Effect of High SUV, etc on staging survival percentages

Portal Forums Lung/Thoracic Cancer Cancer Basics Survivorship and Follow-up Effect of High SUV, etc on staging survival percentages

This topic contains 27 replies, has 5 voices, and was last updated by Dr West Dr West 1 year, 8 months ago.

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December 11, 2016 at 10:33 am  #1289493    

me53

I guess to finish commenting on the things you are posting, I am not at all sure what effect going 8 months has – metastasis peaks at 1.5 years, and doesn’t usually start till end of 10th month — but that is not my question. You are making assumptions about the importance of the suv findings which I do not share — any doctor following lung cancer, beyond a narrow chemo view, will know of them I think and could put this NEWly established info into context for a cancer patient who is in my position — it is part of understanding prognosis, and potentially a newer, additional tool and I want to know how it intersects with TNM staging — my question was short and deserved to be reviewed by someone who knows re this — if Dr. West himself doesn’t know, I’d think it’s something he would want to take a look at, but I’d suspect he does. You have tortured me with so much time typing and responding to people who are not in a position to answer the question but feel free to keep trying to get me to accept their take or that “no one knows” or can — this is just not true coming from a lay person. Stop making my question buried in extraneous, voluminous extraneous stuff calling it into question as a question — that you are making assumptions dr. west would not be familiar with these studies is rich and really not your place in my view. And adjuvant chemo does not aid survival more than 5% or so, so something that does not help 95% of those who take it is hardly worth so much talking about, especially as you know I chose not to do it; it’s also not clear how suv correlates to response to chemo, but it may mean higher suv less response, I don’t really care it is not my question or my situation. (and as to tki’s, 53-61% respond to alk meds meaning a significant portion don’t — it’s like all the drug discussion assumes you will be kept alive, but for many people, you are not; general chemo close to 70% don’t reply — but, again, it has nothing to do with MY question.

December 11, 2016 at 12:12 pm  #1289494    

onthemark

The 5 year survival rate of stage 3B lung cancer is not 9% as has been erroneously reported in this thread. I hope whoever might stumble across this wouldn’t get unduly discouraged by this incorrect information.

According to the “The IASLC Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in theForthcoming (Eighth) Edition of the TNMClassification for Lung Cancer”

report in 2016, the 5 year survival rate of stage 3B lung cancer is

19% (according to 7th edition criteria)
26% (according to 8th edition criteria)

The eight edition made some changes including introducing the new category stage 3C, which has lower survival. This is why survival for 3B went up in 8th ed. compared to 7th.

I know about these changes because my category also changed for different reasons.

https://www.ncbi.nlm.nih.gov/pubmed/26762738

ME53, if you want to challenge this please provide a publication for reference.


10/2015 Chest xray found a nodule as part of a physical (no symptoms).
01/2016 Upper left lobe lingula preserving lobectomy stage 2b for 1.9 cm invasive adenocarcinoma with additional 2 mm AIS nodule found in pathology.
03-05/2016 Sixteen weeks of adjuvant cisplatin/vinorelbine.
07/2016 Durvalumab adjuvant clinical trial discontinued after 1st dose knocked out thyroid.
12/2016 Revised to stage 1b (due to VPI) after new guidelines for multifocal lepidic lung cancer.
07/2019 Next scan.

December 11, 2016 at 1:04 pm  #1289495    

me53

What an odd tone for a post of this nature. Thank you for posting proposals for changing the TNM prognosis guidelines — whether those proposals will be enacted should be established shortly, as what you post is from Sept. 2015 (and reprinted in Jan. 2016). My question itself remains, of course, which is the effect of primary tumor suv on tnm staging. Needless to say, multiple sources cite the current tnm %’s, the one relevant to me 9%.

