with LN metastasis, lower SUV levels in certain adenocarcinomas suggest correlation with clinical and morphological characteristics could be valuable in tailoring therapeutic management.
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Affiliation(s)
- Kianoosh Keyhanian
- Eastern Ontario Regional Laboratory Association, Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Harmanjatinder S Sekhon
- Eastern Ontario Regional Laboratory Association, Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Parthenolide targets NF-κB (P50) to inhibit HIF-1α-mediated metabolic reprogramming of HCC. Aging (Albany NY) 2022; 14:8346-8356. [PMID: 36260873 PMCID: PMC9648796 DOI: 10.18632/aging.204339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/05/2022] [Indexed: 11/28/2022]
Abstract
We focus on investigating the role of Parthenolide (Par), a small sesquiterpenoid molecule, in hepatocellular carcinoma (HCC) and its effective target. Highly-metastatic HCC cells, MHCC97-H, were divided into the DMSO and the Par groups, of which the Par group was intervened at 5 and 10 mg/L doses. Cell viability was assessed by CCK-8 assay. Transwell chamber assay was performed to examine the metastatic and invasive abilities, while plate clone formation assay was conducted to detect the clone formation ability. For analysis of glucose uptake, glycolytic ability and lactate level, the glycolysis assay was employed. Brdu staining was performed to evaluate the cell proliferative potential. The P50 and HIF-1α levels were measured by immunofluorescence, while the expressions of p-P50 and HIF-1α were determined by Western-Blot. Small molecule–protein docking and Pull-down experiments were conducted to validate the Par–P50 binding model. After establishing the tumor-bearing mouse model, Par was administered by gavage to measure the tissue levels of P50 and HIF-1α, followed by plotting of tumor growth curves. Par could inhibit the metastatic, invasive and clone formation abilities of MHCC97-H cells, reduce the cell proliferative potential, and suppress the glycolysis, as manifested by down-regulated level of lactate and reduced oxygen consumption. Meanwhile, Par inhibited the HIF-1α expression. We found that after silencing P50, the HIF-1α was down-regulated, the glycolytic ability decreased drastically, and the cellular metastatic and invasive abilities were suppressed. After P50 knockout, the effect of Par intervention on the MHCC97-H cells was reduced. In HCC-bearing mice, Par also exhibited an excellent anti-tumor effect, decreasing the tissue levels of P50 and HIF-1α. This study discovers that Par can inhibit the HIF-1α-mediated glycolysis of HCC cells by targeting P50, thereby exerting an anti-tumor effect. P50 is a major effective target of Par.
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Lv L, Huang RH, Li J, Xu J, Gao W. Impact of NSCLC metabolic remodeling on immunotherapy effectiveness. Biomark Res 2022; 10:66. [PMID: 36038935 PMCID: PMC9425942 DOI: 10.1186/s40364-022-00412-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/12/2022] [Indexed: 11/10/2022] Open
Abstract
It is known that metabolic reprogramming (MR) contributes to tumorigenesis through the activation of processes that support survival of cells, proliferation, and grow in the tumor microenvironment. In order to keep the tumor proliferating at a high rate, metabolic pathways must be upregulated, and tumor metabolism must be adapted to meet this requirement. Additionally, immune cells engage in metabolic remodeling to maintain body and self-health. With the advent of immunotherapy, the fate of individuals suffering from non-small cell lung cancer (NSCLC) has been transformed dramatically. MR may have a profound influence on their prognosis. The aim of this review is to summarize current research advancements in metabolic reprogramming and their impact on immunotherapy in NSCLC. Moreover, we talk about promising approaches targeting and manipulating metabolic pathways to improve cancer immunotherapy’s effectiveness in NSCLC.
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Affiliation(s)
- Lulu Lv
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Ruo Han Huang
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Jiale Li
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Jing Xu
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
| | - Wen Gao
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
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Understanding Breast Cancers through Spatial and High-Resolution Visualization Using Imaging Technologies. Cancers (Basel) 2022; 14:cancers14174080. [PMID: 36077616 PMCID: PMC9454728 DOI: 10.3390/cancers14174080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/17/2022] Open
Abstract
Breast cancer is the most common cancer affecting women worldwide. Although many analyses and treatments have traditionally targeted the breast cancer cells themselves, recent studies have focused on investigating entire cancer tissues, including breast cancer cells. To understand the structure of breast cancer tissues, including breast cancer cells, it is necessary to investigate the three-dimensional location of the cells and/or proteins comprising the tissues and to clarify the relationship between the three-dimensional structure and malignant transformation or metastasis of breast cancers. In this review, we aim to summarize the methods for analyzing the three-dimensional structure of breast cancer tissue, paying particular attention to the recent technological advances in the combination of the tissue-clearing method and optical three-dimensional imaging. We also aimed to identify the latest methods for exploring the relationship between the three-dimensional cell arrangement in breast cancer tissues and the gene expression of each cell. Finally, we aimed to describe the three-dimensional imaging features of breast cancer tissues using noninvasive photoacoustic imaging methods.
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HIF-1α Expression Increases Preoperative Concurrent Chemoradiotherapy Resistance in Hyperglycemic Rectal Cancer. Cancers (Basel) 2022; 14:cancers14164053. [PMID: 36011045 PMCID: PMC9406860 DOI: 10.3390/cancers14164053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/09/2022] [Accepted: 08/16/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose: Preoperative concurrent chemoradiotherapy (CCRT) is the standard treatment for locally advanced rectal cancer patients. However, the poor therapeutic efficacy of CCRT was found in rectal cancer patients with hyperglycemia. This study investigated how hyperglycemia affects radiochemotherapy resistance in rectal cancer. Methods and Materials: We analyzed the correlation between prognosis indexes with hypoxia-inducible factor-1 alpha (HIF-1α) in rectal cancer patients with preoperative CCRT. In vitro, we investigated the effect of different concentrated glucose of environments on the radiation tolerance of rectal cancers. Further, we analyzed the combined HIF-1α inhibitor with radiation therapy in hyperglycemic rectal cancers. Results: The prognosis indexes of euglycemic or hyperglycemic rectal cancer patients after receiving CCRT treatment were investigated. The hyperglycemic rectal cancer patients (n = 13, glycosylated hemoglobin, HbA1c > 6.5%) had poorer prognosis indexes. In addition, a positive correlation was observed between HIF-1α expression and HbA1c levels (p = 0.046). Therefore, it is very important to clarify the relationship between HIF-1α and poor response in patients with hyperglycemia receiving pre-operative CCRT. Under a high glucose environment, rectal cancer cells express higher levels of glucose transport 1 (GLUT1), O-GlcNAc transferase (OGT), and HIF-1α, suggesting that the high glucose environment might stimulate HIF-1α expression through the GLUT1-OGT-HIF-1α pathway promoting tolerance to Fluorouracil (5-FU) and radiation. In the hyperglycemic rectal cancer animal model, rectal cancer cells confirmed that radiation exposure reduces apoptosis by overexpressing HIF-1α. Combining HIF-1α inhibitors was able to reverse radioresistance in a high glucose environment. Lower HIF-1α levels increased DNA damage in tumors leading to apoptosis. Conclusions: The findings here show that hyperglycemia induces the expression of GLUT1, OGT, and HIF-1α to cause CCRT tolerance in rectal cancer and suggest that combining HIF-1α inhibitors could reverse radioresistance in a high glucose environment. HIF-1α inhibitors may be useful for development as CCRT sensitizers in patients with hyperglycemic rectal cancer.
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Nomura K, Nakai T, Nishina Y, Sakamoto N, Miyoshi T, Tane K, Samejima J, Aokage K, Kojima M, Sakashita S, Taki T, Miyazaki S, Watanabe R, Suzuki K, Tsuboi M, Ishii G. FDG uptake in PET is associated with the tumor microenvironment in metastatic lymph nodes and prognosis in N2 lung adenocarcinoma. Cancer Sci 2022; 113:1488-1496. [PMID: 35023268 PMCID: PMC8990723 DOI: 10.1111/cas.15266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/22/2021] [Accepted: 12/31/2021] [Indexed: 11/26/2022] Open
Abstract
Positron emission tomography is a useful technique for diagnosing lymph node (LN) metastasis. This study aimed to elucidate the association between fluorodeoxyglucose accumulation and the microenvironment in metastatic LNs in lung adenocarcinoma. We retrospectively analyzed 62 patients with surgically resected pathological N2 lung adenocarcinoma who underwent preoperative PET. The maximum standardized uptake value (SUVmax) in the metastatic LNs was measured. Lymph node specimens were immunohistochemically analyzed for CD8+, FoxP3+, and CD79a+ lymphocytes, CD204+ tumor‐associated macrophages (TAMs), and alpha‐smooth muscle actin‐positive cancer‐associated fibroblasts (αSMA+ CAFs). We compared the clinicopathologic and immunohistochemical characteristics between two groups with high and low LN SUVmax. Using novel 3D hybrid spheroid models, we investigated the change in invasiveness of cancer cells in the presence of CAFs. In the multivariate analyses, LN SUVmax was an independent prognostic factor. The overall survival in the LN SUVmax high group was significantly worse than in the low group (P = .034). In the LN SUVmax high group, metastatic cancer cell invasion of extranodal tissue was more frequent (P = .005) and the number of CD204+ TAMs and αSMA+ CAFs in metastatic LNs was significantly higher than in the low group (P < .001 and P = .002, respectively). Hybrid spheroid models revealed that cancer cells coexisting with CAFs were more invasive than those without CAFs. Our results indicated a strong association between LN SUVmax and poor prognosis in patients with N2 lung adenocarcinoma. Moreover, LN SUVmax was suggested to be associated with the presence of tumor‐promoting stromal cells in metastatic LNs.
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Affiliation(s)
- Kotaro Nomura
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.,Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.,Departments of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Tokiko Nakai
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Yukino Nishina
- Department of Integrated Biosciences, Laboratory of Cancer Biology, Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa, Chiba, Japan.,Division of Pathology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, Japan
| | - Naoya Sakamoto
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.,Division of Pathology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, Japan
| | - Tomohiro Miyoshi
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Kenta Tane
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Joji Samejima
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Keiju Aokage
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Motohiro Kojima
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.,Division of Pathology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, Japan
| | - Shingo Sakashita
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.,Division of Pathology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, Japan
| | - Tetsuro Taki
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Saori Miyazaki
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Reiko Watanabe
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Kenji Suzuki
- Departments of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Masahiro Tsuboi
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Genichiro Ishii
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.,Department of Integrated Biosciences, Laboratory of Cancer Biology, Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa, Chiba, Japan.,Division of Innovative Pathology and Laboratory Medicine, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, Chiba, Japan
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13
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Divisi D, Rinaldi M, Necozione S, Curcio C, Rea F, Zaraca F, De Vico A, Zaccagna G, Di Leonardo G, Crisci R. Is It Possible to Establish a Reliable Correlation between Maximum Standardized Uptake Value of 18-Fluorine Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography and Histological Types of Non-Small Cell Lung Cancer? Analysis of the Italian VATS Group Database. Diagnostics (Basel) 2021; 11:diagnostics11101901. [PMID: 34679600 PMCID: PMC8534503 DOI: 10.3390/diagnostics11101901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/08/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Although positron emission tomography/computed tomography, often integrated with 2-deoxy-2-[fluorine-18] fluorine-D-glucose (18F-FDG-PET/CT), is fundamental in the assessment of lung cancer, the relationship between metabolic avidity of different histotypes and maximum standardized uptake value (SUVmax) has not yet been thoroughly investigated. The aim of the study is to establish a reliable correlation between Suvmax and histology in non-small cell lung cancer (NSCLC), in order to facilitate patient management. METHODS We retrospectively assessed the data about lung cancer patients entered in the Italian Registry of VATS Group from January 2014 to October 2019, after establishing the eligibility criteria of the study. In total, 8139 patients undergoing VATS lobectomy were enrolled: 3260 females and 4879 males. The relationship between SUVmax and tumor size was also analyzed. RESULTS The mean values of SUVmax in the most frequent types of lung cancer were as follows: (a) 4.88 ± 3.82 for preinvasive adenocarcinoma; (b) 5.49 ± 4.10 for minimally invasive adenocarcinoma; (c) 5.87 ± 4.18 for invasive adenocarcinoma; and (d) 8.85 ± 6.70 for squamous cell carcinoma. Processing these data, we displayed a statistically difference (p < 0.000001) of FDG avidity between adenocarcinoma and squamous cell carcinoma. Moreover, by classifying patients into five groups based on tumor diameter and after evaluating the SUVmax value for each group, we noted a statistical correlation (p < 0.000001) between size and FDG uptake, also confirmed by the post hoc analysis. CONCLUSIONS There is a correlation between SUVmax, histopathology outcomes and tumor size in NSCLC. Further clinical trials should be performed in order to confirm our data.
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Affiliation(s)
- Duilio Divisi
- Thoracic Surgery Unit, Department of Life, Health & Environmental Sciences, University of L’Aquila, “Giuseppe Mazzini” Hospital, Piazza Italia 1, 64100 Teramo, Italy; (M.R.); (A.D.V.); (G.Z.); (G.D.L.); (R.C.)
