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Original Articles: General Thoracic

Maximal Standardized Uptake Value on FDG-PET Is Correlated With Cyclooxygenase-2 Expression in Patients With Lung Adenocarcinoma

Department of General Thoracic Surgery, Kawasaki Medical School, Kurashiki, Japan

Accepted for publication October 14, 2011.

^_* Address correspondence to Dr Shimizu, Department of General Thoracic Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki Okayama 701-0192, Japan (Email: kshimizu{at}med.kawasaki-m.ac.jp).

Background: Cyclooxygenase-2 (COX-2) is constitutively overexpressed in a variety of epithelial malignancies and is usually associated with a poor prognosis. Fluorodeoxyglucose positron emission tomography (FDG-PET) has become an important tool for the diagnosis and staging of non–small-cell lung cancer. The maximal standardized uptake values (SUV_max) of primary tumors on FDG-PET have been shown to be correlated with some clinicopathologic factors. In this study, we investigated the prediction of intratumoral COX-2 expression by FDG-PET in cases of lung adenocarcinoma.

Methods: We conducted a retrospective review of the data of 60 patients with lung adenocarcinoma measuring less than 3 cm in diameter. Immunohistochemical staining for COX-2 and other biological factors that might influence cancer progression was performed, and the correlations of the selective tumor marker expression with the SUV_max were evaluated.

Results: A significant correlation was observed between the SUV_max and the expressions of COX-2, Ki-67, and vascular endothelial growth factor (VEGF). Multiple stepwise regression analysis revealed significant relationships between the SUV_max and the expression of COX-2 (p < 0.001) and Ki-67 (p = 0.016). Of the 2, COX-2 expression was the stronger determinant of the SUV_max, which increased in proportion to the score for COX-2 expression. The recurrence-free survival of patients with elevated COX-2 expression was significantly worse than that of patients not showing COX-2 expression.

Conclusions: The expression of COX-2 in primary tumors is as strongly correlated with a worse clinical outcome as is increased FDG uptake in cases of lung adenocarcinoma. These findings indicate that the SUV_max of primary tumors might reflect the biological malignant potential in lung adenocarcinomas.

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