Ali ÇAKMAKCILAR, Zekiye HASBEK, Birsen YÜCEL, Ersin TUNCER, Seyit Ahmet ERTÜRK, Ömer Tamer DOĞAN
The Injector - 2026;5(1):15-31
Objective: This study aimed to determine the relationship between the cellular expression levels of HIF-1alpha, VEGF and p53, as well as metabolic parameters measured by 18F-FDG PET/CT, and their effect on survival in non-small cell lung cancer (NSCLC). Methods: The study included 36 patients (4 female, 32 male) diagnosed with NSCLC who underwent 18F-FDG PET/CT imaging for staging purposes and subsequently underwent pneumonectomy, lobectomy, or wedge resection. Fourteen patients (39%) had adenocarcinoma, and 22 patients (61%) had squamous cell carcinoma. MIP and MAC images of the 18F-FDG PET/CT scans were analyzed for necrosis, and 25% of patients showed no visual necrosis. Results: HIF-1alpha staining scores were negative in 10 patients (28%), positive in nine patients (25%), strongly positive in five patients (14%), and very strongly positive in 12 patients (33%). VEGF staining was positive in eight patients (22%) and negative in 28 patients (78%). p53 staining was positive in 18 patients (50%) and negative in 18 patients (50%). HIF-1alpha expression was not significantly associated with age (p=0.119), gender (p=0.918), tumor stage (p=0.724), or VEGF positivity (p=0.901). Similarly, no significant association was observed between HIF-1alpha expression and disease-free survival (p=0.260) or SUVmax (p=0.879). However, HIF-1alpha staining score was significantly associated with recurrence during follow-up (p=0.020). Follow-up metastasis was significantly more frequent in patients with VEGF-positive staining than in patients with VEGF-negative staining (p=0.009). There was no statistically significant association between VEGF positivity and SUVmax (p=0.909) or overall survival (p=0.327). Pathological necrosis was significantly more frequent in VEGF-negative patients (p=0.013). No statistically significant associations were found between p53 expression and tumor type (p=0.153), overall survival (p=0.968), SUVmax (p=0.692), or HIF-1alpha staining level (p=0.194). However, p53 positivity was significantly associated with tumor nuclear grade (p=0.026). No statistically significant associations were found for SUVmean, MTV, or TLG with HIF-1alpha (p=0.860, p=0.839, and p=0.949, respectively), p53 (p=0.716, p=0.776, and p=0.924, respectively), or VEGF (p=1.000, p=0.493, and p=0.196, respectively). Conclusion: In the present study, which had a limited number of patients, no significant correlations were found between HIF-1alpha, VEGF, p53, and PET parameters and survival. However, further studies with larger patient populations are needed.