- Correspondence: or ; Tel.: +39-0861-42-94-82; Fax: +39-0861-42-94-78
| | - Marta Rinaldi
- Thoracic Surgery Unit, Department of Life, Health & Environmental Sciences, University of L’Aquila, “Giuseppe Mazzini” Hospital, Piazza Italia 1, 64100 Teramo, Italy; (M.R.); (A.D.V.); (G.Z.); (G.D.L.); (R.C.)
| | - Stefano Necozione
- Department of Internal Medicine and Public Health, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Carlo Curcio
- Division of Thoracic Surgery, Monaldi Hospital, 80131 Naples, Italy;
| | - Federico Rea
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova City Hospital, 35100 Padova, Italy;
| | - Francesco Zaraca
- Department of Vascular and Thoracic Surgery, Central Hospital, 39100 Bolzano, Italy;
| | - Andrea De Vico
- Thoracic Surgery Unit, Department of Life, Health & Environmental Sciences, University of L’Aquila, “Giuseppe Mazzini” Hospital, Piazza Italia 1, 64100 Teramo, Italy; (M.R.); (A.D.V.); (G.Z.); (G.D.L.); (R.C.)
| | - Gino Zaccagna
- Thoracic Surgery Unit, Department of Life, Health & Environmental Sciences, University of L’Aquila, “Giuseppe Mazzini” Hospital, Piazza Italia 1, 64100 Teramo, Italy; (M.R.); (A.D.V.); (G.Z.); (G.D.L.); (R.C.)
| | - Gabriella Di Leonardo
- Thoracic Surgery Unit, Department of Life, Health & Environmental Sciences, University of L’Aquila, “Giuseppe Mazzini” Hospital, Piazza Italia 1, 64100 Teramo, Italy; (M.R.); (A.D.V.); (G.Z.); (G.D.L.); (R.C.)
| | - Roberto Crisci
- Thoracic Surgery Unit, Department of Life, Health & Environmental Sciences, University of L’Aquila, “Giuseppe Mazzini” Hospital, Piazza Italia 1, 64100 Teramo, Italy; (M.R.); (A.D.V.); (G.Z.); (G.D.L.); (R.C.)
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14
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Lin P, Min M, Lai K, Lee M, Holloway L, Xuan W, Bray V, Fowler A, Lee CS, Yong J. Mid-treatment Fluorodeoxyglucose Positron Emission Tomography in Human Papillomavirus-related Oropharyngeal Squamous Cell Carcinoma Treated with Primary Radiotherapy: Nodal Metabolic Response Rate can Predict Treatment Outcomes. Clin Oncol (R Coll Radiol) 2021; 33:e586-e598. [PMID: 34373179 DOI: 10.1016/j.clon.2021.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 06/05/2021] [Accepted: 07/16/2021] [Indexed: 11/26/2022]
Abstract
AIMS To evaluate whether biomarkers derived from fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) performed prior to (prePET) and during the third week (interim PET; iPET) of radiotherapy can predict treatment outcomes in human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPC). MATERIALS AND METHODS This retrospective analysis included 46 patients with newly diagnosed OPC treated with definitive (chemo)radiation and all patients had confirmed positive HPV status (HPV+OPC) based on p16 immunohistochemistry. The maximum standardised uptake value (SUVmax), metabolic tumour volume (MTV) and total lesional glycolysis (TLG) of primary, index node (node with the highest TLG) and total lymph nodes and their median percentage (≥50%) reductions in iPET were analysed, and correlated with 5-year Kaplan-Meier and multivariable analyses (smoking, T4, N2b-3 and AJCC stage IV), including local failure-free survival, regional failure-free survival, locoregional failure-free survival (LRFFS), distant metastatic failure-free survival (DMFFS), disease-free survival (DFS) and overall survival. RESULTS There was no association of outcomes with prePET parameters observed on multivariate analysis. A complete metabolic response of primary tumour was seen in 13 patients; the negative predictive value for local failure was 100%. More than a 50% reduction in total nodal MTV provided the best predictor of outcomes, including LRFFS (88% versus 47.1%, P = 0.006, hazard ratio = 0.153) and DFS (78.2% versus 41.2%, P = 0.01, hazard ratio = 0.234). More than a 50% reduction in index node TLG was inversely related to DMFFS: a better nodal response was associated with a higher incidence of distant metastatic failure (66.7% versus 100%, P = 0.009, hazard ratio = 3.0). CONCLUSION The reduction (≥50%) of volumetric nodal metabolic burden can potentially identify a subgroup of HPV+OPC patients at low risk of locoregional failure but inversely at higher risk of distant metastatic failure and may have a role in individualised adaptive radiotherapy and systemic therapy.
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Affiliation(s)
- P Lin
- Department of Nuclear Medicine and PET, Liverpool Hospital, Liverpool, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, New South Wales, Australia; School of Medicine, Western Sydney University, New South Wales, Australia.
| | - M Min
- Department of Radiation Oncology, Sunshine Coast University Hospital, Queensland, Australia; Faculty of Science, Health, Education and Engineering, University of Sunshine Coast, Queensland, Australia; Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - K Lai
- Department of Nuclear Medicine and PET, Liverpool Hospital, Liverpool, New South Wales, Australia; School of Medicine, Western Sydney University, New South Wales, Australia
| | - M Lee
- South Western Sydney Clinical School, University of New South Wales, New South Wales, Australia; Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - L Holloway
- South Western Sydney Clinical School, University of New South Wales, New South Wales, Australia; School of Medicine, Western Sydney University, New South Wales, Australia; Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia; Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia
| | - W Xuan
- South Western Sydney Clinical School, University of New South Wales, New South Wales, Australia; Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia
| | - V Bray
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - A Fowler
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - C S Lee
- South Western Sydney Clinical School, University of New South Wales, New South Wales, Australia; School of Medicine, Western Sydney University, New South Wales, Australia; Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia; Department of Anatomical Pathology, Liverpool Hospital, Liverpool, New South Wales, Australia; Central Clinical School, University of Sydney, New South Wales, Australia
| | - J Yong
- Department of Anatomical Pathology, Liverpool Hospital, Liverpool, New South Wales, Australia
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15
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Nehmeh SA, Moussa MB, Lee N, Zanzonico P, Gönen M, Humm JL, Schöder H. Comparison of FDG and FMISO uptakes and distributions in head and neck squamous cell cancer tumors. EJNMMI Res 2021; 11:38. [PMID: 33855685 PMCID: PMC8046891 DOI: 10.1186/s13550-021-00767-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/26/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose Glycolysis is increased by hypoxia, suggesting a possible correlation between the accumulation of 2-[18F]fluoro-2-deoxy-D-glucose (FDG) in malignant tumors and regional hypoxia defined by 1H-1-(3-[18F]fluoro-2-hydroxypropyl)-2-nitroimidazole (FMISO) PET. The aim of this study is to investigate the intra-tumoral spatial distribution and quantitative relationship between FDG and FMISO in a cohort of head and neck squamous cell cancer (HNSCC) patients. Methods Twenty HNSCC patients with 20 primary tumors and 19 metastatic lymph nodes (LNs) underwent FDG and FMISO PET within 1 week. The metabolic target volume (MTV) was defined on the FDG PET images using a region growing algorithm. The hypoxic volume (HV) was defined by the volume of voxels in an FMISO image within the MTV that satisfy a tumor-to-blood ratio (T/B) greater than 1.2. FDG and FMISO lesions were co-registered, and a voxel-by-voxel correlation between the two datasets was performed. FDG and FMISO TVs’ SUVs were also compared as well as the intra-tumoral homogeneity of the two radiotracers. Separate analysis was performed for the primary tumors and LNs. Results Twenty-six percent of the primary tumors and 15% of LNs showed a strong correlation (R > 0.7) between FDG and FMISO intra-tumor distributions when considering the MTV. For the HV, only 19% of primary tumors and 12% of LN were strongly correlated. A weak and moderate correlation existed between the two markers SUVavg, and SUVmax in the case of the primary tumors, respectively. However, this was not the case for the LNs. Good concordances were also observed between the primary tumor’s and LNs HV SUVavgs as well as between the corresponding hypoxic fractions (HF’s). Conclusions A moderate correlation between FDG and hypoxia radiotracer distribution, as measured by FMISO, seems to exist for primary tumors. However, discordant results were found in the case of LNs. Hypoxia appears to be the dominant driver of high FDG uptake in selected tumors only, and therefore FDG PET images cannot be used as a universal surrogate to identify or predict intra-tumor hypoxia.
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Affiliation(s)
- Sadek A Nehmeh
- Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. .,Weill Cornell Medical College, New York, NY, 10021, USA.
| | - Mohamed B Moussa
- Chemistry Department, Stony Brook University, Stony Brook, NY, USA
| | - Nancy Lee
- Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Pat Zanzonico
- Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Mithat Gönen
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - John L Humm
- Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Heiko Schöder
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Architectural control of metabolic plasticity in epithelial cancer cells. Commun Biol 2021; 4:371. [PMID: 33742081 PMCID: PMC7979883 DOI: 10.1038/s42003-021-01899-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 02/15/2021] [Indexed: 12/11/2022] Open
Abstract
Metabolic plasticity enables cancer cells to switch between glycolysis and oxidative phosphorylation to adapt to changing conditions during cancer progression, whereas metabolic dependencies limit plasticity. To understand a role for the architectural environment in these processes we examined metabolic dependencies of cancer cells cultured in flat (2D) and organotypic (3D) environments. Here we show that cancer cells in flat cultures exist in a high energy state (oxidative phosphorylation), are glycolytic, and depend on glucose and glutamine for growth. In contrast, cells in organotypic culture exhibit lower energy and glycolysis, with extensive metabolic plasticity to maintain growth during glucose or amino acid deprivation. Expression of KRASG12V in organotypic cells drives glucose dependence, however cells retain metabolic plasticity to glutamine deprivation. Finally, our data reveal that mechanical properties control metabolic plasticity, which correlates with canonical Wnt signaling. In summary, our work highlights that the architectural and mechanical properties influence cells to permit or restrict metabolic plasticity.
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Carles M, Fechter T, Radicioni G, Schimek-Jasch T, Adebahr S, Zamboglou C, Nicolay NH, Martí-Bonmatí L, Nestle U, Grosu AL, Baltas D, Mix M, Gkika E. FDG-PET Radiomics for Response Monitoring in Non-Small-Cell Lung Cancer Treated with Radiation Therapy. Cancers (Basel) 2021; 13:cancers13040814. [PMID: 33672052 PMCID: PMC7919471 DOI: 10.3390/cancers13040814] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/05/2021] [Accepted: 02/07/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary In this study, we strive to identify clinically relevant image feature (IF) changes during chemoradiation in patients with non-small-cell lung cancer (NSCLC) to be able to predict tumor responses in an early stage of treatment. All patients underwent static (3D) and respiratory-gated 4D PET/CT scans before treatment and a 3D scan during or after treatment. Our proposed method rejects IF changes due to intrinsic variability such as noise, resolution and movement through breathing. The IF variability observed across 4D PET is employed as a patient individualized normalization factor to emphasize statistically relevant IF changes during treatment. Abstract The aim of this study is to identify clinically relevant image feature (IF) changes during chemoradiation and evaluate their efficacy in predicting treatment response. Patients with non-small-cell lung cancer (NSCLC) were enrolled in two prospective trials (STRIPE, PET-Plan). We evaluated 48 patients who underwent static (3D) and retrospectively-respiratory-gated 4D PET/CT scans before treatment and a 3D scan during or after treatment. Our proposed method rejects IF changes due to intrinsic variability. The IF variability observed across 4D PET is employed as a patient individualized normalization factor to emphasize statistically relevant IF changes during treatment. Predictions of overall survival (OS), local recurrence (LR) and distant metastasis (DM) were evaluated. From 135 IFs, only 17 satisfied the required criteria of being normally distributed across 4D PET and robust between 3D and 4D images. Changes during treatment in the area-under-the-curve of the cumulative standard-uptake-value histogram (δAUCCSH) within primary tumor discriminated (AUC = 0.87, Specificity = 0.78) patients with and without LR. The resulted prognostic model was validated with a different segmentation method (AUC = 0.83) and in a different patient cohort (AUC = 0.63). The quantification of tumor FDG heterogeneity by δAUCCSH during chemoradiation correlated with the incidence of local recurrence and might be recommended for monitoring treatment response in patients with NSCLC.
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Affiliation(s)
- Montserrat Carles
- Department of Radiation Oncology, Division of Medical Physics, University Medical Center Freiburg, Faculty of Medicine, 79106 Freiburg, Germany; (T.F.); (D.B.)
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Partner Site Freiburg of the German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (S.A.); (C.Z.); (N.H.N.); (U.N.); (A.L.G.); (E.G.)
- La Fe Health Research Institute, Biomedical Imaging Research Group (GIBI230-PREBI) and Imaging La Fe Node at Distributed Network for Biomedical Imaging (ReDIB) Unique Scientific and Technical Infrastructures (ICTS), 46026 Valencia, Spain;
- Correspondence:
| | - Tobias Fechter
- Department of Radiation Oncology, Division of Medical Physics, University Medical Center Freiburg, Faculty of Medicine, 79106 Freiburg, Germany; (T.F.); (D.B.)
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Partner Site Freiburg of the German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (S.A.); (C.Z.); (N.H.N.); (U.N.); (A.L.G.); (E.G.)
| | - Gianluca Radicioni
- Department of Radiation Oncology, University Medical Center Freiburg, Faculty of Medicine, 79106 Freiburg, Germany; (G.R.); (T.S.-J.)
| | - Tanja Schimek-Jasch
- Department of Radiation Oncology, University Medical Center Freiburg, Faculty of Medicine, 79106 Freiburg, Germany; (G.R.); (T.S.-J.)
| | - Sonja Adebahr
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Partner Site Freiburg of the German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (S.A.); (C.Z.); (N.H.N.); (U.N.); (A.L.G.); (E.G.)
- Department of Radiation Oncology, University Medical Center Freiburg, Faculty of Medicine, 79106 Freiburg, Germany; (G.R.); (T.S.-J.)
| | - Constantinos Zamboglou
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Partner Site Freiburg of the German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (S.A.); (C.Z.); (N.H.N.); (U.N.); (A.L.G.); (E.G.)
