[Impact of stress-related neural activity on major adverse cardiovascular events in non-small cell lung cancer patients using 18F-FDG PET-CT].

Objective: To explore the associations between stress-related neural activity (SNA) and major adverse cardiovascular events (MACE) in non-small cell lung cancer (NSCLC) patients based on [¹⁸F] Fludeoxyglucose positron emission tomography-computed tomography (¹⁸F-FDG PET-CT). Methods: Patients with pathologically confirmed diagnosis of NSCLC and with at least one-year follow up were retrospectively collected in Nanjing Jinling Hospital between January 2018 and December 2019. All the patients undergoing ¹⁸F-FDG PET-CT and chest CT at baseline. The maximum target-to-background ratio (TBR_max) values of amygdala, which represented as SNA, and bone marrow, which represented as bone marrow activity (BMA), coronary artery calcium volume and coronary artery calcium score (CACS) were measured. Patients were grouped according to presence or absence of MACE. The baseline clinical variable, SNA, BMA and CACS were compared between two groups. Patients were divided as low-and high-amygdala TBR_max groups according to the median of amygdala TBR_max. According to the CACS, patients with CACS=0 were classified as non-calcification group, while those with CACS>0 are classified into the calcification group. The Kaplan-Meier analysis was used to plot survival curves, the log-rank test was employed to compare intergroup differences in MACE incidence and the Cox proportional hazards model was performed to analyze risk factors for MACE. Results: A total of 94 NSCLC patients were included, aged (61.7±11.1) years and including 62 males (66.0%). There were 13 patients (13.8%) in the MACE goup and 81 patients (86.2%) in the non-MACE group. The amygdala TBR_max, coronary artery calcium volume and CACS in the MACE group were higer than those in non-MACE group. The follow-up time was [M (Q₁, Q₃), 41 (19, 58)] months. The cumulative incidence of MACE in the high-amygdala TBR_max group was higher than that in the low-amygdala TBR_max group (29.8% vs 2.6%, P=0.006). The cumulative incidence of MACE in the calcification group was higher than that in the noncalcification (39.9% vs 5.2%, P=0.010). Multivariate Cox regression analysis showed that compared with low-amygdala TBR_max group, the incidence rate of MACE increased in high-amygdala TBR_max group (HR_adj=11.832, 95%CI: 1.328-105.457, P=0.027). Further, patients were grouped according to amygdala TBR_max combined with CACS, high-amygdala TBR_max with CACS>0 group had increased risk for MACE compared to the remaining groups (HR_adj=18.613, 95%CI: 1.587-218.315, P=0.020). Conclusions: SNA was associated with the incidence of MACE in NSCLC patients. The incidence of MACE in high-amygdala TBR_max group was higher than that in low-amygdala TBR_max group.