title: Prognostic Significance of the Standardized Uptake Value on Positron Emission Tomography in Patients with Multiple Clinical-N0 Lung Cancers.
abstract: BACKGROUND
  While there have been many attempts to differentiate multiple lung cancers (MLCs) using the clinicopathological presentation and molecular profile, there are still some controversies regarding the prognostic factors for MLCs with clinical-N0 status.
  
  
  METHODS
  Between 1996 and 2012, 131 patients were diagnosed as MLCs pathologically. The main lesion of MLCs was defined as follows: (1) among synchronous lesions, the radiologically denser or larger tumor on thin-section computed tomography (CT) or (2) the second tumor among metachronous lesions. (18)F-fluorodeoxyglucose uptake on positron emission tomography (PET) scan was examined to evaluate maximum standardized uptake value (SUVmax) of the main tumor.
  
  
  RESULTS
  Among 131 patients with clinical-N0 status, 66 were men and 65 were women and they had an average age of 67 years. One-hundred nine patients were diagnosed as MPLCs, and 22 were intrapulmonary metastases (PMs). Based on multivariate analyses, SUVmax was a significant prognostic factor in both synchronous and metachronous clinical-N0 MLCs (p = 0.0060, 0.0451, respectively). Among the overall patients, while pathological diagnosis, maximum tumor dimension, consolidation status, and SUVmax were all significant prognostic factors by a univariate analysis, SUVmax (p = 0.0016) was superior to pathological diagnosis based on the Martini and Melamed classification (p = 0.2258) based on a multivariate analysis. The 5-year survival rate of MPLCs (78.7%) was significantly greater than that of PMs (30.5%) (p = 0.0036). Furthermore, the 5-year survival rate in patients with low SUVmax (91.1%) was far better than that in patients with high SUVmax (17.9%) (p = 0.0001).
  
  
  CONCLUSIONS
  SUVmax on PET was a significant clinical factor that more precisely reflected the prognosis of MLCs with clinical-N0 status, and could be superior to a pathological diagnosis based on the Martini and Melamed classification.
authors.affiliation: Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Aritoshi
authors.initials: A
authors.lastname: Hattori
authors.affiliation: Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Suzuki
authors.affiliation: Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Matsunaga
authors.affiliation: Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Takamochi
authors.affiliation: Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Shiaki
authors.initials: S
authors.lastname: Oh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000494:pharmacology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology; D016609:Neoplasms, Second Primary / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology; D049268:Positron-Emission Tomography / Q000379:methods; D011237:Predictive Value of Tests; D011379:Prognosis; D019275:Radiopharmaceuticals / Q000494:pharmacology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18