Is there any significance of lung cancer histology to compare the diagnostic accuracies of (18)F-FDG-PET/CT and (99m)Tc-MDP BS for the detection of bone metastases in advanced NSCLC?

Comparison of 68Ga-FAP-2286 and 18F-FDG PET/CT in the diagnosis of advanced lung cancer

Purpose

The 68Ga/177Lu-FAP-2286 is a newly developed tumor imaging agent that shows potential for visualizing and treating tumor stroma. The objective of this research was to evaluate the effectiveness of 68Ga-FAP-2286 PET/CT and 18F-FDG PET/CT in diagnosing advanced lung cancer.

Methods

In this prospective study, patients with lung cancer who underwent 68Ga-FAP-2286 and 18F-FDG PET/CT examinations between September 2022 and June 2023 were analyzed. Lesion uptake was converted to SUVmax. A paired T-test was used to compare the SUVmax, and the number of positive lesions detected by the two methods was recorded.

Results

In total, 31 participants (median age: 56 years) were assessed. The uptake of 68Ga-FAP-2286 was significantly higher than that of 18F-FDG in primary lesions (9.90 ± 5.61 vs. 6.09 ± 2.84, respectively, P < 0.001), lymph nodes (7.95 ± 2.75 vs. 5.55 ± 1.59, respectively, P=0.01), and bone metastases (7.74 ± 3.72 vs. 5.66 ± 3.55, respectively, P=0.04). Furthermore, the detection sensitivity of lymph nodes using 68Ga-FAP-2286 PET/CT was superior to that with 18F-FDG PET/CT [100% (137/137) vs. 78.8% (108/137), respectively], as well as for bone metastases [100% (384/384) vs. 68.5% (263/384), respectively]. However, the detection sensitivity for primary tumors using both modalities was comparable [100% (13/13) for both].

Conclusion

Compared to 18F-FDG PET/CT, 68Ga-FAP-2286 PET/CT demonstrated better lesion detection capabilities for lung cancer, particularly in lymph nodes and bone metastases, providing compelling imaging evidence for the efficacy of 177Lu-FAP-2286 treatment.

Establishment of a regression model of bone metabolism markers for the diagnosis of bone metastases in lung cancer

Background

The aim of this study was to establish a regression equation model of serum bone metabolism markers. We analyzed the diagnostic value of bone metastases in lung cancer and provided laboratory evidence for the early clinical treatment of bone metastases in lung cancer.

Methods

A total of 339 patients with non-metastatic lung cancer, patients with lung cancer with bone metastasis, and patients with benign lung disease who were treated in our hospital from July 2012 to October 2015 were included. A total of 103 patients with lung cancer in the non-metastatic group, 128 patients with lung cancer combined with bone metastasis group, and 108 patients with benign lung diseases who had nontumor and nonbone metabolism-related diseases were selected as the control group. Detection and analysis of type I collagen carboxyl terminal peptide β-special sequence (β-CTX), total type I procollagen amino terminal propeptide (TPINP), N-terminal-mid fragment of osteocalcin (N-MID), parathyroid hormone (PTH), vitamin D (VitD3), alkaline phosphatase (ALP), calcium (CA), phosphorus (P), cytokeratin 19 fragment (F211), and other indicators were performed. Four multiple regression models were established to determine the best diagnostic model for lung cancer with bone metastasis.

Results

Analysis of single indicators of bone metabolism markers in lung cancer was performed, among which F211, β-CTX, TPINP, and ALP were significantly different (P < 0.05). The ROC curve of each indicator was less than 0.712. Based on the multiple regression models, the fourth model was the best and was much better than a single indicator with an AUC of 0.856, a sensitivity of 70.0%, a specificity of 91.0%, a positive predictive value of 82.5%, and a negative predictive value of 72.0%.

Conclusion

Multiple regression models of bone metabolism markers were established. These models can be used to evaluate the progression of lung cancer and provide a basis for the early treatment of bone metastases.

Fluorine-18-fluorodeoxyglucose-positron emission tomography evaluation in metastatic bone lesions in lung cancer: Possible prediction of pain and skeletal-related events

Background

Fluorine‐18‐fluorodeoxyglucose‐positron emission tomography (FDG‐PET) uptake in primary lesions has been well studied, but little information is available about metastatic bone lesions in patients with lung cancer. The present study was performed to evaluate the relationships between metastatic bone FDG uptake and clinical parameters in patients with lung cancer.