- Department of Radiation Oncology, University Medical Center Freiburg, Faculty of Medicine, 79106 Freiburg, Germany; (G.R.); (T.S.-J.)
| | - Nils H. Nicolay
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Partner Site Freiburg of the German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (S.A.); (C.Z.); (N.H.N.); (U.N.); (A.L.G.); (E.G.)
- Department of Radiation Oncology, University Medical Center Freiburg, Faculty of Medicine, 79106 Freiburg, Germany; (G.R.); (T.S.-J.)
| | - Luis Martí-Bonmatí
- La Fe Health Research Institute, Biomedical Imaging Research Group (GIBI230-PREBI) and Imaging La Fe Node at Distributed Network for Biomedical Imaging (ReDIB) Unique Scientific and Technical Infrastructures (ICTS), 46026 Valencia, Spain;
| | - Ursula Nestle
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Partner Site Freiburg of the German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (S.A.); (C.Z.); (N.H.N.); (U.N.); (A.L.G.); (E.G.)
- Department of Radiation Oncology, University Medical Center Freiburg, Faculty of Medicine, 79106 Freiburg, Germany; (G.R.); (T.S.-J.)
- Department of Radiation Oncology, Kliniken Maria Hilf, GmbH Moenchengladbach, 41063 Moechengladbach, Germany
| | - Anca L. Grosu
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Partner Site Freiburg of the German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (S.A.); (C.Z.); (N.H.N.); (U.N.); (A.L.G.); (E.G.)
- Department of Radiation Oncology, University Medical Center Freiburg, Faculty of Medicine, 79106 Freiburg, Germany; (G.R.); (T.S.-J.)
| | - Dimos Baltas
- Department of Radiation Oncology, Division of Medical Physics, University Medical Center Freiburg, Faculty of Medicine, 79106 Freiburg, Germany; (T.F.); (D.B.)
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Partner Site Freiburg of the German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (S.A.); (C.Z.); (N.H.N.); (U.N.); (A.L.G.); (E.G.)
| | - Michael Mix
- Department of Nuclear Medicine, University Medical Center Freiburg, Faculty of Medicine, 79106 Freiburg, Germany;
| | - Eleni Gkika
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Partner Site Freiburg of the German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (S.A.); (C.Z.); (N.H.N.); (U.N.); (A.L.G.); (E.G.)
- Department of Radiation Oncology, University Medical Center Freiburg, Faculty of Medicine, 79106 Freiburg, Germany; (G.R.); (T.S.-J.)
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Jiménez-Sánchez J, Bosque JJ, Jiménez Londoño GA, Molina-García D, Martínez Á, Pérez-Beteta J, Ortega-Sabater C, Honguero Martínez AF, García Vicente AM, Calvo GF, Pérez-García VM. Evolutionary dynamics at the tumor edge reveal metabolic imaging biomarkers. Proc Natl Acad Sci U S A 2021; 118:e2018110118. [PMID: 33536339 PMCID: PMC8017959 DOI: 10.1073/pnas.2018110118] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 01/04/2021] [Indexed: 01/09/2023] Open
Abstract
Human cancers are biologically and morphologically heterogeneous. A variety of clonal populations emerge within these neoplasms and their interaction leads to complex spatiotemporal dynamics during tumor growth. We studied the reshaping of metabolic activity in human cancers by means of continuous and discrete mathematical models and matched the results to positron emission tomography (PET) imaging data. Our models revealed that the location of increasingly active proliferative cellular spots progressively drifted from the center of the tumor to the periphery, as a result of the competition between gradually more aggressive phenotypes. This computational finding led to the development of a metric, normalized distance from 18F-fluorodeoxyglucose (18F-FDG) hotspot to centroid (NHOC), based on the separation from the location of the activity (proliferation) hotspot to the tumor centroid. The NHOC metric can be computed for patients using 18F-FDG PET-computed tomography (PET/CT) images where the voxel of maximum uptake (standardized uptake value [SUV]max) is taken as the activity hotspot. Two datasets of 18F-FDG PET/CT images were collected, one from 61 breast cancer patients and another from 161 non-small-cell lung cancer patients. In both cohorts, survival analyses were carried out for the NHOC and for other classical PET/CT-based biomarkers, finding that the former had a high prognostic value, outperforming the latter. In summary, our work offers additional insights into the evolutionary mechanisms behind tumor progression, provides a different PET/CT-based biomarker, and reveals that an activity hotspot closer to the tumor periphery is associated to a worst patient outcome.
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Affiliation(s)
- Juan Jiménez-Sánchez
- Mathematical Oncology Laboratory, Universidad de Castilla-La Mancha, Ciudad Real, 13071, Spain
| | - Jesús J Bosque
- Mathematical Oncology Laboratory, Universidad de Castilla-La Mancha, Ciudad Real, 13071, Spain
| | | | - David Molina-García
- Mathematical Oncology Laboratory, Universidad de Castilla-La Mancha, Ciudad Real, 13071, Spain
| | - Álvaro Martínez
- Mathematical Oncology Laboratory, Universidad de Castilla-La Mancha, Ciudad Real, 13071, Spain
- Nuclear Medicine Unit, Hospital General Universitario de Ciudad Real, Ciudad Real, 13005, Spain
| | - Julián Pérez-Beteta
- Mathematical Oncology Laboratory, Universidad de Castilla-La Mancha, Ciudad Real, 13071, Spain
| | - Carmen Ortega-Sabater
- Mathematical Oncology Laboratory, Universidad de Castilla-La Mancha, Ciudad Real, 13071, Spain
| | | | - Ana M García Vicente
- Thoracic Surgery Unit, Hospital General Universitario de Albacete, Albacete, 02006, Spain
| | - Gabriel F Calvo
- Mathematical Oncology Laboratory, Universidad de Castilla-La Mancha, Ciudad Real, 13071, Spain;
| | - Víctor M Pérez-García
- Mathematical Oncology Laboratory, Universidad de Castilla-La Mancha, Ciudad Real, 13071, Spain;
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19
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Duan C, Chaovalitwongse WA, Bai F, Hippe DS, Wang S, Thammasorn P, Pierce LA, Liu X, You J, Miyaoka RS, Vesselle HJ, Kinahan PE, Rengan R, Zeng J, Bowen SR. Sensitivity analysis of FDG PET tumor voxel cluster radiomics and dosimetry for predicting mid-chemoradiation regional response of locally advanced lung cancer. Phys Med Biol 2020; 65:205007. [PMID: 33027064 PMCID: PMC7593986 DOI: 10.1088/1361-6560/abb0c7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We investigated the sensitivity of regional tumor response prediction to variability in voxel clustering techniques, imaging features, and machine learning algorithms in 25 patients with locally advanced non-small cell lung cancer (LA-NSCLC) enrolled on the FLARE-RT clinical trial. Metabolic tumor volumes (MTV) from pre-chemoradiation (PETpre) and mid-chemoradiation fluorodeoxyglucose-positron emission tomography (FDG PET) images (PETmid) were subdivided into K-means or hierarchical voxel clusters by standardized uptake values (SUV) and 3D-positions. MTV cluster separability was evaluated by CH index, and morphologic changes were captured by Dice similarity and centroid Euclidean distance. PETpre conventional features included SUVmean, MTV/MTV cluster size, and mean radiation dose. PETpre radiomics consisted of 41 intensity histogram and 3D texture features (PET Oncology Radiomics Test Suite) extracted from MTV or MTV clusters. Machine learning models (multiple linear regression, support vector regression, logistic regression, support vector machines) of conventional features or radiomic features were constructed to predict PETmid response. Leave-one-out-cross-validated root-mean-squared-error (RMSE) for continuous response regression (ΔSUVmean) and area-under-receiver-operating-characteristic-curve (AUC) for binary response classification were calculated. K-means MTV 2-clusters (MTVhi, MTVlo) achieved maximum CH index separability (Friedman p < 0.001). Between PETpre and PETmid, MTV cluster pairs overlapped (Dice 0.70-0.87) and migrated 0.6-1.1 cm. PETmid ΔSUVmean response prediction was superior in MTV and MTVlo (RMSE = 0.17-0.21) compared to MTVhi (RMSE = 0.42-0.52, Friedman p < 0.001). PETmid ΔSUVmean response class prediction performance trended higher in MTVlo (AUC = 0.83-0.88) compared to MTVhi (AUC = 0.44-0.58, Friedman p = 0.052). Models were more sensitive to MTV/MTV cluster regions (Friedman p = 0.026) than feature sets/algorithms (Wilcoxon signed-rank p = 0.36). Top-ranked radiomic features included GLZSM-LZHGE (large-zone-high-SUV), GTSDM-CP (cluster-prominence), GTSDM-CS (cluster-shade) and NGTDM-CNT (contrast). Top-ranked features were consistent between MTVhi and MTVlo cluster pairs but varied between MTVhi-MTVlo clusters, reflecting distinct regional radiomic phenotypes. Variability in tumor voxel cluster response prediction can inform robust radiomic target definition for risk-adaptive chemoradiation in patients with LA-NSCLC. FLARE-RT trial: NCT02773238.
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Affiliation(s)
- Chunyan Duan
- Department of Mechanical Engineering, Tongji University School of Mechanical Engineering, Shanghai China
- Department of Industrial Engineering, University of Arkansas College of Engineering, Fayetteville AR
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle WA
| | - W. Art Chaovalitwongse
- Department of Industrial Engineering, University of Arkansas College of Engineering, Fayetteville AR
| | - Fangyun Bai
- Department of Management Science and Engineering, Tongji University School of Economics and Management, Shanghai China
- Department of Industrial, Manufacturing, & Systems Engineering, University of Texas at Arlington College of Engineering, Arlington, TX
| | - Daniel S. Hippe
- Department of Radiology, University of Washington School of Medicine, Seattle WA
| | - Shouyi Wang
- Department of Industrial, Manufacturing, & Systems Engineering, University of Texas at Arlington College of Engineering, Arlington, TX
| | - Phawis Thammasorn
- Department of Industrial Engineering, University of Arkansas College of Engineering, Fayetteville AR
| | - Larry A. Pierce
- Department of Radiology, University of Washington School of Medicine, Seattle WA
| | - Xiao Liu
- Department of Industrial Engineering, University of Arkansas College of Engineering, Fayetteville AR
| | - Jianxin You
- Department of Management Science and Engineering, Tongji University School of Economics and Management, Shanghai China
| | - Robert S. Miyaoka
- Department of Radiology, University of Washington School of Medicine, Seattle WA
| | - Hubert J. Vesselle
- Department of Radiology, University of Washington School of Medicine, Seattle WA
| | - Paul E. Kinahan
- Department of Radiology, University of Washington School of Medicine, Seattle WA
| | - Ramesh Rengan
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle WA
| | - Jing Zeng
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle WA
| | - Stephen R. Bowen
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle WA
- Department of Radiology, University of Washington School of Medicine, Seattle WA
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20
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The Relative Importance of Clinical and Socio-demographic Variables in Prognostic Prediction in Non-Small Cell Lung Cancer: A Variable Importance Approach. Med Care 2020; 58:461-467. [PMID: 31985586 DOI: 10.1097/mlr.0000000000001288] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Prognostic modeling in health care has been predominantly statistical, despite a rapid growth of literature on machine-learning approaches in biological data analysis. We aim to assess the relative importance of variables in predicting overall survival among patients with non-small cell lung cancer using a Variable Importance (VIMP) approach in a machine-learning Random Survival Forest (RSF) model for posttreatment planning and follow-up. METHODS A total of 935 non-small cell lung cancer patients were randomly and equally divided into 2 training and testing cohorts in an RFS model. The prognostic variables included age, sex, race, the TNM Classification of Malignant Tumors (TNM) stage, smoking history, Eastern Cooperative Oncology Group performance status, histologic type, treatment category, maximum standard uptake value of whole-body tumor (SUVmaxWB), whole-body metabolic tumor volume (MTVwb), and Charlson Comorbidity Index. The VIMP was calculated using a permutation method in the RSF model. We further compared the VIMP of the RSF model to that of the standard Cox survival model. We examined the order of VIMP with the differential functional forms of the variables. RESULTS In both the RSF and the standard Cox models, the most important variables are treatment category, TNM stage, and MTVwb. The order of VIMP is more robust in RSF model than in Cox model regarding the differential functional forms of the variables. CONCLUSIONS The RSF VIMP approach can be applied alongside with the Cox model to further advance the understanding of the roles of prognostic factors, and improve prognostic precision and care efficiency.
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21
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Ventura L, Scarlattei M, Gnetti L, Silini EM, Rossi M, Tiseo M, Sverzellati N, Bocchialini G, Musini L, Balestra V, Ampollini L, Rusca M, Carbognani P, Ruffini L. Prognostic value of [ 18F]FDG PET/CT parameters in surgically resected primary lung adenocarcinoma: a single-center experience. TUMORI JOURNAL 2020; 106:300891620904404. [PMID: 32056506 DOI: 10.1177/0300891620904404] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the prognostic role of maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) measured by FDG-positron emission tomography (PET)/computed tomography (CT) in patients with primary lung adenocarcinoma undergoing surgical resection. METHODS All consecutive patients undergoing curative surgery for primary lung adenocarcinoma at the Thoracic Surgery Unit of the University Hospital of Parma between January 2009 and December 2014 were retrospectively analyzed. The cutoff point of each continuous PET parameter was determined through receiver operating characteristic curve and Youden index, using overall survival (OS) as the classification status. Univariate and multivariate Cox proportional hazards models were applied to evaluate the association between OS and potential prognostic variables, including SUVmax, MTV, and TLG. RESULTS A total of 193 patients were considered eligible for this study. The mean 5-year OS rate was 70.5 ± 3.5%. Acinar and lepidic patterns were more frequently associated with absent or low (<2.5) SUVmax values [18F]FDG uptake. At univariate analysis, male sex, advanced stage, micropapillary and solid pattern, lymphatic, blood vessels and pleural invasion, high SUVmax, MTV, and TLG were significantly associated with poorer OS. Multivariate analyses revealed that only sex, stage, and TLG were independent factors for OS, with male sex, stage 3+4, and high TLG value (p = 0.041) significantly associated with poorer OS. CONCLUSIONS In this study, [18F]FDG PET/CT parameters SUVmax, MTV, and TLG were prognostic factors in patients with surgically resected lung adenocarcinoma, able to predict OS and helping to further stratify these patients into prognostic subsets. Elevated TLG was also an independent predictor for shorter OS.
