Fluorodeoxyglucose positron emission tomography and tumor marker expression in non–small cell lung cancer

Taylor, Matthew D.; Smith, Philip W.; Brix, William K.; Wick, Mark R.; Theodosakis, Nicholas; Swenson, Brian R.; Kozower, Benjamin D.; Lau, Christine L.; Jones, David R.

doi:10.1016/j.jtcvs.2008.10.014

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 137, Issue 1 , Pages 43-48, January 2009

Fluorodeoxyglucose positron emission tomography and tumor marker expression in non–small cell lung cancer

Matthew D. Taylor, MD
- Department of Surgery, University of Virginia, Charlottesville, Va
Philip W. Smith, MD
- Department of Surgery, University of Virginia, Charlottesville, Va
William K. Brix, MD
- Department of Pathology, University of Virginia, Charlottesville, Va
Mark R. Wick, MD
- Department of Pathology, University of Virginia, Charlottesville, Va
Nicholas Theodosakis
- Department of Surgery, University of Virginia, Charlottesville, Va
Brian R. Swenson, MD, MS
- Department of Surgery, University of Virginia, Charlottesville, Va
Benjamin D. Kozower, MD
- Department of Surgery, University of Virginia, Charlottesville, Va
Christine L. Lau, MD
- Department of Surgery, University of Virginia, Charlottesville, Va
David R. Jones, MD
- Department of Surgery, University of Virginia, Charlottesville, Va
- Address for reprints: David R. Jones, MD, Professor of Surgery, University of Virginia, Department of Surgery, Box 800679, Charlottesville, VA 22908-0679.

Received 24 June 2008; received in revised form 18 September 2008; accepted 13 October 2008.

Objective

The best current noninvasive surrogate for tumor biology is fluorodeoxyglucose positron emission tomography (FDG–PET). Both FDG–PET maximal standardized uptake values and selected tumor markers have been shown to correlate with stage, nodal disease, and survival in non–small cell lung cancer (NSCLC). However, there are limited data correlating FDG–PET with tumor markers. The purpose of this study was to determine the correlation of tumor marker expression with FDG–PET maximal standardized uptake values in NSCLC.

Methods

FDG–PET maximal standardized uptake values were calculated in patients with NSCLC (n = 149). No patient had induction chemoradiotherapy. Intraoperative NSCLC tissue was obtained and tissue microarrays were created. Immunohistochemical analysis was performed for 5 known NSCLC tumor markers (glucose transporter 1, p53, cyclin D1, epidermal growth factor receptor, and vascular endothelial growth factor). Each tumor marker was assessed independently by two pathologists using common grading criteria. Subgroup analysis based on histologic characteristics and regional nodal status was performed.

Results

FDG–PET correlated with T classification (P < .0001), N stage (P = .002), and greatest tumor dimension (P < .0001). In addition, increasing maximal standardized uptake values correlated with increased expression of glucose transporter 1 (P < .0001) and p53 (P = .04) in adenocarcinoma. Epidermal growth factor receptor expression correlated with maximal standardized uptake values without predilection for histologic subtype (P = .004).

Conclusion

FDG–PET maximal standardized uptake values correlate with an increased expression of glucose transporter 1 and p53 in lung adenocarcinoma, but not squamous cell cancer. Future studies attempting to correlate FDG–PET with tumor biology will need to consider the effect of different tumor histologic types.

Abbreviations and Acronyms: CT, computed tomography, EGFR, epidermal growth factor receptor, FDG, F-deoxyglucose, FDG–PET, fluorodeoxyglucose positron emission tomography, GLUT-1, glucose transporter 1, NSCLC, non–small cell lung cancer, SUVmax, maximal standardized uptake values, VEGF, vascular endothelial growth factor