Methods

FDG uptake was evaluated as the maximum standardized uptake (SUVmax) value of each targeted bone lesion, and the bone to primary lesion ratio of SUVmax (B/P ratio) was calculated. Forty‐nine patients (27 men and 22 women) with a diagnosis of lung cancer (small cell lung cancer [SCLC], n = 7; non‐small cell lung cancer [NSCLC], n = 42) with bone metastasis, and a total of 185 bone metastatic lesions were evaluated.

Results

The SUVmax in bone and the B/P ratio were significantly higher in patients with pain and subsequent development of skeletal‐related events than in those without pain or skeletal‐related events, respectively. In addition, the SUVmax in metastatic bone lesions and the B/P ratio in SCLC were significantly lower than those in NSCLC, despite similar FDG uptake in the primary tumor.

Conclusion

Our findings suggest that FDG‐PET evaluation in metastatic bone lesions could be useful to predict initial pain and subsequent clinical outcomes of local bone status in initially diagnosed lung cancer patients with bone metastasis. In addition, our results suggest that there could be histological differences in the biological activity of bone metastatic lesions in lung cancer, especially between SCLC and NSCLC.

[Risk Factors of Non-small Cell Lung Cancer with Bone Metastasis after Therapy]

背景与目的

肺癌目前是死亡率最高的肿瘤, 非小细胞肺癌(non-small cell lung cancer, NSCLC)患者在手术后通常会发生远处转移, 如骨转移、脑转移、肺转移等。本研究旨在探究NSCLC患者术后发生骨转移的危险因素。

方法

选择本院于2009年5月-2011年5月确诊收治的NSCLC患者176例, 按照是否发生骨转移将患者分为两组, 即骨转移组和无骨转移组。对比两组患者的一般临床病理资料, 并通过多因素分析对比发生骨转移的独立危险因素。

结果

NSCLC患者的一般临床病理资料中血栓与否, 肿瘤-淋巴结-转移(tumor-node-metastasis, TNM)分期与是否发生骨转移关系密切, 有统计学意义(均P < 0.01);在两组患者的凝血功能指标中发现凝血酶原时间、活化部分凝血酶活酶时间、纤维蛋白原、凝血酶时间、血小板计数、D-二聚体以及碱性磷酸酶之间存在明显的差异性, 有统计学意义(均P < 0.05);Logistic回归分析发现纤维蛋白原、碱性磷酸酶、T4期、N3期和D-二聚体为NSCLC患者发生骨转移的独立危险因素。

结论

纤维蛋白原、活化部分凝血酶活酶时间、碱性磷酸酶、T3期、N2期和D-二聚体为NSCLC患者发生骨转移的独立危险因素。

Distribution Features of Skeletal Metastases: A Comparative Study between Pulmonary and Prostate Cancers

Bone scintigraphies are widely applied for detecting bone metastases. The aim of this study was to investigate distribution features of bone metastases in pulmonary and prostate cancers. Bone scintigraphies were performed in 460 patients with pulmonary cancer and 144 patients with prostate cancer. Patients were divided into three groups according to the total number of bone metastases: few bone metastases, moderate bone metastases, and extensive bone metastases. We compared the distribution of bone metastases in the two cancers, and analyzed the relationship between the distribution of metastatic lesions and their metastatic patterns. A total of 2279 and 2000 lesions of bone metastases were detected in 258 patients with pulmonary cancer and 102 patients with prostate cancer, respectively. In patients with few bone metastases, the distributions of metastatic lesions in the vertebrae (χ2 = 16.0, P = 0.000) and thoracic bones (χ2 = 20.7, P = 0.002) were significantly different between pulmonary and prostate cancers. In cases with moderate bone metastases, the distributions in the vertebrae (χ2 = 6.6, P = 0.010), pelvis (χ2 = 15.1 P = 0.000), and thoracic bones (χ2 = 38.8, P = 0.000) were also significantly different between the two cancers. However, in patients with extensive bone metastases, the distributions were very similar. As the total number of bone metastases increased, their distribution in pulmonary cancer did not noticeably change, but the distribution in the vertebrae and thoracic bones of prostate cancer patients significantly changed. Accordingly, the distribution characteristics of bone metastases differed in pulmonary and prostate cancers, mainly in the early stages of metastasis.