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Affiliation(s)
- Luigi Ventura
- Thoracic Surgery, Department of Vascular, Cardiac and Thoracic Surgery, University Hospital of Parma, Parma, Italy
| | - Maura Scarlattei
- Nuclear Medicine Unit, University Hospital of Parma, Parma, Italy
| | - Letizia Gnetti
- Pathology Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Enrico Maria Silini
- Pathology Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Maurizio Rossi
- Department of Clinical and Experimental Medicine, University Hospital of Parma, Parma, Italy
| | - Marcello Tiseo
- Medical Oncology, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Nicola Sverzellati
- Section of Radiology, Diagnostic Department, University Hospital of Parma, Parma, Italy
| | - Giovanni Bocchialini
- Thoracic Surgery, Department of Vascular, Cardiac and Thoracic Surgery, University Hospital of Parma, Parma, Italy
| | - Luca Musini
- Thoracic Surgery, Department of Vascular, Cardiac and Thoracic Surgery, University Hospital of Parma, Parma, Italy
| | - Valeria Balestra
- Thoracic Surgery, Department of Vascular, Cardiac and Thoracic Surgery, University Hospital of Parma, Parma, Italy
| | - Luca Ampollini
- Thoracic Surgery, Department of Vascular, Cardiac and Thoracic Surgery, University Hospital of Parma, Parma, Italy
| | - Michele Rusca
- Thoracic Surgery, Department of Vascular, Cardiac and Thoracic Surgery, University Hospital of Parma, Parma, Italy
| | - Paolo Carbognani
- Thoracic Surgery, Department of Vascular, Cardiac and Thoracic Surgery, University Hospital of Parma, Parma, Italy
| | - Livia Ruffini
- Nuclear Medicine Unit, University Hospital of Parma, Parma, Italy
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22
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Cortese N, Capretti G, Barbagallo M, Rigamonti A, Takis PG, Castino GF, Vignali D, Maggi G, Gavazzi F, Ridolfi C, Nappo G, Donisi G, Erreni M, Avigni R, Rahal D, Spaggiari P, Roncalli M, Cappello P, Novelli F, Monti P, Zerbi A, Allavena P, Mantovani A, Marchesi F. Metabolome of Pancreatic Juice Delineates Distinct Clinical Profiles of Pancreatic Cancer and Reveals a Link between Glucose Metabolism and PD-1 + Cells. Cancer Immunol Res 2020; 8:493-505. [PMID: 32019781 DOI: 10.1158/2326-6066.cir-19-0403] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/30/2019] [Accepted: 01/28/2020] [Indexed: 11/16/2022]
Abstract
Better understanding of pancreatic diseases, including pancreatic ductal adenocarcinoma (PDAC), is an urgent medical need, with little advances in preoperative differential diagnosis, preventing rational selection of therapeutic strategies. The clinical management of pancreatic cancer patients would benefit from the identification of variables distinctively associated with the multiplicity of pancreatic disorders. We investigated, by 1H nuclear magnetic resonance, the metabolomic fingerprint of pancreatic juice (the biofluid that collects pancreatic products) in 40 patients with different pancreatic diseases. Metabolic variables discriminated PDAC from other less aggressive pancreatic diseases and identified metabolic clusters of patients with distinct clinical behaviors. PDAC specimens were overtly glycolytic, with significant accumulation of lactate, which was probed as a disease-specific variable in pancreatic juice from a larger cohort of 106 patients. In human PDAC sections, high expression of the glucose transporter GLUT-1 correlated with tumor grade and a higher density of PD-1+ T cells, suggesting their accumulation in glycolytic tumors. In a preclinical model, PD-1+ CD8 tumor-infiltrating lymphocytes differentially infiltrated PDAC tumors obtained from cell lines with different metabolic consumption, and tumors metabolically rewired by knocking down the phosphofructokinase (Pfkm) gene displayed a decrease in PD-1+ cell infiltration. Collectively, we introduced pancreatic juice as a valuable source of metabolic variables that could contribute to differential diagnosis. The correlation of metabolic markers with immune infiltration suggests that upfront evaluation of the metabolic profile of PDAC patients could foster the introduction of immunotherapeutic approaches for pancreatic cancer.
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Affiliation(s)
- Nina Cortese
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Giovanni Capretti
- Section of Pancreatic Surgery, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy.,Humanitas University, Department of Biomedical Sciences, Pieve Emanuele-Milan, Italy
| | - Marialuisa Barbagallo
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Alessandra Rigamonti
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy.,Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Panteleimon G Takis
- Giotto Biotech S.R.L., Sesto Fiorentino, Florence, Italy.,Department of Metabolism, Digestion and Reproduction, National Phenome Centre, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Giovanni F Castino
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Debora Vignali
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giulia Maggi
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy.,Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Francesca Gavazzi
- Section of Pancreatic Surgery, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Cristina Ridolfi
- Section of Pancreatic Surgery, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Gennaro Nappo
- Section of Pancreatic Surgery, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Greta Donisi
- Section of Pancreatic Surgery, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Marco Erreni
- Unit of Advanced Optical Microscopy, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Roberta Avigni
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Daoud Rahal
- Department of Pathology, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Paola Spaggiari
- Department of Pathology, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Massimo Roncalli
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele-Milan, Italy.,Department of Pathology, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Paola Cappello
- Center for Experimental Research and Medical Studies, Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Francesco Novelli
- Center for Experimental Research and Medical Studies, Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Paolo Monti
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessandro Zerbi
- Section of Pancreatic Surgery, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy.,Humanitas University, Department of Biomedical Sciences, Pieve Emanuele-Milan, Italy
| | - Paola Allavena
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Alberto Mantovani
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy.,Humanitas University, Department of Biomedical Sciences, Pieve Emanuele-Milan, Italy.,The William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Federica Marchesi
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy. .,Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
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23
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Influx rate constant of 18F-FDG increases in metastatic lymph nodes of non-small cell lung cancer patients. Eur J Nucl Med Mol Imaging 2020; 47:1198-1208. [PMID: 31974680 DOI: 10.1007/s00259-020-04682-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 01/02/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE Primary tumor (PT) and metastatic lymph node (MLN) status have a great influence on diagnosis and treatment of lung cancer. Our main purpose was to investigate the imaging characteristics of PT or MLN by applying the 18F-FDG PET dynamic modeling approach for non-small cell lung cancer (NSCLC). METHODS Dynamic 18F-FDG PET scans were performed for 76 lung cancer patients, and 62 NSCLC cases were finally included in this study: 37 with newly diagnosed early and locally advanced lung cancer without distant metastases (group M0) and 25 metastatic lung cancer (group M1). Patlak graphic analysis (Ki calculation) based on the dynamic modeling and SUV analysis from conventional static data were performed. RESULTS For PT, both KiPT (0.050 ± 0.005 vs 0.026 ± 0.004 min-1, p < 0.001) and SUVPT (8.41 ± 0.64 vs 5.23 ± 0.73, p < 0.01) showed significant higher values in group M1 than M0. For MLN, KiMLN showed significant higher values in M1 than M0 (0.033 ± 0.005 vs 0.016 ± 0.003 min-1, p < 0.01), while no significant differences were found for SUVMLN between M0 and M1 (4.22 ± 0.49 vs 5.57 ± 0.59, p > 0.05). Both SUV PT and KiPT showed significant high values in squamous cell carcinoma than adenocarcinoma, but neither SUVPT nor KiPT showed significant differences between EGFR mutants versus wild types. The overall Spearman analysis for SUV and Ki from different groups showed variable correlation (r = 0.46-0.94). CONCLUSION The dynamic modeling for MLN (KiMLN) showed more sensitive than the static analysis (SUV) to detect metastatic lymph nodes in NSCLC, although both methods were sensitive for PT. This methodology of non-invasive imaging may become an important tool to evaluate MLN and PT status for patients who cannot undergo histological examination. CLINICAL TRIAL REGISTRATION The clinical trial registration number is NCT03679936 (http://www.clinicaltrials.gov/).
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24
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Akaike K, Saruwatari K, Oda S, Shiraishi S, Takahashi H, Hamada S, Iyama S, Horio Y, Tomita Y, Saeki S, Okamoto S, Ichiyasu H, Fujii K, Sakagami T. Predictive value of 18F-FDG PET/CT for acute exacerbation of interstitial lung disease in patients with lung cancer and interstitial lung disease treated with chemotherapy. Int J Clin Oncol 2019; 25:681-690. [PMID: 31781994 DOI: 10.1007/s10147-019-01584-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/19/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND We examined whether fluorine-18 2-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) performed before chemotherapy could predict the onset of acute exacerbation of interstitial lung disease (AE-ILD) in patients with lung cancer and ILD treated with chemotherapy. METHODS Thirty-three patients with lung cancer and ILD who underwent 18F-FDG PET/CT and were treated with chemotherapy at Kumamoto University Hospital between April 2006 and March 2018 were retrospectively analyzed. The maximum standardized uptake value (SUVmax) of interstitial lesions was measured to quantify the background ILD activity. A prediction model of AE-ILD was developed using logistic regression analyses for the SUVmax, and receiver operating characteristic (ROC) curve analyses were conducted. RESULTS Among the 33 patients, 7 experienced AE-ILD. The SUVmax of contralateral interstitial lesions was significantly higher in patients with vs. without AE-ILD (median SUVmax: 2.220 vs. 1.795, P = 0.025). Univariable logistic regression analyses showed that the SUVmax of contralateral interstitial lesions trended towards being significantly associated with the onset of AE-ILD [odds ratio: 8.683, 95% confidence interval (CI) 0.88-85.83, P = 0.064]. The area under the ROC curve of the SUVmax for predicting AE-ILD was 0.780 (95% CI 0.579-0.982, P = 0.025). The optimal cut-off value for SUVmax was 2.005, with sensitivity and specificity values of 0.857 and 0.769, respectively. CONCLUSIONS The SUVmax of contralateral interstitial lesions in 18F-FDG PET/CT images might be useful for predicting the onset of AE-ILD in patients with lung cancer and ILD treated with chemotherapy.
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Affiliation(s)
- Kimitaka Akaike
- Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, Kumamoto, 860-8556, Japan
| | - Koichi Saruwatari
- Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, Kumamoto, 860-8556, Japan.
| | - Seitaro Oda
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Shinya Shiraishi
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Hiroshi Takahashi
- Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, Kumamoto, 860-8556, Japan
| | - Shohei Hamada
- Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, Kumamoto, 860-8556, Japan
| | - Shinji Iyama
- Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, Kumamoto, 860-8556, Japan
| | - Yuko Horio
- Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, Kumamoto, 860-8556, Japan
| | - Yusuke Tomita
- Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, Kumamoto, 860-8556, Japan
| | - Sho Saeki
- Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, Kumamoto, 860-8556, Japan
| | - Shinichiro Okamoto
- Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, Kumamoto, 860-8556, Japan
| | - Hidenori Ichiyasu
- Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, Kumamoto, 860-8556, Japan
| | - Kazuhiko Fujii
- Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, Kumamoto, 860-8556, Japan
| | - Takuro Sakagami
- Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, Kumamoto, 860-8556, Japan
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25
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Relationships between hypoxia induced factor-1α and 18F-FDG PET/CT parameters in colorectal cancer. Rev Esp Med Nucl Imagen Mol 2019. [DOI: 10.1016/j.remnie.2019.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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26
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Hasbek Z, Ozer H, Erturk SA, Erdiş E, Yucel B, Çiftçi E, Çakmakcilar A. Relationships between hypoxia induced factor-1α and 18F-FDG PET/CT parameters in colorectal cancer. Rev Esp Med Nucl Imagen Mol 2019; 38:355-361. [PMID: 31672495 DOI: 10.1016/j.remn.2019.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/28/2019] [Accepted: 05/02/2019] [Indexed: 10/25/2022]
Abstract
AIM The hypoxia-inducible factor 1 (HIF-1) has a critical role in oxygen homeostasis and it is a transcriptional activator of angiogenesis, erythropoiesis, iron and glucose metabolism. Glucose metabolism rate is increased in some tumours via HIF-1α. Our aim is to evaluate the relationship between hypoxia in colorectal cancer, PET parameters, necrotic tissue size and pathologic prognostic factors via using HIF-1α. MATERIALS/METHODS 70 patients (28 female/42 male; median age: 63 years) who were diagnosed with colorectal cancer via biopsy were staged with preoperative PET/CT and operated subsequently. Immunohistochemical evaluation scoring was done according to nuclear HIF-1α expression, staining density and intensity. Metabolic tumour volume (MTV), total lesion glycolysis (TLG) and tumour volume (TV) were calculated by using volume of an ellipsoid formula via CT images, and percentage of tumour necrosis (%TmNcr) that was calculated by the difference between TV and recorded MTV. RESULTS There was a moderately meaningful positive correlation between tumour SUVmax and TV and %TmNcr (r=0.403, p=0.001 and r=0.500, p=0.0001, respectively). There were no statistically significant relationships between HIF-1α expression levels and tumour SUVmax, TLG, MTV, TV, %TmNcr, tumour stage, lymphovascular invasion, perineural invasion and extracapsular/capsular lymph node involvement. On the other hand, strong nuclear immunohistochemical staining was seen in tumour cells adjacent to invasive border, inflammatory cells. Although not statistically significant, moderate or strong nuclear staining were seen in 64.9% of metastatic patients. CONCLUSION Although the presence of a positive correlation between tumour SUVmax and %TmNcr shows that there are hypoxic cells in cancer tissue with high FDG uptake, the relationship between the presence of HIF-1α and enhanced glucose metabolism and pathological prognostic factors of tumour was not shown. Strong nuclear immunohistochemical staining in tumour cells adjacent to invasive border and inflammatory cells leads us to believe that HIF-1α plays a role in the invasion area of tumour microenvironment.
