The summary and preliminary analysis of clinical and PET/CT features of patients with intestinal metastasis of primary lung cancer

The summary and preliminary analysis of clinical and PET/CT features of patients with intestinal metastasis of primary lung cancer | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The summary and preliminary analysis of clinical and PET/CT features of patients with intestinal metastasis of primary lung cancer Ruping Li, Yiwen Mo, Si Zhou, Xing Ma, Fuqiang Zhang, Xianmin Ding, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4679252/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose This study aimed to analyze the influence of clinical manifestation, PET/CT parameters, and treatment on the prognosis of patients with primary lung cancer who developed intestinal metastasis. Method We collected data from 21 cases of primary lung cancer with intestinal metastasis. The data included basic information, examination results, treatment processes, and prognosis. We employed Kaplan-Meier (K-M) analysis, multivariate Cox regression analysis, and t-test for prognosis analysis. Results Intestinal obstruction and advanced stage were associated with poor progression-free survival (PFS) (P = 0.017 and 0.038, respectively). Smoking, intestinal obstruction, and the lack of chemotherapy were associated with worse overall survival (OS) (P = 0.043, 0.021, 0.013, respectively). Anti-PD-1 therapy (P = 0.006) and pneumonectomy (P = 0.007) improved patient outcomes. The immunohistochemical results showed no correlation between these markers and prognosis (P > 0.05). The mean SUVmax of intestinal metastases (10.23 ± 3.59) was higher than that of primary lung cancer (7.57 ± 3.42), and the former was also higher than the latter in both death and survival groups. There was no significant correlation between PET parameters (SUVmax, TLG, MTV) and prognosis (P > 0.05). Conclusion Smoking, intestinal obstruction, advanced stage, and lack of chemotherapy were risk factors for poor outcomes in primary lung cancer with intestinal metastasis. Patients treated with anti-PD-1 therapy and pneumonectomy tended to have better outcomes. The mean SUVmax of intestinal metastases was higher than that of primary lung cancer. Lung cancer with intestinal metastasis intestinal obstruction anti-PD-1 therapy PET/CT SUVmax Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Lung cancer remains the leading cause of cancer-related mortality (1) and is the primary cause of death in men and the second cause of death in women worldwide (2, 3). Moreover, approximately 50% of the patients are diagnosed with distant metastases (4). The most common metastase sites are lymph nodes, liver, adrenal glands, bones, and brain. Intestinal metastasis was considered an unusual part of primary lung metastases consisting mainly of case reports. Due to the asymptomatic progress of the disease, it's not always easy to diagnose (5). Intestinal metastasis from lung cancer is rare; solid clinical data are still scarce. Diagnosing intestinal metastasis of primary lung cancer is challenging, as most patients with intestinal metastases present no symptoms. Intestinal metastases are generally detected through CT and PET/CT evaluations and eventually confirmed by colonoscopy and histopathology (6)(7, 8). However, with the widespread application of PET/CT in clinical practice, an increasing number of lung cancer patients are receiving PET/CT examinations during their diagnosis and treatment. The sensitivity and specificity of PET/CT for primary lung cancer and its distant metastatic lesions have highlighted its clinical value in diagnosing primary lung cancer with intestinal metastasis (9). Nonetheless, the criteria for diagnosing and treating lung cancer with intestinal metastasis, especially the role of FDG PET/CT in diagnosis, remain controversial. The consensus is that few cases have been reported, and reliable clinical data are scarce. To better understand the clinical and PET/CT characteristics of lung cancer patients with intestinal metastasis, we have summarized and analyzed related cases. Methods Patients This single-center study was approved by the institutional review board (B2022-435-01). Patients diagnosed with primary lung cancer with or without intestinal metastasis at SYSUCC between March 2009 and March 2021 were retrospectively enrolled. The inclusion criteria were: a. pathology confirmed intestinal metastasis from primary lung cancer; b. age ≥ 18 years old. The exclusion criteria were a history of other cancer and incomplete clinical data. For the included patients, clinical characteristics were collected: age (≤ 50, > 50 years), gender (male, female), smoking history (smoking, no smoking), American Joint Committee on Cancer (AJCC) stages IVA and IVB, pathological histology, peripheral blood tumor markers, and immunohistochemistry molecular markers. Obtained the treatment results and follow-up from the SYSUCC database, including the therapeutic schedule (pneumonectomy, enterectomy, chemotherapy, radiotherapy, targeted therapy, anti-PD-1 therapy), ileus or not, the results of PET/CT scan, the date of the last follow-up, and the outcomes of patients (disease progression, relapse or death). Disease progression was confirmed by pathological or imaging examination. Peripheral blood tumor markers Examined tumor markers of most patients to summarize the expression characteristics, mainly including CA15-3, CEA, CyFra21-1, HCG-β, and NSE. Carried out the examination works in the laboratory of SYSUCC. The inspection machine and conditions are consistent. Results were classified as usual (test result within the reference range) and abnormal (test result above the maximum value of the reference range). Immunohistochemistry molecular markers All patients underwent biopsy or lesion resection and the immunohistochemical markers in their pathology specimen were examined, mainly including CK, P40, P63, CK7, TTF-1, ALK (D5F3), ALK-N, NapsinA, CK20, LCA, CDX-2, VILLIN, SYN, Ki67, CD56, CK5/6. The Department of Molecular Pathology completed all the examination works, and the detection conditions were consistent. PET/CT imaging For patients who underwent PET/CT scans before any related treatment, all of them fast for 5 to 6 h before F-18 fluorodeoxyglucose (F-18 FDG) injection, and the blood glucose levels were stable and lower than 200 mg/dL (11.1 mmol/L). PET/CT scans were performed with integrated PET/CT scanners (Biograph mCT, Siemens Healthcare, Henkestr, Germany). Acquired PET/CT image data 60 ± 10 min after the 18 F-FDG injection (3.7 ± 0.37 MBq [0.1 ± 0.01 mCi]/kg body weight). CT scans were obtained in an arm-up position with a Discovery ST (automatic tube current modulation, tube voltage 140 kV, rotation time 0.8 s, pitch 1.0, the field of view 50cm, collimation 16×1.25mm, slice thickness 3.75mm), and were reconstructed in 512×512 matrices. Whole-body imaging from the skull to the mid-thigh in 6–8 bed positions (3 min/bed with the Discovery ST). The PET images were reconstructed with a slice thickness of 3.25mm (2D) in a 128×128 matrix or 2mm (3D) in a 200×200 matrix using the ordered subsets expectation maximization (OSEM) iterative image reconstruction method. Generated PET, CT, and fused PET/ CT images for review on a Xeleris computer workstation (GE Medical Systems) (10). PET/CT parameters analyses An abnormal PET finding was defined as a focal or diffuse FDG uptake above the background and incompatible with a normal physiological uptake. The PET images were analyzed visually and semi-quantitatively by measuring several metabolic parameters. We used the fixed threshold method to delineate the volume of interest (VOI) around the lesions. Based on the recommendation