Utility of the FDG-PET/CT Deauville score in the preoperative evaluation of clinical stage I NSCLC

T. Fukami¹, A. Hamada¹, K. Suda¹, H. Kaida², Y. Yoshida³, K. kitajima⁴, K. Ito⁵, T. Sekine⁶, k. takegahara⁷, h. daisaki⁸, m. hashimoto⁹, t. kabasawa¹⁰, t. yamasaki¹¹, s. hirota¹¹, j. usuda⁷, k. ishii², j. soh¹, t. mitsudomi¹, y. tsutani^1
1Division of Thoracic Surgery, Department of Surgery, Kinki University Hospital, Osakasayama, Osaka ²Department of Radiology, Kindai University Faculty of Medicine, Osakasayama, Osaka ³Department of Thoracic Surgery, National Cancer Center Hospital, tokyo, Tokyo ⁴Department of Radiology, Hyogo Medical University School of Medicine, Nishinomiya, Hyogo ⁵Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Tokyo ⁶Department of Radiology, Nippon Medical School Musashi Kosugi Hospital, Kawasaki, Kanagawa ⁷Department of Thoracic Surgery, Nippon Medical School Hospital, Tokyo, Tokyo ⁸Department of Radiological Technology, School of Radiological Technology, Gunma Prefectural College of Health Sciences, Maebashi, Gumma ⁹Departments of Thoracic Surgery and Orthopedic Surgery, Hyogo Medical University School of Medicine, Nishinomiya, Hyogo ¹⁰Department of Pathological Diagnostics, Faculty of Medicine, Yamagata University, Yamagata, Yamagata ¹¹Department of Surgical Pathology, Hyogo Medical University School of Medicine, Nishinomiya, Hyogo

Purpose: Previous studies reported that FDG-PET parameters are useful to predict occult lymph node metastasis or patients’ survivals in clinical stage I NSCLC patients. However, these parameters differ between institutions, which hampers clinical application of the FDG-PET data. Here, we evaluated usefulness of the Deauville score using multi-institutional FDG-PET data.

Methods: We retrospectively examined 483 clinical stage I NSCLC patients who underwent FDG-PET/CT examinations prior to pulmonary resection between 2013 and 2014 at four institutions. The Deauville score quantified the metabolic activity of the tumor area using a 5-point visual evaluating method. Overall survival (OS) and recurrence-free survival (RFS) were assessed by the Kaplan-Meier method. Correlation between the Deauville score and clinicopathological variables was assessed using Cochran-Armitage trend test.

Results: Patients were grouped into three groups (Deauville scores of 1-2, 3, 4-5) based on previous studies [Kagimoto A, et al. Ann Thorac Surg 2020 and Kagimoto A, et al. Ann Surg Oncol 2021]. In the analysis of clinicopathological variables, increased Deauville score was significantly associated with male, non-adenocarcinoma histology, occult lymph node metastasis, and pathological invasiveness defined as the presence of either lymphatic/vascular invasion, pleural invasion, and/or nodal involvement, but not with age and smoking status (Table 1). In the analysis of survivals, both of the RFS and OS decreased as the Deauville score increased, except for OS between Deauville scores 1-2 vs 3 (Figure 1).

Conclusion: In this multicenter retrospective study, we found that the Deauville score is a simple and useful FDG-PET parameter to predict occult lymph node metastasis, pathological invasiveness, and survivals.

Identify the source of the funding for this research project: This study was supported by grants-in-aid for scientific research from the Japan Society for the Promotion of Science (grant 20K17763 to Dr Hamada, grant 19K08187 to Dr Kitajima, grant 22K07291 to Dr Suda, grant 22K08986 to Dr Soh, and grant 20H03773 to Dr Mitsudomi).