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Affiliation(s)
- Z Hasbek
- Cumhuriyet University, School of Medicine, Department of Nuclear Medicine, Sivas, Turquía.
| | - H Ozer
- Cumhuriyet University, School of Medicine, Department of Pathology, Sivas, Turquía
| | - S A Erturk
- Cumhuriyet University, School of Medicine, Department of Nuclear Medicine, Sivas, Turquía
| | - E Erdiş
- Cumhuriyet University, School of Medicine, Department of Radiation Oncology, Sivas, Turquía
| | - B Yucel
- Cumhuriyet University, School of Medicine, Department of Radiation Oncology, Sivas, Turquía
| | - E Çiftçi
- Sakarya University, School of Medicine, Research and Training Hospital, Department of Nuclear Medicine, Sakarya, Turquía
| | - A Çakmakcilar
- Cumhuriyet University, School of Medicine, Department of Nuclear Medicine, Sivas, Turquía
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Ichikawa T, Aokage K, Miyoshi T, Tane K, Suzuki K, Makinoshima H, Tsuboi M, Ishii G. Correlation between maximum standardized uptake values on FDG-PET and microenvironmental factors in patients with clinical stage IA radiologic pure-solid lung adenocarcinoma. Lung Cancer 2019; 136:57-64. [DOI: 10.1016/j.lungcan.2019.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/26/2019] [Accepted: 08/02/2019] [Indexed: 10/26/2022]
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Tubin S, Popper HH, Brcic L. Novel stereotactic body radiation therapy (SBRT)-based partial tumor irradiation targeting hypoxic segment of bulky tumors (SBRT-PATHY): improvement of the radiotherapy outcome by exploiting the bystander and abscopal effects. Radiat Oncol 2019; 14:21. [PMID: 30696472 PMCID: PMC6352381 DOI: 10.1186/s13014-019-1227-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 01/20/2019] [Indexed: 12/31/2022] Open
Abstract
Background Despite the advances in oncology, patients with bulky tumors have worse prognosis and often receive only palliative treatments. Bulky disease represents an important challenging obstacle for all currently available radical treatment options including conventional radiotherapy. The purpose of this study was to assess a retrospective outcome on the use of a newly developed unconventional stereotactic body radiation therapy (SBRT) for PArtial Tumor irradiation of unresectable bulky tumors targeting exclusively their HYpoxic segment (SBRT-PATHY) that exploits the non-targeted effects of radiotherapy: bystander effects (local) and the abscopal effects (distant). Materials and methods Twenty-three patients with bulky tumors received partial bulky irradiation in order to induce the local non-targeted effect of radiation (bystander effect). The hypoxic tumor segment, called the bystander tumor volume (BTV), was defined using PET and contrast-enhanced CT, as a hypovascularized-hypometabolic junctional zone between the central necrotic and peripheral hypervascularized-hypermetabolic tumor segment. Based on tumor site and volume, the BTV was irradiated with 1–3 fractions of 10–12 Gy prescribed to 70% isodose-line. The pathologic lymph nodes and metastases were not irradiated in order to assess the distant non-targeted effects of radiation (abscopal effect). No patient received any systemic therapy. Results At the time of analysis, with median follow-up of 9.4 months (range: 4–20), 87% of patients remained progression-free. The bystander and abscopal response rates were 96 and 52%, respectively. Median shrinkage of partially irradiated bulky tumor expressing intensity of the bystander effect was 70% (range 30–100%), whereas for the non-irradiated metastases (intensity of the abscopal effect), it was 50% (range 30–100%). No patient experienced acute or late toxicity of any grade. Conclusions SBRT-PATHY showed very inspiring results on exploitation of the radiation-hypoxia-induced non-targeted effects that need to be confirmed through our ongoing prospective trial. Present study has been retrospectively registered by the local ethic committee under study number A 26/18.
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Affiliation(s)
- Slavisa Tubin
- KABEG Klinikum Klagenfurt, Institute of Radiation Oncology, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Austria.
| | - Helmut H Popper
- Medical University of Graz, Diagnostic and Research Institute of Pathology, Neue Stiftingtalstrasse 6, 8036, Graz, Austria
| | - Luka Brcic
- Medical University of Graz, Diagnostic and Research Institute of Pathology, Neue Stiftingtalstrasse 6, 8036, Graz, Austria
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Can the Efficacy of [ 18F]FDG-PET/CT in Clinical Oncology Be Enhanced by Screening Biomolecular Profiles? Pharmaceuticals (Basel) 2019; 12:ph12010016. [PMID: 30678034 PMCID: PMC6469153 DOI: 10.3390/ph12010016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 01/03/2019] [Accepted: 01/14/2019] [Indexed: 12/22/2022] Open
Abstract
Positron Emission Tomography (PET) is a functional imaging modality widely used in clinical oncology. Over the years the sensitivity and specificity of PET has improved with the advent of specific radiotracers, increased technical accuracy of PET scanners and incremental experience of Radiologists. However, significant limitations exist—most notably false positives and false negatives. Additionally, the accuracy of PET varies between cancer types and in some cancers, is no longer considered a standard imaging modality. This review considers the relative influence of macroscopic tumour features such as size and morphology on 2-Deoxy-2-[18F]fluoroglucose ([18F]FDG) uptake by tumours which, though well described in the literature, lacks a comprehensive assessment of biomolecular features which may influence [18F]FDG uptake. The review aims to discuss the potential influence of individual molecular markers of glucose transport, glycolysis, hypoxia and angiogenesis in addition to the relationships between these key cellular processes and their influence on [18F]FDG uptake. Finally, the potential role for biomolecular profiling of individual tumours to predict positivity on PET imaging is discussed to enhance accuracy and clinical utility.
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Thureau S, Dubray B, Modzelewski R, Bohn P, Hapdey S, Vincent S, Anger E, Gensanne D, Pirault N, Pierrick G, Vera P. FDG and FMISO PET-guided dose escalation with intensity-modulated radiotherapy in lung cancer. Radiat Oncol 2018; 13:208. [PMID: 30352608 PMCID: PMC6199734 DOI: 10.1186/s13014-018-1147-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 10/03/2018] [Indexed: 12/25/2022] Open
Abstract
Background Concomitant chemo-radiotherapy is the reference treatment for non-resectable locally-advanced Non-Small Cell Lung Cancer (NSCLC). Increasing radiotherapy total dose in the whole tumour volume has been shown to be deleterious. Functional imaging with positron emission tomography (PET/CT) offers the potential to identify smaller and biologically meaningful target volumes that could be irradiated with larger doses without compromising Organs At Risk (OAR) tolerance. This study investigated four scenarios, based on 18FDG and 18F-miso PET/CT, to delineate the target volumes and derive radiotherapy plans delivering up to 74Gy. Method Twenty-one NSCLC patients, selected from a prospective phase II trial, had 18FDG- and 18F-miso PET/CT before the start of radiotherapy and 18FDG PET/CT during the radiotherapy (42Gy). The plans were based planned on a standard plan delivering 66 Gy (plan 1) and on three different boost strategies to deliver 74Gy total dose in pre-treatment 18FDG hotspot (70% of SUVmax) (plan 2), pre-treatment 18F-miso target (SUVmax > 1.4) (plan 3) and per-treatment 18FDG residual (40% of SUVmax). (plan 4). Results The mean target volumes were 4.8 cc (± 1.1) for 18FDG hotspot, 38.9 cc (± 14.5) for 18F-miso and 36.0 cc (± 10.1) for per-treatment 18FDG. In standard plan (66 Gy), the mean dose covering 95% of the PTV (D95%) were 66.5 (± 0.33), 66.1 (± 0.32) and 66.1 (± 0.32) Gy for 18FDG hotspot, 18F-miso and per-treatment 18FDG. In scenario 2, the mean D95% was 72.5 (± 0.25) Gy in 18FDG hotspot versus 67.9 (± 0.49) and 67.9 Gy (± 0.52) in 18F-miso and per-treatment 18FDG, respectively. In scenario 3, the mean D95% was 72.2 (± 0.27) Gy to 18F-miso versus 70.4 (± 0.74) and 69.5Gy (± 0.74) for 18FDG hotspot and per-treatment 18FDG, respectively. In scenario 4, the mean D95% was 73.1 (± 0.3) Gy to 18FDG per-treatment versus 71.9 (± 0.61) and 69.8 (± 0.61) Gy for 18FDG hotspot and 18F-miso, respectively. The dose/volume constraints to OARs were matched in all scenarios. Conclusion Escalated doses can be selectively planned in NSCLC target volumes delineated on 18FDG and 18F-miso PET/CT functional images. The most relevant strategy should be investigated in clinical trials. Trial registration (RTEP5, NCT01576796, registered 15 june 2012)
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Affiliation(s)
- Sébastien Thureau
- Department of Radiation Oncology and Medical Physics, Centre Henri Becquerel, QuantIF - LITIS [EA 4108], Université de Normandie, CS 11516, rue d'Amiens, 76038, Rouen Cedex 1, France. .,Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108 - FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France.
| | - Bernard Dubray
- Department of Radiation Oncology and Medical Physics, Centre Henri Becquerel, QuantIF - LITIS [EA 4108], Université de Normandie, CS 11516, rue d'Amiens, 76038, Rouen Cedex 1, France
| | - Romain Modzelewski
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108 - FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France
| | - Pierre Bohn
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108 - FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France
| | - Sébastien Hapdey
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108 - FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France
| | - Sabine Vincent
- Department of Radiation Oncology and Medical Physics, Centre Henri Becquerel, QuantIF - LITIS [EA 4108], Université de Normandie, CS 11516, rue d'Amiens, 76038, Rouen Cedex 1, France
| | - Elodie Anger
- Department of Radiation Oncology and Medical Physics, Centre Henri Becquerel, QuantIF - LITIS [EA 4108], Université de Normandie, CS 11516, rue d'Amiens, 76038, Rouen Cedex 1, France
| | - David Gensanne
- Department of Radiation Oncology and Medical Physics, Centre Henri Becquerel, QuantIF - LITIS [EA 4108], Université de Normandie, CS 11516, rue d'Amiens, 76038, Rouen Cedex 1, France
| | - Nicolas Pirault
- Department of Radiation Oncology and Medical Physics, Centre Henri Becquerel, QuantIF - LITIS [EA 4108], Université de Normandie, CS 11516, rue d'Amiens, 76038, Rouen Cedex 1, France
| | - Gouel Pierrick
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108 - FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France
| | - Pierre Vera
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108 - FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France
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Tumor heterogeneity, hypoxia, and immune markers in surgically resected non-small-cell lung cancer. Nucl Med Commun 2018; 39:636-644. [PMID: 29608508 DOI: 10.1097/mnm.0000000000000832] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES This study aimed to determine the prognostic role of textural features and their association with metabolic parameters, hypoxia, and cancer-related immune markers in non-small-cell lung cancer (NSCLC) patients. PATIENTS AND METHODS The trial was registered at http://www.clinicaltrials.gov (NCT02519062). From January 2010 to May 2014, 44 patients (male : female=33 : 11; median age: 69.5 years), referred to our Institution for NSCLC resection, were enrolled. Tumor specimens were assessed for HIF-1α, CD68-TAMs, CD8-TILs, PD-1-TILs, and PD-L1 expressions. All patients underwent fluorine-18-fluorodeoxyglucose (F-FDG) PET before surgery. Semiquantitative parameters included maximum standardized uptake value (SUVmax), SUVpeak, SUVmean, metabolic tumor volume, and total lesion glycolysis, whereas for heterogeneity, we considered tumor sphericity, skewness, kurtosis, entropy, and energy. Parameters were correlated with disease-free survival (DFS) considering a median follow-up of 22.7 months. RESULTS SUVmax (cutoff: 7.9; P=0.015), SUVpeak (cutoff: 6.7; P=0.013), SUVmean (cutoff: 5.5; P=0.028), metabolic tumor volume (cutoff: 3.6 cm; P=0.027), and entropy (cutoff: 1.89; P=0.045) showed a statistically significant association with DFS. Also, a high expression of cytoplasmic HIF-1α (score 3) was associated with DFS (hazard ratio: 0.09; P=0.003). All F-FDG PET variables differed significantly in tumors with high or low entropy (≤1.89). Also, a significantly higher level of mean CD8-TILs was observed in tumors with higher entropy (P=0.041).Using identified prognostic factors, we developed a scoring system, which was confirmed to be associated with DFS (P<0.004). On receiver operating characteristics analysis, a score above 3 was defined as the optimal cutoff point. CONCLUSION Tumor heterogeneity, metabolic parameters, and high expression of hypoxia were found to be prognostic factors in NSCLC patients who were candidates for surgery. Higher levels of entropy appear to be associated with increased density of CD8-TILs. The combination of investigated prognostic factors enabled the development of a potential scoring system associated with DFS.