of the European Association of Nuclear Medicine guideline, we used the fixed 41% maximum standard value (SUV max ) threshold to improve inter-observer reproducibility in Siemens Syngo image analysis software (Frimley, UK) (11). The SUV max , SUV mean , and metabolic tumor volume (MTV) were collected, processed, and outputted by the semi-automatic system. Total glycolysis of lesions (TLG) was the sum of MTV and its SUV mean in every lesion. Statistical analysis Performed all statistical analysis with Statistical Package for the Social Sciences (SPSS) version 25.0 (IBM, Chicago, IL). Estimated survival probabilities with K-M analysis, and differences between groups were tested with the log-rank test. Multivariate Cox proportional hazards regression models were used to determine the prognostic factors. A paired t-test was used to examine the difference between PET/CT parameters of primary lung foci and those of intestinal metastatic foci. P < 0.05 was regarded as statistically significant. Results Patients’ characteristics Among 21 patients with proven intestinal metastasis of lung cancer, 15 (71.4%) were male, and 6 (28.6%) were female. The average age was 59.57 years (43–71 years). According to the 8th AJCC stage system, IVA and IVB stages accounted for 28.6% (6/21) and 71.4% (15/21), respectively. Because some patients have two intestinal metastases, there were 24 sites of metastasis in 21 patients. Sixteen patients (76.2%) occurred in the small intestine, and 8 (38.1%) involved the large intestine (Fig. 1 ). And four patients (19.0%) showed intestinal obstruction. The detailed clinical information of each patient is in Table 1 . The baseline clinical features of patients are summarized in Table 2 . Table 1 Clinical data of 21 patients. No. G Age year Smoking (Year/No.) P T N M AJCC Stage IM IO Chemo- therapy F Radio- therapy Pneumon- ectomy Bowel resection Target therapy Anti- PD-1 PFS (Month) OS (Month) 1 M 45 Yes PDAC 2 1 1c IVB SI Yes No 0 No No No No No 1m 4m 2 M 71 Yes PDA 2 2 1c IVB LI Yes No 0 No No Yes No No 1m 5m 3 F 65 No HMDA 3 1 1b IVA SI No No idea 3 No Yes No No No 33m 71m 4 M 63 Yes PDA 2 1 1c IVB LI No No 6 No No No No No 1m 22m 5 M 58 Yes SCC 3 2 1c IVB SI No Platinum 12 Lung No No No No 24m 38m 6 M 57 Yes PDA 1 0 1c IVB SLI No Platinum 1 Brain No No No No 2m 4m 7 M 60 Yes PDA X 1 1b IVA SI Yes Platinum 0 No No Yes No No 2m 11m 8 M 66 Yes SCC 2 2 1c IVB SI No Platinum 4 No No No No No 3m 5m 9 M 69 Yes PDA 2 2 1c IVB SI No Platinum 7 No No No Yes No 1m 9m 10 F 61 No IA 1 1 1c IVB LI No Platinum 4 Lung Yes No No No 11m 31m 11 F 52 No IA 1 1 1c IVB SI No Platinum 4 Lung Yes No Yes No 11m 28m 12 F 43 No PDA X 1 1c IVB LI No Platinum 8 No No No Yes No 14m 25m 13 M 63 Yes PDA 1 0 1b IVA SI No Platinum 6 No Yes No Yes Yes 10m 26 14 M 59 Yes IA 4 0 1c IVB SI No Platinum 4 Brain No No Yes No 13m 13m 15 F 58 No MPDA 3 1 1c IVB SI No Platinum 0 No Yes No Yes Yes 6m 16m 16 M 59 Yes PDSCC 3 1 1c IVB LI Yes Platinum 6 No No No No No 22m 63m 17 M 49 Yes PDA 3 2 1c IVB LI No Platinum 6 Lung No Yes No Yes 10m 20m 18 M 61 Yes PDA 3 1 1b IVA SI No Platinum 6 No No Yes No Yes 4m 15m 19 F 70 No PDA 2 1 1b IVA LI No No 0 No No No No Yes 10m 10m 20 M 61 Yes PDA 4 3 1c IVB SI No Platinum 2 Brain No No No No 3m 3m 21 M 61 Yes MPDA 3 1 1b IVA SI No Platinum 2 Lung No No Yes Yes 35m 39m No.: Number; G: Gender; P: Pathologic types; T: Tumor; N: Lymph node; M: Metastasis; IM: Im transfer; O: intestinal obstruction; F: Frequency; PDSCC: Poorly differentiated squamous cell carcinoma; PDAC: Poorly differentiated adenosquamous carcinoma; HMDA: High-medium differentiated adenocarcinoma; SCC: Small cell carcinoma; IA: Invasive adenocarcinoma; MPDA: Moderate to poorly differentiated adenocarcinoma; PDA: Poorly differentiated adenocarcinoma; SI: Small intestine; LI: Large intestine; SLI: Small and large intestine Table 2 Baseline clinical features of 21 patients. Characteristics Amount(n = 21) Percentage(%) Age,years ≤ 50 3 14.3 > 50 18 85.7 Gender Male 15 71.4 Female 6 28.6 Pathological pattern Small cell carcinoma 2 9.5 Poorly differentiated squamous cell carcinoma 1 4.8 Poorly differentiated adenosquamous carcinoma 1 4.8 Invasive adenocarcinoma 3 14.3 High - medium differentiated adenocarcinoma 1 4.8 Moderate to poorly differentiated adenocarcinoma 2 9.5 Poorly differentiated adenocarcinoma 11 52.4 T Staging Tx 2 9.5 T1 4 19.0 T2 6 28.6 T3 7 33.3 T4 2 9.5 AJCC Staging IVA 6 28.6 IVB 15 71.4 Site of intestinal metastasis Small intestine 16 76.2 Large intestine 8 38.1 Intestinal obstruction or not Yes 4 19.0 No 17 81.0 Smoking history Male(First) 17 100 Female 0 0 Patients’ outcomes and clinical characteristics Among the 21 patients, 19 progressed, and nine died. Median PFS and OS were 12 months (range 1–35 months) and 16 months (range 8–63 months), respectively. For dead patients, the median survival time was 15 months (range 4–71 months). Advanced clinical stage, without chemotherapy and radiotherapy, associated with inferior PFS, although statistical significance was not achieved (P = 0.017, 0.103, and 0.151, respectively) (Fig. 2 ). Patients with smoking (P = 0.043), intestinal obstruction (P = 0.021), and no-chemotherapy (P = 0.013) were associated with worse OS. Anti-PD-1 therapy and pneumonectomy may be associated with better OS, although statistical significance was not achieved (P = 0.059 and 0.061, respectively) (Fig. 3 ). There was no significant correlation between stage, the site of intestinal metastasis, radiotherapy, targeted therapy, intestinal resection, and OS (P˃0.05). The multivariate analysis determined that anti-PD-1 therapy (P = 0.006) and pulmonary resection (P = 0.007) were the independent prognostic values for OS, and advanced clinical stage (P = 0.038) were the separate values for PFS. Patients’ outcomes and tumor markers or immunohistochemistry molecular markers The distribution of patients with positive and negative peripheral blood tumor markers or immunohistochemistry molecular markers is demonstrated in Fig. 4 . All patients showed positive CK7 expression. CK was found to be positive in 11/12 patients (91.7%), TTF-1 in 15/18 (83.3%) patients, and NapsinA in 11/16 (68.8%) patients. There were no significant correlations between peripheral blood tumor markers or immunohistochemistry molecular markers and outcomes in OS and PFS (P > 0.05). Patients’ outcomes and PET characteristics A total of 10 patients (10/21) had the PET/CT examination. These patients were divided into a death group (n = 5), and a survival group (n = 5), and the parameters of primary lung lesions and intestinal metastases were compared, and their impact on prognosis was analyzed. The SUV max of intestinal metastasis was higher than the primary lung tumor (10.23 ± 3.59 vs 7.57 ± 3.42, P < 0.001). The SUV max of the intestinal metastasis in the dead group was higher than the survival group although statistical significance was not achieved (11.01 ± 2.90 vs 9.44 ± 4.36, P = 0.523). The SUV max of primary lung lesion in the death group was higher than the survival group, but there was no statistical significance (8.00 ± 3.86 vs 7.144 ± 3.32, P = 0.718). The PET parameters of patients are summarized and contrasted in Table 3 . Table 3 PET/CT parameters of pulmonary primary tumors and intestinal metastases. Lung(Average:N = 10) P value Intestines(Average:N = 10) P value SUVmax 7.57 ± 3.42 < 0.001 10.23 ± 3.59 < 0.001 TLG 105.81 ± 186.47 0.106 65.39 ± 59.78 0.007 MTV 21.52 ± 28.98 0.043 15.84 ± 18.77 0.026 P < 0.05 SUV max : The fixed 41% maximum standard value; MTV: Metabolic tumor volume; TLG: Total glycolysis of lesions . No significant correlation was found between PET parameters and outcomes. TLG and MTV of intestinal metastases in dead patients (65.39 ± 59.78 and 15.84 ± 18.77, respectively) were lower than in the survival group (P = 0.007 and 0.026, respectively). The PET parameters of patients are summarized and contrasted in Table 4 and Fig. 5 . Table 4 PET/CT parameters of pulmonary primary tumors and intestinal metastases in death and survival patients. Survival(Average:N = 5) Death(Average:N = 5) P value SUVmaxL 7.14 ± 3.32 8.00 ± 3.86 0.718 TLGL 68.48 ± 64.11 143.14 ± 265.78 0.48 MTVL 17.36 ± 18.77 25.69 ± 38.64 0.964 SUVmaxI 9.44 ± 4.26 11.01 ± 2.90 0.523 TLGI 77.24 ± 83.23 53.54 ± 27.58 0.964 MTVI 20.05 ± 26.32 11.63 ± 7.46 0.784 P < 0.05 SUVmaxL: SUVmax of primary lung disease; TLGL: TLG of primary lung disease; MTVL: MTV of primary lung disease; TVL:TV of primary lung disease; SUVmaxI: SUVmax of intestinal metastases; TLGI: TLG of intestinal metastases; MTVI: MTV of intestinal metastases. Discussion The incidence of intestinal metastasis with clinical evidence of lung cancer is only 0.2%-0.5%. In contrast, the incidence of primary lung cancer with intestinal metastasis has been reported in autopsy studies to be about 0.2%-14% (12, 13). Analysis of these studies has suggested that the incidence of primary lung cancer with intestinal metastasis is clinically not very low. The most common site of metastasis is the small intestine, with isolated cases of large intestine and anus also reported (14). Since lung cancer progresses to intestinal metastasis without apparent symptoms, most cases are detected by examination to exclude common site metastasis (15). It is found that a small percentage of intestinal obstruction is due to intestinal metastasis (16). Generally, the diagnosis of primary lung cancer with intestinal metastasis is late, and the incidence is low (13, 17). There is no unified standard for selecting clinical features and treatment methods for such cases. The overall clinical incidence rate was low, and there was no mature treatment experience for primary lung cancer with intestinal metastasis. Most patients with intestinal metastasis of primary lung cancer will present with ileus or acute abdomen and require surgical intervention (18). Individualized treatment may improve the survival rate for these patients. Some studies showed no difference in the PFS between the patients who received adjuvant chemotherapy and those who received adjuvant chemo-radiotherapy (7). Our study suggested that patients who underwent surgical resection of the primary lesion or chemotherapy could improve their OS, which was inconsistent with previous studies. The literature reports that the most common metastatic sites of lung cancer were bone (34%), brain (28%), adrenal gland (17%), liver (13%), and other tissues, but intestinal metastasis was rare (19). The intestinal metastasis of primary lung cancer is insidious and lacks specific clinical symptoms, most of which are asymptomatic (20). The most common site of primary lung cancer with intestinal metastasis is the small intestine, and the lesions are primarily located in the ileum and jejunum, followed by the duodenum (14). The data in this study suggest that three-fifths of patients have small intestine metastasis, and nearly two-fifths have extensive intestine metastasis, which is consistent with previous studies. The symptoms of intestinal metastasis mainly include acute intestinal obstruction, intestinal perforation, and even acute abdominal diseases such as intestinal bleeding and peritonitis (21). A Conventional endoscopic examination cannot explore the lesion site, but abdominal CT is helpful to identify the lesion (22). Therefore, for lung cancer patients with small bowel obstruction, intestinal metastasis should be highly vigilant, and abdominal CT should be perfected to evaluate the disease as far as possible. They should consider abdominal CT findings of local intestinal wall thickening, intestinal polyps, and surrounding lymph node lesions for intestinal metastasis(23). It has been reported that lung squamous cell carcinoma, large cell carcinoma, and multitype cell carcinoma are prone to intestinal metastasis. Some studies and autopsy data also show that lung adenocarcinoma is more prone to digestive tract metastasis (7). Our data tips pathological subtype of patients with intestinal metastasis of lung cancer are -- small cell carcinoma, poorly differentiated squamous cell carcinoma, poorly differentiated adenosquamous carcinoma, high-medium differentiated adenocarcinoma, invasive adenocarcinoma, moderate to poorly differentiated adenocarcinoma, poorly differentiated adenocarcinoma. The primary pathological type was adenocarcinoma, especially poorly differentiated adenocarcinoma; this is inconsistent with previous studies. The relationship between histologic classification of lung cancer and susceptibility to intestinal metastasis is unclear. TTF-1, CDX-2, CK7, and CK20 Immunohistochemistry helps identify cancer cells’ tissue origin. Primary lung adenocarcinoma was positive for TTF-1, NapsinA, CK7, CK8, CK18 (24–26). Primary lung squamous cell carcinoma was positive for P40, P63, and CK5/6(26). Primary bowel cancer was positive for CK20 and CDX-2 but negative for CK7 and TTF-1(27). Our results are CK7 in all testing in patients with positive; CK, TTF − 1, NapsinA positive and CK20, CDX-2 negative in most patients. The pathological types and molecular marks of intestinal metastasis were consistent with lung primary lesions. Most patients with intestinal metastases of primary lung cancer have no specific clinical manifestations, only showing positive fecal occult blood test, and a small number of patients present with intestinal symptoms such as abdominal pain, diarrhea, and hemifacial, while some patients present with acute abdominal symptoms such as acute intestinal obstruction and perforation (28). Most of the patients with intestinal metastases of primary lung cancer but without intestinal symptoms were detected by PET/CT whole-body scan. Therefore, for lung cancer patients, we should improve, especially those with distant metastasis to the liver, bone, and brain, fecal occult blood tests, and enhanced abdominal CT to guard against digestive tract metastasis (29). When not explained by the primary disease symptoms such as abdominal pain, diarrhea, or blood, we should think of the possibility of transferring the digestive tract. In recent years, there have been more and more reports of systemic PET/CT scans finding intestinal metastasis. For lung cancer patients without intestinal symptoms, the value of PET/CT in early detection of intestinal metastasis can be seen (30). In the routine diagnosis and treatment process of lung cancer patients, more and more doctors and patients choose PET/CT examination, but its clinical application is far from enough. PET/CT can detect intestinal metastasis, avoid missed diagnosis rates of CT scans and invasive endoscopy, and it's non-invasive. Semi-quantitative parameters of PET/CT can provide metabolic information on lesions. It can be used to understand the patient's condition, to help select treatment options and to assess prognosis. PET/CT examination can improve the efficacy and prognosis of patients with intestinal metastasis of lung cancer. Due to the limited data, this study could not explain the relationship between the semi-quantitative parameters of PET/CT and prognosis. However, our study showed that the SUV max of intestinal metastasis was higher than primary lung lesions, which improved our understanding of the diagnosis of primary lung cancer with intestinal metastasis. Systemic therapy (systemic chemotherapy, radiotherapy, targeted therapy, monoclonal antibody therapy) is the first choice for primary lung cancer with intestinal metastasis (31). If intestinal