Co-Occurrence Patterns of Pathological High-Risk Factors and Predictive Value of PET Metabolic Features in Lung Adenocarcinoma: A Retrospective Cohort Study of 1292 Cases

Background/Objectives: Co-occurrence patterns among pathological high-risk factors in lung adenocarcinoma remain poorly characterized, and whether preoperative 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) predicts them is unsettled. We mapped their interrelationships and evaluated the predictive value of preoperative maximum standardized uptake value (SUVmax).

Methods

We retrospectively enrolled 1292 consecutive patients with resected invasive lung adenocarcinoma (May 2020–September 2023) and extracted six high-risk factors: spread through air spaces (STAS), visceral pleural invasion (VPI), lymphovascular invasion (LVI), occult lymph node metastasis (OLNM), and solid and micropapillary components. Pairwise co-occurrence was quantified by the Phi coefficient with Bonferroni correction; logistic regression and receiver operating characteristic (ROC) analysis assessed the predictive value of SUVmax. High-risk burden was defined as ≥3 concurrent factors.