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Zhang J, Zhu Y, Dong M, Yang J, Weng W, Teng L. Iodine-125 interstitial brachytherapy reduces tumor growth via Warburg effect inhibition in non-small cell lung cancer A549 ×enografts. Oncol Lett 2018; 16:5969-5977. [PMID: 30344747 PMCID: PMC6176348 DOI: 10.3892/ol.2018.9346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 08/10/2018] [Indexed: 11/16/2022] Open
Abstract
Iodine-125 interstitial brachytherapy (125I-IBT) is an alternative and effective treatment option for unresectable non-small cell lung cancer (NSCLC), and the Warburg effect is a determinant of tumor growth. The present study aimed to explore the influence of 125I-IBT on tumor growth and the Warburg effect, and the potential mechanisms underlying NSCLC progression. Mice with A549 cell xenografts were evenly divided into a control group without 125I-IBT, and three treatment groups receiving 125I-IBT with 20, 40 and 60 Gy. Tumor volume (TV), maximum standardized uptake value (SUVmax) determined by 18F-fluorodeoxyglucose (18F-FDG) micro-positron emission tomography/computed tomography and mean optical density (MOD) of mammalian target of rapamycin (mTOR), c-Myc, hypoxia inducible factor-1α (HIF-1α) and glucose transporter 1 (GLUT1) staining were compared among groups. Tumor inhibition rate (TIR), 18F-FDG uptake attenuation rate (FUAR) and expression suppression rate (ESR) were also calculated on day 14 and 28. The results demonstrated that the mean TV in the 60 and 40 Gy groups was smaller compared with the control TVs since days 14 and 16, respectively. The mean SUVmax value of the 60 Gy group at day 14, and all treatment group SUVmax values at day 28 were lower compared with the controls. In addition, the MOD of mTOR and GLUT1 was lower in the 60 Gy group, compared with the other groups, and c-Myc and HIF-1α values were lower in the 40 and 60 Gy groups, compared with the control and 20 Gy group (P<0.05). SUVmax positively correlated to TV (day 14, r=0.711; day 28, r=0.586) and the MOD of c-Myc and GLUT1 (r=0.621 and 0.546, respectively; P<0.01). Furthermore, dose dependent increases were observed for TIR, FUAR and ESR. In conclusion, 125I-IBT reduced tumor growth by inhibiting the Warburg effect, which may have resulted from downregulation of mTOR, c-Myc, HIF-1α and GLUT1 expression, particularly c-Myc and GLUT1, in NSCLC A549 ×enografts.
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Affiliation(s)
- Jun Zhang
- Department of Nuclear Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Yangjun Zhu
- Department of Ultrasonography, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Mengjie Dong
- Department of Nuclear Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Jun Yang
- Department of Nuclear Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Wanwen Weng
- Department of Nuclear Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Lisong Teng
- Department of Surgical Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China.,Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
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A secondary analysis of FDG spatio-temporal consistency in the randomized phase II PET-boost trial in stage II–III NSCLC. Radiother Oncol 2018; 127:259-266. [DOI: 10.1016/j.radonc.2018.03.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 03/14/2018] [Accepted: 03/15/2018] [Indexed: 12/25/2022]
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Carles M, Bach T, Torres-Espallardo I, Baltas D, Nestle U, Martí-Bonmatí L. Significance of the impact of motion compensation on the variability of PET image features. Phys Med Biol 2018; 63:065013. [PMID: 29469054 DOI: 10.1088/1361-6560/aab180] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In lung cancer, quantification by positron emission tomography/computed tomography (PET/CT) imaging presents challenges due to respiratory movement. Our primary aim was to study the impact of motion compensation implied by retrospectively gated (4D)-PET/CT on the variability of PET quantitative parameters. Its significance was evaluated by comparison with the variability due to (i) the voxel size in image reconstruction and (ii) the voxel size in image post-resampling. The method employed for feature extraction was chosen based on the analysis of (i) the effect of discretization of the standardized uptake value (SUV) on complementarity between texture features (TF) and conventional indices, (ii) the impact of the segmentation method on the variability of image features, and (iii) the variability of image features across the time-frame of 4D-PET. Thirty-one PET-features were involved. Three SUV discretization methods were applied: a constant width (SUV resolution) of the resampling bin (method RW), a constant number of bins (method RN) and RN on the image obtained after histogram equalization (method EqRN). The segmentation approaches evaluated were 40[Formula: see text] of SUVmax and the contrast oriented algorithm (COA). Parameters derived from 4D-PET images were compared with values derived from the PET image obtained for (i) the static protocol used in our clinical routine (3D) and (ii) the 3D image post-resampled to the voxel size of the 4D image and PET image derived after modifying the reconstruction of the 3D image to comprise the voxel size of the 4D image. Results showed that TF complementarity with conventional indices was sensitive to the SUV discretization method. In the comparison of COA and 40[Formula: see text] contours, despite the values not being interchangeable, all image features showed strong linear correlations (r > 0.91, [Formula: see text]). Across the time-frames of 4D-PET, all image features followed a normal distribution in most patients. For our patient cohort, the compensation of tumor motion did not have a significant impact on the quantitative PET parameters. The variability of PET parameters due to voxel size in image reconstruction was more significant than variability due to voxel size in image post-resampling. In conclusion, most of the parameters (apart from the contrast of neighborhood matrix) were robust to the motion compensation implied by 4D-PET/CT. The impact on parameter variability due to the voxel size in image reconstruction and in image post-resampling could not be assumed to be equivalent.
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Affiliation(s)
- M Carles
- Division of Medical Physics, Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany. Clinical Area of Medical Imaging, Hospital Universitario y Politécnico La Fe, Valencia, Spain. Author to whom any correspondence should be addressed
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Quantitative assessment of Zirconium-89 labeled cetuximab using PET/CT imaging in patients with advanced head and neck cancer: a theragnostic approach. Oncotarget 2018; 8:3870-3880. [PMID: 27965472 PMCID: PMC5354801 DOI: 10.18632/oncotarget.13910] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 12/02/2016] [Indexed: 12/25/2022] Open
Abstract
Biomarkers predicting treatment response to the monoclonal antibody cetuximab in locally advanced head and neck squamous cell carcinomas (LAHNSCC) are lacking. We hypothesize that tumor accessibility is an important factor in treatment success of the EGFR targeting drug. We quantified uptake of cetuximab labeled with Zirconium-89 (89Zr) using PET/CT imaging. Seventeen patients with stage III-IV LAHNSCC received a loading dose unlabeled cetuximab, followed by 10 mg 54.5±9.6 MBq 89Zr-cetuximab. PET/CT images were acquired either 3 and 6 or 4 and 7 days post-injection. 89Zr-cetuximab uptake was quantified using standardized uptake value (SUV) and tumor-to-background ratio (TBR), and correlated to EGFR immunohistochemistry. TBR was compared between scan days to determine optimal timing. Uptake of 89Zr-cetuximab varied between patients (day 6-7: SUVpeak range 2.5-6.2). TBR increased significantly (49±28%, p < 0.01) between first (1.1±0.3) and second scan (1.7±0.6). Between groups with a low and high EGFR expression a significant difference in SUVmean (2.1 versus 3.0) and SUVpeak (3.2 versus 4.7) was found, however, not in TBR. Data is available at www.cancerdata.org (DOI: 10.17195/candat.2016.11.1). In conclusion, 89Zr-cetuximab PET imaging shows large inter-patient variety in LAHNSCC and provides additional information over FDG-PET and EGFR expression. Validation of the predictive value is recommended with scans acquired 6-7 days post-injection.
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Zha Z, Ploessl K, Lieberman BP, Wang L, Kung HF. Alanine and glycine conjugates of (2S,4R)-4-[ 18F]fluoroglutamine for tumor imaging. Nucl Med Biol 2018. [PMID: 29525446 DOI: 10.1016/j.nucmedbio.2018.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Glutamine is an essential source of energy, metabolic substrates, and building block for supporting tumor proliferation. Previously, (2S,4R)-4-[18F]fluoroglutamine (4F-Gln) was reported as a glutamine-related metabolic imaging agent. To improve the in vivo kinetics of this radiotracer, two new dipeptides, [18F]Gly-(2S,4R)4-fluoroglutamine (Gly-4F-Gln) and [18F]Ala-(2S,4R)4-fluoroglutamine (Ala-4F-Gln) were investigated. METHODS Radiolabeling was performed via 2-steps 18F-fluorination. Cell uptake studies of Gly-4F-Gln and Ala-4F-Gln were investigated in 9 L cell lines. In vitro and in vivo metabolism studies were carried out in Fisher 344 rats. Biodistribution and microPET imaging studies were performed in 9 L tumor-bearing rats. RESULTS In vitro incubation of these [18F]dipeptides in rat and human blood showed a rapid conversion to (2S,4R)-4-[18F]fluoroglutamine (t1/2 = 2.3 and 0.2 min for [18F]Gly-4F-Gln and [18F]Ala-4F-Gln, respectively for human blood). Biodistribution and PET imaging in Fisher 344 rats bearing 9 L tumor xenografts showed that these dipeptides rapidly localized in the tumors, comparable to that of (2S,4R)-4-[18F]fluoroglutamine (4F-Gln). CONCLUSIONS The results support that these dipeptides, [18F]Gly-4F-Gln and [18F]Ala-4F-Gln, are prodrugs, which hydrolyze in the blood after an iv injection. They appear to be selectively taken up and trapped by tumor tissue in vivo. The dipeptide, [18F]Ala-4F-Gln, may be suitable as a PET tracer for imaging glutaminolysis in tumors.
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Affiliation(s)
- Zhihao Zha
- Department of Radiology University of Pennsylvania, Philadelphia, PA 19104, United States; Beijing Institute for Brain Disorders, Capital Medical University, Beijing, 100069, China
| | - Karl Ploessl
- Department of Radiology University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Brian P Lieberman
- Department of Radiology University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Limin Wang
- Department of Radiology University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Hank F Kung
- Department of Radiology University of Pennsylvania, Philadelphia, PA 19104, United States; Beijing Institute for Brain Disorders, Capital Medical University, Beijing, 100069, China.
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Lee S, Choi S, Kim SY, Yun MJ, Kim HI. Potential Utility of FDG PET-CT as a Non-invasive Tool for Monitoring Local Immune Responses. J Gastric Cancer 2017; 17:384-393. [PMID: 29302378 PMCID: PMC5746659 DOI: 10.5230/jgc.2017.17.e43] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 12/22/2017] [Accepted: 12/22/2017] [Indexed: 01/15/2023] Open
Abstract
Purpose The tumor microenvironment is known to be associated with the metabolic activity of cancer cells and local immune reactions. We hypothesized that glucose metabolism measured by 2-deoxy-2-(18F)fluoro-D-glucose (18F-FDG) positron emission tomography (PET)-computed tomography (CT) (18F-FDG PET-CT) would be associated with local immune responses evaluated according to the presence of tumor infiltrating lymphocytes (TILs). Materials and Methods We retrospectively reviewed 56 patients who underwent 18F-FDG PET-CT prior to gastrectomy. In resected tumor specimens, TIL subsets, including cluster of differentiation (CD) 3, CD4, CD8, Forkhead box P3 (Foxp3), and granzyme B, were subjected to immunohistochemical analysis. The prognostic nutritional index (PNI) was calculated as: (10×serum albumin value)+(0.005×peripheral lymphocyte counts). Additionally, the maximum standard uptake value (SUVmax) was calculated to evaluate the metabolic activity of cancer cells. Results The SUVmax was positively correlated with larger tumor size (R=0.293; P=0.029) and negatively correlated with PNI (R=−0.407; P=0.002). A higher SUVmax showed a marginal association with higher CD3 (+) T lymphocyte counts (R=0.227; P=0.092) and a significant association with higher Foxp3 (+) T lymphocyte counts (R=0.431; P=0.009). No other clinicopathological characteristics were associated with SUVmax or TILs. Survival analysis, however, indicated that neither SUVmax nor Foxp3 held prognostic significance. Conclusions FDG uptake on PET-CT could be associated with TILs, especially regulatory T cells, in gastric cancer. This finding may suggest that PET-CT could be of use as a non-invasive tool for monitoring the tumor microenvironment in patients with gastric cancer.
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Affiliation(s)
- Seungho Lee
- Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Seohee Choi
- Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Sang Yong Kim
- Medical Research Center, Yonsei University College of Medicine, Seoul, Korea.,Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Mi Jin Yun
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.,Medical Research Center, Yonsei University College of Medicine, Seoul, Korea.,Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei University Health System, Seoul, Korea
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Hunting for abscopal and bystander effects: clinical exploitation of non-targeted effects induced by partial high-single-dose irradiation of the hypoxic tumour segment in oligometastatic patients. Acta Oncol 2017; 56:1333-1339. [PMID: 28686524 DOI: 10.1080/0284186x.2017.1346385] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Incerti E, Mapelli P, Vuozzo M, Fallanca F, Monterisi C, Bettinardi V, Moresco RM, Gianolli L, Picchio M. Clinical PET imaging of tumour hypoxia in lung cancer. Clin Transl Imaging 2017. [DOI: 10.1007/s40336-017-0243-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Suzuki H, Kato K, Nishio M, Tamaki T, Fujimoto Y, Hiramatsu M, Hanai N, Kodaira T, Itoh Y, Naganawa S, Sone M, Hasegawa Y. FDG-PET/CT predicts survival and lung metastasis of hypopharyngeal cancer in a multi-institutional retrospective study. Ann Nucl Med 2017; 31:514-520. [PMID: 28470631 DOI: 10.1007/s12149-017-1176-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 04/24/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We investigated a possible correlation between the maximum standardized uptake value (SUVmax), which is assessed by pretreatment 18F-fluorodeoxyglucose positron emission tomography with computed tomography, and the overall survival (OS) in patients with hypopharyngeal squamous cell carcinoma from two institutions on long-term follow-up, and examined whether SUVmax is correlated with several survival outcomes, including lung metastasis-free survival. METHODS A total of 81 patients were enrolled. The survival rate was calculated by the Kaplan-Meier method. Both univariate and multivariate survival analyses were assessed by a Cox proportional hazards model. RESULTS SUVmax ≥15.2 in institution A (p = 0.0306) or SUVmax ≥8 in institution B (p = 0.0132) was significantly predictor of a lower OS. We disaggregated the data by high SUVmax (SUVmax ≥15.2 from institution A and SUVmax ≥8 from institution B) and low SUVmax (SUVmax <15.2 from institution A and SUVmax <8 from institution B). Patients with a high SUVmax exhibited a significantly lower OS in both univariate (p = 0.001) and multivariate (p = 0.0046) analyses for adjusted for the clinical stage and treatment group. The patients with a high SUVmax exhibited significantly shorter disease-specific (p = 0.0068), distant metastasis-free (p = 0.0428), and lung metastasis-free (p = 0.0328) survivals. CONCLUSIONS High SUVmax was significantly correlated with a lower OS, disease-specific survival, distant metastasis-free survival, and lung metastasis-free survival in a multi-institutional retrospective study.