metastasis causes bleeding, obstruction, perforation, and other complications, emergency surgical treatment or immediate treatment is preferred (32). Our data suggest pneumonectomy, chemotherapy, and anti-PD-1 therapy improve patient outcomes. For patients who cannot tolerate surgical treatment, they can adopt other methods to relieve symptoms as much as possible. Due to the continuous improvement of early diagnosis of tumors, the incidence of primary lung cancer with intestinal metastasis is increasing (33). However, there are few clinical cases and no complete diagnosis and treatment guidelines. The use of PET/CT in tumor patients provides strong evidence for screening and timely detection of primary lung cancer with intestinal metastasis. Previous studies have shown that the time interval between the diagnosis of primary lung cancer and intestinal metastasis is between 2 weeks and 4 years, it should improve the follow-up during the treatment process. Combined with the experience of advanced lung cancer treatment for comprehensive and individual treatment. The early detection of intestinal metastasis will contribute to timely treatment and improve the prognosis. Therefore, PET/CT can improve the diagnosis rate of primary lung cancer with intestinal metastasis, timely treatment, and avoiding the occurrence of intestinal obstruction can improve the prognosis of patients. Conclusion Clinical features and treatment modalities affect the prognosis of primary lung cancer with intestinal metastasis. The SUV max of intestinal metastasis was higher than that of the lung primary lesion. PET/CT plays a vital role in the diagnosis of primary lung cancer with intestinal metastasis. Declarations Funding This work was supported by the Science and Technology Project of Henan Province(242102311045). Conflicts of interest/Competing interests The authors declare no conflict of interest. Ethics approval This study was approved by the Institutional Animal Care and Use Committee (IACUC) at Sun Yat-sen University Cancer Center, and the number of Ethics is SL-B2022-435-01. Consent to participate Not applicable. Consent for publication All authors approved of the manuscript and consented to its publication. Author Contribution All authors contributed to the study conception and design. Data collection and analysis were performed by Li, R. Mo, Y mainly help with data processing and article modification. Zhou, S and Ma, X mainly help with data processing. Zhang, F, Ding, X and Zhang, Y mainly help with article modification. Ding, Y mainly help with data collection. The whole manuscript was completed under the guidance of Yang, H and Li, W. The first draft of the manuscript was written by Li, R. All authors commented on previous versions of the manuscript and approved the final manuscript. Availability of data and material. All data are included in the manuscript. Code availability Not applicable. References Brownmiller T, Juric JA, Ivey AD, Harvey BM, Westemeier ES, Winters MT, et al. Y Chromosome LncRNA Are Involved in Radiation Response of Male Non-Small Cell Lung Cancer Cells. 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Malipatel R, Patil M, Rout P, Correa M, Devarbhavi H. Primary Intestinal Lymphoma: Clinicopathological Characteristics of 55 Patients. Euroasian J Hepatogastroenterol. 2021;11(2):71-5. DOT: 10.5005/jp-journals-10018-1345. Zhu K, Chen L, He C, Lang Y, Kong X, Qu C, et al. Prediction of Pleural Invasion in Challenging Non-Small-Cell Lung Cancer Patients Using Serum and Imaging Markers. Dis Markers. 2020;2020:6430459.DOI: 10.1155/2020/6430459. Zuo M, Yao L, Wen L, Shen J, Zhang N, Bai T, et al. The expression of miRNA-216b is negatively correlated with 18F-FDG uptake in non-small cell lung cancer. World J Surg Oncol. 2021;19(1):262. DOI: 10.1186/s12957-021-02376-2. Gozzi E, Angelini F, Rossi L, Leoni V, Trenta P, Cimino G, et al. Alectinib in the treatment of ocular metastases of ALK rearranged non small cell lung cancer: Description of 2 case reports. Medicine (Baltimore). 2020;99(27):e21004. DOI: 10.1097/MD.0000000000021004. Tanaka M, Kitago M, Akiyama N, Iwamaru A, Yamamoto T, Suzuki F, et al. Usefulness of immunohistochemical studies in diagnosing metachronous gallbladder and small intestinal metastases from lung cancer with gastrointestinal hemorrhage: a case report. World J Surg Oncol. 2015;13:63. DOI: 10.1186/s12957-015-0435-7. Saladi L, Maddu SM, Niazi M, Matela A. Adenocarcinoma of Lung and Bronchial Carcinoid Presenting as Double Synchronous Primary Lung Cancer: A Case Report and Review of Literature. World J Oncol. 2018;9(4):110-4. DOI:10.14740/wjon1129w Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4679252","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":330956892,"identity":"fec7e9bb-1bd1-498c-b993-9b3d99f9d530","order_by":0,"name":"Ruping Li","email":"","orcid":"","institution":"Department of Nuclear Medicine, The Affiliated Cancer Hospital of Zhengzhou University \u0026 Henan Cancer Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ruping","middleName":"","lastName":"Li","suffix":""},{"id":330956893,"identity":"821ff2da-57d5-49a4-8626-02c3c700088f","order_by":1,"name":"Yiwen Mo","email":"","orcid":"","institution":"Sun Yat-Sen University Cancer Center, Sun Yat-Sen University","correspondingAuthor":false,"prefix":"","firstName":"Yiwen","middleName":"","lastName":"Mo","suffix":""},{"id":330956894,"identity":"a2d727b2-b4bf-447e-9842-eb3856c9d1bd","order_by":2,"name":"Si Zhou","email":"","orcid":"","institution":"Department of Nuclear Medicine, The Affiliated Cancer Hospital of Zhengzhou University \u0026 Henan Cancer Hospital","correspondingAuthor":false,"prefix":"","firstName":"Si","middleName":"","lastName":"Zhou","suffix":""},{"id":330956895,"identity":"53b0d380-aea8-481c-9520-0e43e0261713","order_by":3,"name":"Xing Ma","email":"","orcid":"","institution":"Department of Nuclear Medicine, The Affiliated Cancer Hospital of Zhengzhou University \u0026 Henan Cancer Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xing","middleName":"","lastName":"Ma","suffix":""},{"id":330956896,"identity":"cbcb1460-966c-42dd-84bd-43655353fee2","order_by":4,"name":"Fuqiang Zhang","email":"","orcid":"","institution":"Department of Nuclear Medicine, The Affiliated Cancer Hospital of Zhengzhou University \u0026 Henan Cancer Hospital","correspondingAuthor":false,"prefix":"","firstName":"Fuqiang","middleName":"","lastName":"Zhang","suffix":""},{"id":330956897,"identity":"9fa3b85b-804e-40a5-a395-333eafad4c2c","order_by":5,"name":"Xianmin Ding","email":"","orcid":"","institution":"Department of Nuclear Medicine, The Affiliated Cancer Hospital of Zhengzhou University \u0026 Henan Cancer Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xianmin","middleName":"","lastName":"Ding","suffix":""},{"id":330956898,"identity":"eac66057-efd8-4cc0-a927-5e492486637a","order_by":6,"name":"Yingying Zhang","email":"","orcid":"","institution":"Department of Nuclear Medicine, The Affiliated Cancer Hospital of Zhengzhou University \u0026 Henan Cancer Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yingying","middleName":"","lastName":"Zhang","suffix":""},{"id":330956899,"identity":"eedbcd48-0c8d-4965-b9fd-318aba8034f4","order_by":7,"name":"Ying Ding","email":"","orcid":"","institution":"Department of Nuclear Medicine, The Affiliated Cancer Hospital of Zhengzhou University \u0026 Henan Cancer Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ying","middleName":"","lastName":"Ding","suffix":""},{"id":330956900,"identity":"97f7c5d5-be78-4dfe-a2d0-faf9ff6e9105","order_by":8,"name":"Wenliang Li","email":"","orcid":"","institution":"Department of Nuclear Medicine, The Affiliated Cancer Hospital of Zhengzhou University \u0026 Henan Cancer