December 11, 2016 at 1:24 pm  #1289496    

me53

What you’ve posted really should have its own thread for discussion. It is odd that they say 7th ed. has such high rates of survival for iiib – no where else has posted this – it is simply not accepted; perhaps it includes their alterations of staging (moving people from different stages by redefining them). The 8th edition should be out soon they say, we’ll see then. Please let’s set up a second page if you want to discuss this proposed change to staging and prognosis and keep this thread for my question for now. Odd no one in USA on their list (or maybe not!)

December 11, 2016 at 2:49 pm  #1289497    

onthemark

I have already posted a paper that shows that SUV max is not prognostic in stage 3 lung cancer. Indeed there are other recent papers showing the same. However other features of pre-treatment PET are found to be prognostic for stage III but not SUV max. You have not posted any papers to justify your claims. Why don’t you read the paper I posted?

About the large database giving the survival stats for the 7th edition and 8th edition Stage IIIB (7th would have been in place in 2015) this is it:

“The new IASLC database has information on 94,708 new patients diagnosed of lung cancer between 1999 and 2010. They originated from 35 sources in 16 countries, and 4,667 were submitted via the online electronic data capture system. Europe contributed 46,560 patients, Asia: 41,705, North America: 4,660, Australia: 1,593, and South America: 190. After exclusions, 77,156 (70,967 with nonsmall cell lung cancer and 6,189 with small cell lung cancer) remained for analysis. This database will be analyzed according to established objectives for the T, the N, and the M components to inform the eighth edition of the TNM classification of lung cancer due to be published in 2016. ”

https://www.ncbi.nlm.nih.gov/pubmed/25436796

Again you have not posted any paper to justify your use of 9% survival.

Maybe this is good news for you?


10/2015 Chest xray found a nodule as part of a physical (no symptoms).
01/2016 Upper left lobe lingula preserving lobectomy stage 2b for 1.9 cm invasive adenocarcinoma with additional 2 mm AIS nodule found in pathology.
03-05/2016 Sixteen weeks of adjuvant cisplatin/vinorelbine.
07/2016 Durvalumab adjuvant clinical trial discontinued after 1st dose knocked out thyroid.
12/2016 Revised to stage 1b (due to VPI) after new guidelines for multifocal lepidic lung cancer.
07/2019 Next scan.

December 11, 2016 at 6:38 pm  #1289515    
Dr West
Dr West

I cannot give you exact numbers, nor do I believe anyone can, because there are not large studies of people that get as granular as your question. Current staging analyses that provide prognostic assessments do not include either PET SUV or intracellular mucin because these are not reliable indicators in large studies, even if they are factors that tend to be associated with a worse prognosis.

I would consider it very likely that with T4 disease, very PET-avid disease in more than one node, the probability of recurrence is quite high — not 100%, but likely higher than 90-95%. I don’t think it’s possible to put a finer point on it — there just aren’t data on populations of patients with T4, high SUV, adenosquamous NSCLC to guide expectations.

Good luck.
-Dr. West

December 11, 2016 at 9:16 pm  #1289527    

me53

Thank you for helping me make sense of the data, Dr. West. I do wonder if tracking SUVmax within stages might be helpful as the spread within stages, even of high in stage I and low in stage IV suggests there might be a hidden connection (are the survivors in stage IV all or most low SUV? Do the high SUVmax in stage I partly account for its death rate)? Or perhaps your statement that they are not reliable indicators in large studies means it has been looked at…

December 12, 2016 at 8:59 am  #1289529    
Dr West
Dr West

The trials basically show that, stage for stage, patients with a poorly differentiated cancer and/or high SUV tend to do worse. I don’t know that you can say that a high SUV accounts for a death rate, but there’s a definite correlation — it just hasn’t been precisely quantified. It is fair to say that a low SUV on PET tends to go with a more indolent pattern of progression and longer survival, while a higher SUV is associated with a more rapid rate of progression, higher risk of recurrence in earlier stage, etc. — it’s just that there are definitely people with a high SUV cancer who never have their cancer recur after surgery or chemo/radiation, etc.

-Dr. West

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