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Affiliation(s)
- Hidenori Suzuki
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan.
| | - Katsuhiko Kato
- Department of Radiological Technology of Health Sciences, Nagoya University School of Health Sciences, Nagoya, Japan
| | - Masami Nishio
- Department of Radiology, Nagoya Positron Emission Tomography Imaging Center, Nagoya, Japan
| | - Tsuneo Tamaki
- Department of East Nagoya Positron Emission Tomography Imaging Center, Nagoya, Japan
| | - Yasushi Fujimoto
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mariko Hiramatsu
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuhiro Hanai
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Takeshi Kodaira
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yoshiyuki Itoh
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Michihiko Sone
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhisa Hasegawa
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
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Takamochi K, Mogushi K, Kawaji H, Imashimizu K, Fukui M, Oh S, Itoh M, Hayashizaki Y, Ko W, Akeboshi M, Suzuki K. Correlation of EGFR or KRAS mutation status with 18F-FDG uptake on PET-CT scan in lung adenocarcinoma. PLoS One 2017; 12:e0175622. [PMID: 28422979 PMCID: PMC5396974 DOI: 10.1371/journal.pone.0175622] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 03/27/2017] [Indexed: 12/02/2022] Open
Abstract
Background 18F-fluoro-2-deoxy-glucose (18F-FDG) positron emission tomography (PET) is a functional imaging modality based on glucose metabolism. The correlation between EGFR or KRAS mutation status and the standardized uptake value (SUV) of 18F-FDG PET scanning has not been fully elucidated. Methods Correlations between EGFR or KRAS mutation status and clinicopathological factors including SUVmax were statistically analyzed in 734 surgically resected lung adenocarcinoma patients. Molecular causal relationships between EGFR or KRAS mutation status and glucose metabolism were then elucidated in 62 lung adenocarcinomas using cap analysis of gene expression (CAGE), a method to determine and quantify the transcription initiation activities of mRNA across the genome. Results EGFR and KRAS mutations were detected in 334 (46%) and 83 (11%) of the 734 lung adenocarcinomas, respectively. The remaining 317 (43%) patients had wild-type tumors for both genes. EGFR mutations were more frequent in tumors with lower SUVmax. In contrast, no relationship was noted between KRAS mutation status and SUVmax. CAGE revealed that 4 genes associated with glucose metabolism (GPI, G6PD, PKM2, and GAPDH) and 5 associated with the cell cycle (ANLN, PTTG1, CIT, KPNA2, and CDC25A) were positively correlated with SUVmax, although expression levels were lower in EGFR-mutated than in wild-type tumors. No similar relationships were noted with KRAS mutations. Conclusions EGFR-mutated adenocarcinomas are biologically indolent with potentially lower levels of glucose metabolism than wild-type tumors. Several genes associated with glucose metabolism and the cell cycle were specifically down-regulated in EGFR-mutated adenocarcinomas.
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Affiliation(s)
- Kazuya Takamochi
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
- * E-mail:
| | - Kaoru Mogushi
- Center for Genomic and Regenerative Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Hideya Kawaji
- Preventive Medicine and Applied Genomics Unit, RIKEN Advanced Center for Computing and Communication, Yokohama, Kanagawa, Japan
- RIKEN Preventive Medicine and Diagnosis Innovation Program, Wako, Saitama, Japan
| | - Kota Imashimizu
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Mariko Fukui
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Shiaki Oh
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Masayoshi Itoh
- Preventive Medicine and Applied Genomics Unit, RIKEN Advanced Center for Computing and Communication, Yokohama, Kanagawa, Japan
| | - Yoshihide Hayashizaki
- Preventive Medicine and Applied Genomics Unit, RIKEN Advanced Center for Computing and Communication, Yokohama, Kanagawa, Japan
| | - Weijey Ko
- Diagnostic Imaging Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Masao Akeboshi
- Diagnostic Imaging Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
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Shirai K, Abe T, Saitoh JI, Mizukami T, Irie D, Takakusagi Y, Shiba S, Okano N, Ebara T, Ohno T, Nakano T. Maximum standardized uptake value on FDG-PET predicts survival in stage I non-small cell lung cancer following carbon ion radiotherapy. Oncol Lett 2017; 13:4420-4426. [PMID: 28588712 DOI: 10.3892/ol.2017.5952] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 02/17/2017] [Indexed: 12/29/2022] Open
Abstract
The present study (University Hospital Medical Information Network study no. UMIN000003797) aimed to evaluate whether the maximum standardized uptake value (SUVmax) of pretreatment 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) is prognostic factor for stage I non-small cell lung cancer (NSCLC) treated with carbon ion radiotherapy (C-ion RT). Patients treated between June 2010 and June 2013 at Gunma University Heavy Ion Medical Center (Maebashi, Japan) on a prospective protocol were included in the present study. Patients with T1a-b and T2a NSCLC were treated with C-ion RT at a dose of 52.8 Gy [relative biological effectiveness (RBE)] and 60.0 Gy (RBE), respectively, in four fractions. Prior to treatment, all patients underwent FDG-PET, in which the SUVmax of primary tumors was evaluated. Local control, progression-free survival (PFS), and overall survival (OS) were calculated. A total of 45 patients were analyzed and the median follow-up period was 28.9 months. The 2-year local control, PFS and OS rates for all patients were 93, 78 and 89%, respectively. The mean SUVmax of primary tumors was 5.5, and patients were divided into higher (≥5.5) and lower (<5.5) SUVmax groups. The 2-year PFS rates were 61 and 89% for the higher and lower SUVmax groups, respectively (P=0.01), and the 2-year OS rates for the higher and lower SUVmax groups were 76 and 96%, respectively (P=0.01). The higher SUVmax group exhibited a significantly worse PFS and OS compared with the lower SUVmax group; however, the SUVmax was not associated with the local control rate. In total, 2 patients (4%) experienced grade 2 or 3 radiation pneumonitis, with their symptoms improved through conservative treatment. No patients experienced any grade 4 or 5 toxicities. The results of the present study indicate that pretreatment SUVmax is a prognostic indicator for outcomes in patients with stage I NSCLC treated with C-ion RT.
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Affiliation(s)
- Katsuyuki Shirai
- Gunma University Heavy Ion Medical Center, Maebashi, Gunma 371-8511, Japan
| | - Takanori Abe
- Gunma University Heavy Ion Medical Center, Maebashi, Gunma 371-8511, Japan
| | - Jun-Ichi Saitoh
- Gunma University Heavy Ion Medical Center, Maebashi, Gunma 371-8511, Japan
| | - Tatsuji Mizukami
- Gunma University Heavy Ion Medical Center, Maebashi, Gunma 371-8511, Japan
| | - Daisuke Irie
- Gunma University Heavy Ion Medical Center, Maebashi, Gunma 371-8511, Japan
| | - Yosuke Takakusagi
- Gunma University Heavy Ion Medical Center, Maebashi, Gunma 371-8511, Japan
| | - Shintaro Shiba
- Gunma University Heavy Ion Medical Center, Maebashi, Gunma 371-8511, Japan
| | - Naoko Okano
- Gunma University Heavy Ion Medical Center, Maebashi, Gunma 371-8511, Japan
| | - Takeshi Ebara
- Department of Radiation Oncology, Gunma Prefectural Cancer Center, Ota, Gunma 373-8550, Japan
| | - Tatsuya Ohno
- Gunma University Heavy Ion Medical Center, Maebashi, Gunma 371-8511, Japan
| | - Takashi Nakano
- Gunma University Heavy Ion Medical Center, Maebashi, Gunma 371-8511, Japan
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Chaput A, Calais J, Robin P, Thureau S, Bourhis D, Modzelewski R, Schick U, Vera P, Salaün PY, Abgral R. Correlation between fluorodeoxyglucose hotspots on pretreatment positron emission tomography/CT and preferential sites of local relapse after chemoradiotherapy for head and neck squamous cell carcinoma. Head Neck 2017; 39:1155-1165. [PMID: 28263422 DOI: 10.1002/hed.24738] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 12/29/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The potential benefits of 18 F-fluoro-2-deoxy-D-glucose-positron emission tomography/CT (FDG-PET/CT) imaging for radiotherapy (RT) treatment planning of head and neck squamous cell carcinoma (HNSCC) are increasingly being recognized. It has been suggested that intratumoral subvolumes with high FDG avidity ("hotspots") are potential targets for selected dose escalation. The purposes of this study were to demonstrate that pre-RT FDG-PET/CT can identify intratumoral sites at increased risk of local relapse after RT and to determine an optimal threshold to delineate smaller RT target volumes that would facilitate RT dose escalation without impaired tolerance. METHODS Seventy-two consecutive patients with locally advanced HNSCC treated by RT ± chemotherapy were included in this study. All patients underwent FDG-PET/CT at initial staging (PETA ) and during systematic follow-up (PETR ). FDG-PET/CT was coregistered on the initial CT scan with a rigid method. Various subvolumes (AX ; × = 30%, 40%, 50%, 60%, 70%, 80%, and 90% standardized uptake value maximum [SUVmax] thresholds) within the primary tumor and in the subsequent local relapse (RX ; × = 40% and 70% SUVmax thresholds) were compared together (Dice, Jaccard, overlap fraction, common volume/baseline volume, and common volume/recurrent volume). RESULTS Nineteen patients (26%) had local relapses. Using a 40% SUVmax threshold, the initial metabolic tumor volume was significantly higher in patients with local relapses than in controlled patients (10.4 ± 8.6 vs 5.1 ± 4.9 cc; p = .002) as well as total lesion glycolysis (117.9 ± 88.6 vs 60.6 ± 80.4; p = .013). For both methods, the overlap index among A30 , A40 , and A50 subvolumes on PETA and the whole metabolic volume of recurrence R40 and R70 on PETR showed a moderate agreement (0.52 to 0.43). CONCLUSION Our study does not find high overlap index values between the initial tumor and recurrence subvolumes, probably because of a suboptimal coregistration. Our results also confirm that metabolic tumor volume and total lesion glycolysis are independently correlated with recurrence-free survival in patients with HNSCC. Further larger prospective studies with FDG-PET/CT performed in the same RT position and with a validated elastic registration method are needed. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1155-1165, 2017.
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Affiliation(s)
- Anne Chaput
- Department of Nuclear Medicine, Brest University Hospital, Brest, France
| | - Jérémie Calais
- Department of Nuclear Medicine, Bichat University Hospital, Inserm 1148, DHU FIRE, Assistance Publique - Hôpitaux de Paris, Paris, France.,Department of Nuclear Medicine and Radiology, Henri Becquerel Center, QuantIF (LITIS EA 4108 - FR CNRS 3638), Rouen University Hospital, Rouen, France
| | - Philippe Robin
- Department of Nuclear Medicine, Brest University Hospital, Brest, France.,European University of Brittany, EA3878 GETBO, IFR 148, Brest, France
| | - Sébastien Thureau
- Department of Nuclear Medicine and Radiology, Henri Becquerel Center, QuantIF (LITIS EA 4108 - FR CNRS 3638), Rouen University Hospital, Rouen, France
| | - David Bourhis
- Department of Nuclear Medicine, Brest University Hospital, Brest, France
| | - Romain Modzelewski
- Department of Nuclear Medicine and Radiology, Henri Becquerel Center, QuantIF (LITIS EA 4108 - FR CNRS 3638), Rouen University Hospital, Rouen, France
| | - Ulrike Schick
- Department of Radiotherapy, Brest University Hospital, Brest, France
| | - Pierre Vera
- Department of Nuclear Medicine and Radiology, Henri Becquerel Center, QuantIF (LITIS EA 4108 - FR CNRS 3638), Rouen University Hospital, Rouen, France
| | - Pierre-Yves Salaün
- Department of Nuclear Medicine, Brest University Hospital, Brest, France.,European University of Brittany, EA3878 GETBO, IFR 148, Brest, France
| | - Ronan Abgral
- Department of Nuclear Medicine, Brest University Hospital, Brest, France.,European University of Brittany, EA3878 GETBO, IFR 148, Brest, France
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Correlation of pretreatment 18F-FDG uptake with clinicopathological factors and prognosis in patients with newly diagnosed diffuse large B-cell lymphoma. Nucl Med Commun 2017; 37:689-98. [PMID: 27244584 PMCID: PMC4885594 DOI: 10.1097/mnm.0000000000000496] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Supplemental Digital Content is available in the text. Objectives The aim of this study is to determine the correlation of pretreatment fluorine-18 fluorodeoxyglucose uptake with clinicopathological factors and its prognostic value in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL). Patients and methods A cohort of 162 patients with newly diagnosed DLBCL who had undergone pretreatment PET/computed tomography was retrospectively reviewed. The relationship of pretreatment maximum standard uptake value (SUVmax) with clinical factors, molecular markers, and efficacy was evaluated. The value of SUVmax in predicting progression-free survival (PFS) and overall survival was analyzed. Results In all, 72.9% of the patients received R-CHOP treatment; the rest received CHOP chemotherapy. The median follow-up duration was 30 months (range, 4–124 months). The median SUVmax was 12.2 (range, 1.7–42.7). SUVmax between groups differed significantly with respect to each of International Prognostic Index (IPI) factors, except for age and performance status. High SUVmax was associated with high Ki-67 and Glut-3 protein expression, but not with Glut-1. Complete remission rate differed significantly between the low (SUVmax≤9.0) and the high SUVmax (SUVmax>9.0) groups (91.7 vs. 61.1%, P=0.000). Patients with low SUVmax showed favorable survival (3-year PFS: 92.2 vs. 63.6%, P=0.000; 3-year overall survival: 95.5 vs. 78.3%, P=0.003). On multivariate analyses, SUVmax predicted PFS independent of revised-IPI (SUVmax: P=0.011, hazard ratio 4.784; revised-IPI: P=0.004, hazard ratio 2.551). Conclusion Pretreatment SUVmax was associated with clinicopathological factors, efficacy, and survival outcome. A novel prognostic model on the basis of IPI score/pretreatment SUVmax might be useful for risk stratification of patients with newly diagnosed DLBCL Video abstract: http://links.lww.com/NMC/A55.