Hospital","correspondingAuthor":false,"prefix":"","firstName":"Wenliang","middleName":"","lastName":"Li","suffix":""},{"id":330956901,"identity":"26d4fcbf-cbf1-4511-8ddd-1618f193ee2a","order_by":9,"name":"Yang Hui","email":"data:image/png;base64,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","orcid":"","institution":"Department of Nuclear Medicine, The Affiliated Cancer Hospital of Zhengzhou University \u0026 Henan Cancer Hospital","correspondingAuthor":true,"prefix":"","firstName":"Yang","middleName":"","lastName":"Hui","suffix":""}],"badges":[],"createdAt":"2024-07-03 09:30:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4679252/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4679252/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":61356695,"identity":"2ad31361-fb90-4c1f-b2a1-42bb2c69ddef","added_by":"auto","created_at":"2024-07-29 21:06:01","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":203609,"visible":true,"origin":"","legend":"\u003cp\u003eDifferent metastatic sites of intestinal in patients of primary lung cancer detected by \u003csup\u003e18\u003c/sup\u003eF-FDG PET/CT (duodenum (A/B), jejunum (C/D), colon (E/F) and rectum (G/H)). All intestinal metastatic lesions show high FDG uptake.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4679252/v1/2849d8e24e6aa532fd4fd480.png"},{"id":61356690,"identity":"a82c267f-824d-419b-a958-53ac79df9bbc","added_by":"auto","created_at":"2024-07-29 21:06:01","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":81861,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan–Meier’s curves for PFS according to clinical characteristics ( (A) intestinal obstruction, (B) clinical stage, (C) chemotherapy and (D) radiotherapy.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4679252/v1/e4cb095dadb86e6e808b3c95.png"},{"id":61357769,"identity":"4df180c0-77b1-4828-a076-5e74fd38f52a","added_by":"auto","created_at":"2024-07-29 21:14:01","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":93868,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan–Meier’s curves for OS according to clinical characteristics ( (A) intestinal obstruction, (B) chemotherapy, (C) smoking, (D) anti-PD-1 therapy and (E) pneumonectomy.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-4679252/v1/003241572e615bb27e82bed5.png"},{"id":61358721,"identity":"ad418183-6e54-4345-8f8d-68a870f5ea2f","added_by":"auto","created_at":"2024-07-29 21:22:01","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":39204,"visible":true,"origin":"","legend":"\u003cp\u003e(A) Expression of different peripheral blood tumor markers in patients with intestinal metastasis of primary lung cancer; (B) Expression of immunohistochemistry molecular markers in pathological tissues of intestinal metastases.\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-4679252/v1/eff8c2a3c2917df30cdd45ee.png"},{"id":61356692,"identity":"e65ab163-9f74-4aa5-8947-6106f41a463a","added_by":"auto","created_at":"2024-07-29 21:06:01","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":71712,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of FDG uptake of primary lung lesion and intestinal metastatic tumor between dead and survival patients. SUV\u003csub\u003emax\u003c/sub\u003eL: SUV\u003csub\u003emax\u003c/sub\u003e of primary lung disease; TLGL: TLG of primary lung disease; MTVL: MTV of primary lung disease; SUV\u003csub\u003emax\u003c/sub\u003eI: SUV\u003csub\u003emax\u003c/sub\u003e of intestinal metastases; TLGI: TLG of intestinal metastases; MTVI: MTV of intestinal metastases.\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-4679252/v1/7d28f802303bd87b99784f89.png"},{"id":63008173,"identity":"374d3086-4ee6-43bd-a600-9b14d618882f","added_by":"auto","created_at":"2024-08-22 05:04:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1347443,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4679252/v1/7dd4ce6f-a249-45f3-bb85-29a276890a1f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The summary and preliminary analysis of clinical and PET/CT features of patients with intestinal metastasis of primary lung cancer","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLung cancer remains the leading cause of cancer-related mortality (1) and is the primary cause of death in men and the second cause of death in women worldwide (2, 3). Moreover, approximately 50% of the patients are diagnosed with distant metastases (4). The most common metastase sites are lymph nodes, liver, adrenal glands, bones, and brain. Intestinal metastasis was considered an unusual part of primary lung metastases consisting mainly of case reports. Due to the asymptomatic progress of the disease, it's not always easy to diagnose (5). Intestinal metastasis from lung cancer is rare; solid clinical data are still scarce. Diagnosing intestinal metastasis of primary lung cancer is challenging, as most patients with intestinal metastases present no symptoms. Intestinal metastases are generally detected through CT and PET/CT evaluations and eventually confirmed by colonoscopy and histopathology (6)(7, 8). However, with the widespread application of PET/CT in clinical practice, an increasing number of lung cancer patients are receiving PET/CT examinations during their diagnosis and treatment. The sensitivity and specificity of PET/CT for primary lung cancer and its distant metastatic lesions have highlighted its clinical value in diagnosing primary lung cancer with intestinal metastasis (9). Nonetheless, the criteria for diagnosing and treating lung cancer with intestinal metastasis, especially the role of FDG PET/CT in diagnosis, remain controversial. The consensus is that few cases have been reported, and reliable clinical data are scarce.\u003c/p\u003e \u003cp\u003eTo better understand the clinical and PET/CT characteristics of lung cancer patients with intestinal metastasis, we have summarized and analyzed related cases.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatients\u003c/h2\u003e \u003cp\u003e This single-center study was approved by the institutional review board (B2022-435-01). Patients diagnosed with primary lung cancer with or without intestinal metastasis at SYSUCC between March 2009 and March 2021 were retrospectively enrolled. The inclusion criteria were: a. pathology confirmed intestinal metastasis from primary lung cancer; b. age\u0026thinsp;\u0026ge;\u0026thinsp;18 years old. The exclusion criteria were a history of other cancer and incomplete clinical data.\u003c/p\u003e \u003cp\u003eFor the included patients, clinical characteristics were collected: age (\u0026le;\u0026thinsp;50, \u0026gt;\u0026thinsp;50 years), gender (male, female), smoking history (smoking, no smoking), American Joint Committee on Cancer (AJCC) stages IVA and IVB, pathological histology, peripheral blood tumor markers, and immunohistochemistry molecular markers. Obtained the treatment results and follow-up from the SYSUCC database, including the therapeutic schedule (pneumonectomy, enterectomy, chemotherapy, radiotherapy, targeted therapy, anti-PD-1 therapy), ileus or not, the results of PET/CT scan, the date of the last follow-up, and the outcomes of patients (disease progression, relapse or death). Disease progression was confirmed by pathological or imaging examination.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003ePeripheral blood tumor markers\u003c/h2\u003e \u003cp\u003eExamined tumor markers of most patients to summarize the expression characteristics, mainly including CA15-3, CEA, CyFra21-1, HCG-β, and NSE. Carried out the examination works in the laboratory of SYSUCC. The inspection machine and conditions are consistent. Results were classified as usual (test result within the reference range) and abnormal (test result above the maximum value of the reference range).