{
  "abstract": "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. Results: STAS (29.8%) and the micropapillary component (24.4%) were the most prevalent. All 15 pairwise associations were positive and significant after Bonferroni correction; the strongest enrichment was between LVI and OLNM (observed-to-expected [O/E] ratio 5.85, Phi = 0.41, p < 0.001), with no mutual exclusivity. SUVmax independently predicted all six factors (e.g., solid component, odds ratio [OR] 1.283; STAS, OR 1.225; micropapillary component, OR 1.141; all p < 0.001). For high-risk burden, SUVmax achieved an area under the curve (AUC) of 0.838, which was numerically higher than that for any individual factor. At a cut-off of 3.0, sensitivity was 86.8% and the negative predictive value was 96.8% (bootstrap 95% confidence interval [CI] 0.807–0.865). Conclusions: High-risk pathological factors co-occur rather than segregate. Preoperative SUVmax is independently associated with all six factors but is best positioned to identify high-risk burden rather than individual features, although a clinical benefit remains to be demonstrated.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Qiuyu Leng"
    },
    {
      "affs": [
        0
      ],
      "name": "Yu Huang"
    },
    {
      "affs": [
        0
      ],
      "name": "Bowen Zhao"
    },
    {
      "affs": [
        0
      ],
      "name": "Zuhan Geng"
    },
    {
      "affs": [
        0
      ],
      "name": "Chi Zhang"
    },
    {
      "affs": [
        0
      ],
      "name": "Yongde Liao"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/03hqpmjfxy5n6.bib",
  "cited_by": 0,
  "doi": "10.3390/cancers18213435",
  "fulltext_url": null,
  "id": "03hqpmjfxy5n6",
  "issns": [
    "2072-6694"
  ],
  "landing_url": "https://www.mdpi.com/2072-6694/18/21/3435",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2740|Lung Cancer Diagnosis and Treatment"
    ]
  ],
  "openalex": "W7223699484",
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-23",
  "publisher": "MDPI AG",
  "ris": "https://research.draconitic.com/paper/03hqpmjfxy5n6.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:58Z",
      "native_id": "10.3390/cancers18213435",
      "source": "crossref",
      "url": "https://www.mdpi.com/2072-6694/18/21/3435"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "issn:2072-6694",
      "subfield": "oncology"
    }
  ],
  "title": "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",
  "title_text": "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",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:58Z",
  "url": "https://research.draconitic.com/paper/03hqpmjfxy5n6",
  "venue": "Cancers",
  "versions": []
}