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Assessment of Aggressiveness of Breast Cancer Using Simultaneous 18F-FDG-PET and DCE-MRI: Preliminary Observation. Clin Nucl Med 2017; 41:e355-61. [PMID: 27187730 DOI: 10.1097/rlu.0000000000001254] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE This study aims to investigate the feasibility of using simultaneous breast MRI and PET to assess the synergy of MR pharmacokinetic and fluorine-18 fluorodeoxyglucose (F-FDG) uptake data to characterize tumor aggressiveness in terms of metastatic burden and Ki67 status. METHODS Twelve consecutive patients underwent breast and whole-body PET/MRI. During the MR scan, PET events were simultaneously accumulated. MR contrast kinetic model parametric maps were computed using the extended Tofts model, including the volume transfer constant between blood plasma and the interstitial space (K), the transfer constant from the interstitial space to the blood plasma (kep), and the plasmatic volume fraction (Vp). RESULTS Patients with systemic metastases had a significantly lower kep compared to those with local disease (0.45 vs. 0.99 min, P = 0.011). Metastatic burden correlated positively with K and standardized uptake value (SUV), and negatively with kep. Ki67 positive tumors had a significantly greater K compared to Ki67 negative tumors (0.29 vs. 0.45 min, P = 0.03). A negative correlation was found between metabolic tumor volume and transfer constant (K or Kep). CONCLUSION These preliminary results suggest that MR pharmacokinetic parameters and FDG-PET may aid in the assessment of tumor aggressiveness and metastatic potential. Future studies are warranted with a larger cohort to further assess the role of pharmacokinetic modeling in simultaneous PET/MRI imaging.
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Nodal parameters of FDG PET/CT performed during radiotherapy for locally advanced mucosal primary head and neck squamous cell carcinoma can predict treatment outcomes: SUVmean and response rate are useful imaging biomarkers. Eur J Nucl Med Mol Imaging 2016; 44:801-811. [DOI: 10.1007/s00259-016-3584-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 11/22/2016] [Indexed: 11/25/2022]
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Koh YW, Lee SJ, Park SY. Differential expression and prognostic significance of GLUT1 according to histologic type of non-small-cell lung cancer and its association with volume-dependent parameters. Lung Cancer 2016; 104:31-37. [PMID: 28212997 DOI: 10.1016/j.lungcan.2016.12.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 11/09/2016] [Accepted: 12/10/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND We evaluated glucose transporter type 1 (GLUT1) and carbonic anhydrase IX (CAIX) expression, together with volume-based18F-fluorodeoxyglucose positron emission tomography (FDG-PET) parameters, in non-small cell lung cancer (NSCLC) patients, and examined the prognostic significance of those parameters according to its histologic subtype. METHOD A total of 269 patients, who underwent surgical resection for NSCLC, were reviewed retrospectively. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) values were measured by preoperative 18F-fluorodeoxyglucose positron emission tomography computed tomography. GLUT1 and CAIX expression was evaluated using immunohistochemical method. RESULTS The mean MTV and TLG values were 30.0±57.1 and 165.4±361.3, respectively, and were significantly higher in patients with squamous cell carcinoma than with adenocarcinoma (p=0.047 for MTV; p=0.042 for TLG). GLUT1 expression was identified in 99% of squamous cell carcinoma and 50% of adenocarcinoma patients. MTV and TLG values were significantly higher in GLUT1-positive than GLUT-negative adenocarcinomas; however, CAIX expression did not show this pattern. GLUT1-positive adenocarcinoma patients had a lower OS than GLUT1-negative patients (p<0.001), whereas CAIX-positive and CAIX-negative patients showed similar OS rates (p=0.226). Patients with high MTV and TLG values showed lower OS rates than those with low MTV and TLG values. Multivariate analysis showed that GLUT1 positivity was an independent risk factor for a lower OS rate in lung adenocarcinoma patients (hazard ratio=2.574, p=0.016). GLUT1 expression was associated with micropapillary/solid histology, lymphovascular invasion, and advanced pTNM stage. CONCLUSIONS MTV and TLG values, and GLUT1 expression, significantly differed between patients with squamous cell carcinoma and adenocarcinoma. High GLUT1 expression levels were significantly associated with MTV and TLG values and adverse clinical outcomes in patients with adenocarcinoma.
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Affiliation(s)
- Young Wha Koh
- Department of Pathology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Su Jin Lee
- Department of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, 206 Worldcup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do 16499, Republic of Korea.
| | - Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine, 206 Worldcup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do 16499, Republic of Korea.
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Song B, Zhang Q, Yu M, Qi X, Wang G, Xiao L, Yi Q, Jin W. Ursolic acid sensitizes radioresistant NSCLC cells expressing HIF-1α through reducing endogenous GSH and inhibiting HIF-1α. Oncol Lett 2016; 13:754-762. [PMID: 28356955 PMCID: PMC5351155 DOI: 10.3892/ol.2016.5468] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 10/26/2016] [Indexed: 12/25/2022] Open
Abstract
In previous studies, the present authors demonstrated that effective sensitization of ionizing radiation-induced death of tumor cells, including non-small cell lung cancer (NSCLC) cells, could be produced by oleanolic acid (OA), a pentacyclic triterpenoid present in plants. In the present study, it was investigated whether ursolic acid (UA), an isomer of OA, had also the capacity of sensitizing radioresistant NSCLC cells. The radioresistant cell line H1299/M-hypoxia inducible factor-1α (HIF-1α) was established by transfection with a recombinant plasmid expressing mutant HIF-1α (M-HIF-1α). Compared with parental H1299 cells and H1299 cells transfected with empty plasmid, H1299/M-HIF-1α cells had lower radiosensitivity. Following the use of UA to treat NSCLC cells, elevation of the radiosensitivity of cells was observed by MTT assay. The irradiated H1299/M-HIF-1α cells were more sensitive to UA pretreatment than the irradiated cells with empty plasmid and control. The alteration of DNA damage in the irradiated cells was further measured using micronucleus (MN) assay. The combination of UA treatment with radiation could induce the increase of cellular MN frequencies, in agreement with the change in the tendency observed in the cell viability assay. It was further shown that the endogenous glutathione (GSH) contents were markedly attenuated in the differently irradiated NSCLC cells with UA (80 µmol/l) pretreatment through glutathione reductase/5,5'-dithiobis-(2-nitrob-enzoic acid) (DTNB) recycling assay. The results revealed that UA treatment alone could effectively decrease the GSH content in H1299/M-HIF-1α cells. In addition, the inhibition of HIF-1α expression in radioresistant cells was confirmed by western blotting. It was then concluded that UA could upregulate the radiosensitivity of NSCLC cells, and in particular reduce the refractory response of cells expressing HIF-1α to ionizing radiation. The primary mechanism is associated with reduction of endogenous GSH and inhibition of high expression of intracellular HIF-1α. UA should therefore be deeply studied as a potential radiosensitizing reagent for NSCLC radiotherapy.
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Affiliation(s)
- Bing Song
- Department of Cardiology, First Affiliated Hospital, Anhui Medical University, Hefei, Anhui 230032, P.R. China
| | - Qian Zhang
- Teaching and Research Section of Nuclear Medicine, Anhui Medical University, Hefei, Anhui 230032, P.R. China
| | - Maohu Yu
- Teaching and Research Section of Nuclear Medicine, Anhui Medical University, Hefei, Anhui 230032, P.R. China
| | - Xinrong Qi
- Teaching and Research Section of Nuclear Medicine, Anhui Medical University, Hefei, Anhui 230032, P.R. China
| | - Gang Wang
- Teaching and Research Section of Nuclear Medicine, Anhui Medical University, Hefei, Anhui 230032, P.R. China
| | - Linlin Xiao
- Teaching and Research Section of Nuclear Medicine, Anhui Medical University, Hefei, Anhui 230032, P.R. China
| | - Qiyi Yi
- Teaching and Research Section of Nuclear Medicine, Anhui Medical University, Hefei, Anhui 230032, P.R. China
| | - Wensen Jin
- Teaching and Research Section of Nuclear Medicine, Anhui Medical University, Hefei, Anhui 230032, P.R. China
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Higashi K, Yamagishi T, Ueda Y, Ishigaki Y, Shimasaki M, Nakamura Y, Oguchi M, Takegami T, Sagawa M, Tonami H. Correlation of HIF-1α/HIF-2α expression with FDG uptake in lung adenocarcinoma. Ann Nucl Med 2016; 30:708-715. [PMID: 27663442 DOI: 10.1007/s12149-016-1116-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 08/14/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Hypoxia is a key element involved in the development and progression of tumors. HIF-1α may transiently induce and mediate the response to acute and severe hypoxia, while HIF-2α may induce a longer response and may control the response to chronic and moderate hypoxia. Hypoxia increases the cellular uptake of FDG. Therefore, HIF may play an important role in the process of the cellular uptake of FDG. The aim of this study was to compare HIF-1α/HIF-2α expression with FDG uptake, Glut-1 expression, and prognosis in the patients with lung adenocarcinoma and to investigate the role of HIF-1α/HIF-2α in the uptake of FDG in lung adenocarcinoma. METHODS In the current work, we compared the immunohistochemical expression of HIF-1α and HIF-2α in surgical specimens of 44 patients with lung adenocarcinoma. The relationships between HIF-α expression and Glut-1 expression, FDG uptake, and clinicopathological factors, including prognosis, were analyzed. RESULTS There was a marginal association between HIF-1α and HIF-2α expressions (P = 0.076). We found a significant correlation between HIF-2α expression and FDG uptake (P = 0.0001). HIF-1α expression showed a marginal association with FDG uptake (P = 0.066). FDG uptake correlated more significantly with HIF-2α expression than with HIF-1α expression. A significant correlation was noticed between Glut-1 expression and both HIF-1α and HIF-2α expressions (P = 0.005 and P = 0.003, respectively). Univariate analysis of disease-free survival demonstrated that FDG uptake and HIF-2α expression, but not HIF-1α expression, were related to recurrence (P < 0.0001). CONCLUSION FDG uptake correlated more significantly with HIF-2α expression than with HIF-1α expression, and both FDG uptake and HIF-2α expression, but not HIF-1α expression was correlated with post-operative recurrence in the patients with lung adenocarcinoma. These results suggest that both FDG uptake and HIF-2α expression may represent a more aggressive phenotype and that HIF-2α may play a more important role than HIF-1α in the uptake of FDG in lung adenocarcinoma.
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Affiliation(s)
- Kotaro Higashi
- Department of Radiology, Asanogawa General Hospital, 83 Kosakamachi-Naka, Kanazawa, Ishikawa, 920-8621, Japan.
| | | | - Yoshimichi Ueda
- Department of Pathology, Kanazawa Medical University, Ishikawa, Japan
| | - Yasuhito Ishigaki
- Medical Research Institute, Kanazawa Medical University, Ishikawa, Japan
| | - Miyako Shimasaki
- Department of Pathology, Kanazawa Medical University, Ishikawa, Japan
| | - Yuka Nakamura
- Medical Research Institute, Kanazawa Medical University, Ishikawa, Japan
| | - Manabu Oguchi
- Department of Radiation Therapy, Public Central Hospital of Matto Ishikawa, Ishikawa, Japan
| | - Tsutomu Takegami
- Medical Research Institute, Kanazawa Medical University, Ishikawa, Japan
| | - Motoyasu Sagawa
- Department of Thoracic Surgery, Kanazawa Medical University, Ishikawa, Japan
| | - Hisao Tonami
- Department of Radiology, Kanazawa Medical University, Ishikawa, Japan
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50
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Fu Y, Hu J, Du N, Jiao S, Li F, Li X, Ma J, Zhao H, Kang H. Bevacizumab plus chemotherapy versus chemotherapy alone for preventing brain metastasis derived from advanced lung cancer. J Chemother 2016; 28:218-24. [DOI: 10.1179/1973947815y.0000000045] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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