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eImmunohistochemistry molecular markers\u003c/h2\u003e \u003cp\u003eAll patients underwent biopsy or lesion resection and the immunohistochemical markers in their pathology specimen were examined, mainly including CK, P40, P63, CK7, TTF-1, ALK (D5F3), ALK-N, NapsinA, CK20, LCA, CDX-2, VILLIN, SYN, Ki67, CD56, CK5/6. The Department of Molecular Pathology completed all the examination works, and the detection conditions were consistent.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003ePET/CT imaging\u003c/h2\u003e \u003cp\u003eFor patients who underwent PET/CT scans before any related treatment, all of them fast for 5 to 6 h before F-18 fluorodeoxyglucose (F-18 FDG) injection, and the blood glucose levels were stable and lower than 200 mg/dL (11.1 mmol/L). PET/CT scans were performed with integrated PET/CT scanners (Biograph mCT, Siemens Healthcare, Henkestr, Germany). Acquired PET/CT image data 60\u0026thinsp;\u0026plusmn;\u0026thinsp;10 min after the \u003csup\u003e18\u003c/sup\u003eF-FDG injection (3.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.37 MBq [0.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.01 mCi]/kg body weight). CT scans were obtained in an arm-up position with a Discovery ST (automatic tube current modulation, tube voltage 140 kV, rotation time 0.8 s, pitch 1.0, the field of view 50cm, collimation 16\u0026times;1.25mm, slice thickness 3.75mm), and were reconstructed in 512\u0026times;512 matrices. Whole-body imaging from the skull to the mid-thigh in 6\u0026ndash;8 bed positions (3 min/bed with the Discovery ST). The PET images were reconstructed with a slice thickness of 3.25mm (2D) in a 128\u0026times;128 matrix or 2mm (3D) in a 200\u0026times;200 matrix using the ordered subsets expectation maximization (OSEM) iterative image reconstruction method. Generated PET, CT, and fused PET/ CT images for review on a Xeleris computer workstation (GE Medical Systems) (10).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003ePET/CT parameters analyses\u003c/h2\u003e \u003cp\u003eAn abnormal PET finding was defined as a focal or diffuse FDG uptake above the background and incompatible with a normal physiological uptake. The PET images were analyzed visually and semi-quantitatively by measuring several metabolic parameters. We used the fixed threshold method to delineate the volume of interest (VOI) around the lesions. Based on the recommendation of the European Association of Nuclear Medicine guideline, we used the fixed 41% maximum standard value (SUV\u003csub\u003emax\u003c/sub\u003e) threshold to improve inter-observer reproducibility in Siemens Syngo image analysis software (Frimley, UK) (11). The SUV\u003csub\u003emax\u003c/sub\u003e, SUV\u003csub\u003emean\u003c/sub\u003e, and metabolic tumor volume (MTV) were collected, processed, and outputted by the semi-automatic system. Total glycolysis of lesions (TLG) was the sum of MTV and its SUV\u003csub\u003emean\u003c/sub\u003e in every lesion.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003ePerformed all statistical analysis with Statistical Package for the Social Sciences (SPSS) version 25.0 (IBM, Chicago, IL). Estimated survival probabilities with K-M analysis, and differences between groups were tested with the log-rank test. Multivariate Cox proportional hazards regression models were used to determine the prognostic factors. A paired t-test was used to examine the difference between PET/CT parameters of primary lung foci and those of intestinal metastatic foci. P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was regarded as statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003ePatients\u0026rsquo; characteristics\u003c/h2\u003e \u003cp\u003eAmong 21 patients with proven intestinal metastasis of lung cancer, 15 (71.4%) were male, and 6 (28.6%) were female. The average age was 59.57 years (43\u0026ndash;71 years). According to the 8th AJCC stage system, IVA and IVB stages accounted for 28.6% (6/21) and 71.4% (15/21), respectively. Because some patients have two intestinal metastases, there were 24 sites of metastasis in 21 patients. Sixteen patients (76.2%) occurred in the small intestine, and 8 (38.1%) involved the large intestine (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). And four patients (19.0%) showed intestinal obstruction. The detailed clinical information of each patient is in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The baseline clinical features of patients are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical data of 21 patients.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"20\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c16\" colnum=\"16\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c17\" colnum=\"17\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c18\" colnum=\"18\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c19\" colnum=\"19\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c20\" colnum=\"20\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eG\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003cp\u003eyear\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003cp\u003e(Year/No.)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eAJCC\u003c/p\u003e \u003cp\u003eStage\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eIM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eIO\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eChemo-\u003c/p\u003e \u003cp\u003etherapy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c14\"\u003e \u003cp\u003eRadio-\u003c/p\u003e \u003cp\u003etherapy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c15\"\u003e \u003cp\u003ePneumon-\u003c/p\u003e \u003cp\u003eectomy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c16\"\u003e \u003cp\u003eBowel resection\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c17\"\u003e \u003cp\u003eTarget\u003c/p\u003e \u003cp\u003etherapy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c18\"\u003e \u003cp\u003eAnti-\u003c/p\u003e \u003cp\u003ePD-1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c19\"\u003e \u003cp\u003ePFS\u003c/p\u003e \u003cp\u003e(Month)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c20\"\u003e \u003cp\u003eOS\u003c/p\u003e \u003cp\u003e(Month)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePDAC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eIVB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e1m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e4m\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePDA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eIVB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eLI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e1m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e5m\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHMDA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eIVA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNo idea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e33m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e71m\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePDA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eIVB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eLI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e1m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e22m\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSCC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eIVB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003ePlatinum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eLung\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e24m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e38m\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePDA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eIVB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSLI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003ePlatinum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eBrain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e2m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e4m\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePDA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eX\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eIVA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003ePlatinum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e2m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e11m\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSCC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eIVB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003ePlatinum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e3m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e5m\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePDA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eIVB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003ePlatinum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e1m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e9m\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eIVB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eLI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003ePlatinum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eLung\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e11m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e31m\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eIVB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003ePlatinum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eLung\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e11m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e28m\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePDA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eX\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eIVB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eLI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003ePlatinum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e14m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e25m\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePDA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eIVA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003ePlatinum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e10m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eIVB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003ePlatinum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eBrain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e13m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e13m\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMPDA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eIVB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003ePlatinum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e6m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e16m\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePDSCC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eIVB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eLI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003ePlatinum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e22m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e63m\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePDA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eIVB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eLI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003ePlatinum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eLung\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e10m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e20m\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePDA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eIVA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003ePlatinum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e4m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e15m\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePDA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eIVA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eLI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e10m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e10m\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePDA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eIVB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003ePlatinum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eBrain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e3m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e3m\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMPDA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eIVA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003ePlatinum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eLung\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e35m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e39m\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eNo.: Number; G: Gender; P: Pathologic types; T: Tumor; N: Lymph node; M: Metastasis; IM: Im transfer; O: intestinal obstruction; F: Frequency; PDSCC: Poorly\u003c/p\u003e \u003cp\u003edifferentiated squamous cell carcinoma; PDAC: Poorly differentiated adenosquamous carcinoma; HMDA: High-medium differentiated adenocarcinoma; SCC: Small cell carcinoma; IA: Invasive adenocarcinoma; MPDA: Moderate to poorly differentiated adenocarcinoma; PDA: Poorly differentiated adenocarcinoma; SI: Small intestine; LI: Large intestine; SLI: Small and large intestine\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline clinical features of 21 patients.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAmount(n\u0026thinsp;=\u0026thinsp;21)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge,years\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePathological pattern\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmall cell carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoorly differentiated squamous cell carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoorly differentiated adenosquamous carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInvasive adenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh - medium differentiated adenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate to poorly differentiated adenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoorly differentiated adenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eT Staging\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTx\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAJCC Staging\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIVA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIVB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSite of intestinal metastasis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmall intestine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLarge intestine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIntestinal obstruction or not\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSmoking history\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale(First)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePatients\u0026rsquo; outcomes and clinical characteristics\u003c/h2\u003e \u003cp\u003eAmong the 21 patients, 19 progressed, and nine died. Median PFS and OS were 12 months (range 1\u0026ndash;35 months) and 16 months (range 8\u0026ndash;63 months), respectively. For dead patients, the median survival time was 15 months (range 4\u0026ndash;71 months). Advanced clinical stage, without chemotherapy and radiotherapy, associated with inferior PFS, although statistical significance was not achieved (P\u0026thinsp;=\u0026thinsp;0.017, 0.103, and 0.151, respectively) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003ePatients with smoking (P\u0026thinsp;=\u0026thinsp;0.043), intestinal obstruction (P\u0026thinsp;=\u0026thinsp;0.021), and no-chemotherapy (P\u0026thinsp;=\u0026thinsp;0.013) were associated with worse OS. Anti-PD-1 therapy and pneumonectomy may be associated with better OS, although statistical significance was not achieved (P\u0026thinsp;=\u0026thinsp;0.059 and 0.061, respectively) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). There was no significant correlation between stage, the site of intestinal metastasis, radiotherapy, targeted therapy, intestinal resection, and OS (P˃0.05). The multivariate analysis determined that anti-PD-1 therapy (P\u0026thinsp;=\u0026thinsp;0.006) and pulmonary resection (P\u0026thinsp;=\u0026thinsp;0.007) were the independent prognostic values for OS, and advanced clinical stage (P\u0026thinsp;=\u0026thinsp;0.038) were the separate values for PFS.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003ePatients\u0026rsquo; outcomes and tumor markers or immunohistochemistry molecular markers\u003c/h2\u003e \u003cp\u003eThe distribution of patients with positive and negative peripheral blood tumor markers or immunohistochemistry molecular markers is demonstrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. All patients showed positive CK7 expression. CK was found to be positive in 11/12 patients (91.7%), TTF-1 in 15/18 (83.3%) patients, and NapsinA in 11/16 (68.8%) patients. There were no significant correlations between peripheral blood tumor markers or immunohistochemistry molecular markers and outcomes in OS and PFS (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003ePatients\u0026rsquo; outcomes and PET characteristics\u003c/h2\u003e \u003cp\u003eA total of 10 patients (10/21) had the PET/CT examination. These patients were divided into a death group (n\u0026thinsp;=\u0026thinsp;5), and a survival group (n\u0026thinsp;=\u0026thinsp;5), and the parameters of primary lung lesions and intestinal metastases were compared, and their impact on prognosis was analyzed.\u003c/p\u003e \u003cp\u003eThe SUV\u003csub\u003emax\u003c/sub\u003e of intestinal metastasis was higher than the primary lung tumor (10.23\u0026thinsp;\u0026plusmn;\u0026thinsp;3.59 vs 7.57\u0026thinsp;\u0026plusmn;\u0026thinsp;3.42, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The SUV\u003csub\u003emax\u003c/sub\u003e of the intestinal metastasis in the dead group was higher than the survival group although statistical significance was not achieved (11.01\u0026thinsp;\u0026plusmn;\u0026thinsp;2.90 vs 9.44\u0026thinsp;\u0026plusmn;\u0026thinsp;4.36, P\u0026thinsp;=\u0026thinsp;0.523). The SUV\u003csub\u003emax\u003c/sub\u003e of primary lung lesion in the death group was higher than the survival group, but there was no statistical significance (8.00\u0026thinsp;\u0026plusmn;\u0026thinsp;3.86 vs 7.144\u0026thinsp;\u0026plusmn;\u0026thinsp;3.32, P\u0026thinsp;=\u0026thinsp;0.718). The PET parameters of patients are summarized and contrasted in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePET/CT parameters of pulmonary primary tumors and intestinal metastases.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLung(Average:N\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIntestines(Average:N\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSUVmax\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e7.57\u0026thinsp;\u0026plusmn;\u0026thinsp;3.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e10.23\u0026thinsp;\u0026plusmn;\u0026thinsp;3.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTLG\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e105.81\u0026thinsp;\u0026plusmn;\u0026thinsp;186.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e65.39\u0026thinsp;\u0026plusmn;\u0026thinsp;59.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMTV\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e21.52\u0026thinsp;\u0026plusmn;\u0026thinsp;28.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e15.84\u0026thinsp;\u0026plusmn;\u0026thinsp;18.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003eP\u003c/b\u003e\u0026thinsp;\u0026lt;\u0026thinsp;\u003cb\u003e0.05\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSUV\u003csub\u003emax\u003c/sub\u003e: The fixed 41% maximum standard value; MTV: Metabolic tumor volume; TLG: Total glycolysis of lesions .\u003c/p\u003e \u003cp\u003eNo significant correlation was found between PET parameters and outcomes. TLG and MTV of intestinal metastases in dead patients (65.39\u0026thinsp;\u0026plusmn;\u0026thinsp;59.78 and 15.84\u0026thinsp;\u0026plusmn;\u0026thinsp;18.77, respectively) were lower than in the survival group (P\u0026thinsp;=\u0026thinsp;0.007 and 0.026, respectively). The PET parameters of patients are summarized and contrasted in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePET/CT parameters of pulmonary primary tumors and intestinal metastases in death and survival patients.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurvival(Average:N\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDeath(Average:N\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSUVmaxL\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e7.14\u0026thinsp;\u0026plusmn;\u0026thinsp;3.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e8.00\u0026thinsp;\u0026plusmn;\u0026thinsp;3.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.718\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTLGL\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e68.48\u0026thinsp;\u0026plusmn;\u0026thinsp;64.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e143.14\u0026thinsp;\u0026plusmn;\u0026thinsp;265.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMTVL\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e17.36\u0026thinsp;\u0026plusmn;\u0026thinsp;18.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e25.69\u0026thinsp;\u0026plusmn;\u0026thinsp;38.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.964\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSUVmaxI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e9.44\u0026thinsp;\u0026plusmn;\u0026thinsp;4.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e11.01\u0026thinsp;\u0026plusmn;\u0026thinsp;2.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.523\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTLGI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e77.24\u0026thinsp;\u0026plusmn;\u0026thinsp;83.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e53.54\u0026thinsp;\u0026plusmn;\u0026thinsp;27.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.964\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMTVI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e20.05\u0026thinsp;\u0026plusmn;\u0026thinsp;26.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e11.63\u0026thinsp;\u0026plusmn;\u0026thinsp;7.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.784\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cb\u003eP\u003c/b\u003e\u0026thinsp;\u0026lt;\u0026thinsp;\u003cb\u003e0.05\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSUVmaxL: SUVmax of primary lung disease; TLGL: TLG of primary lung disease; MTVL: MTV of primary lung disease; TVL:TV of primary lung disease; SUVmaxI: SUVmax of intestinal metastases; TLGI: TLG of intestinal metastases; MTVI: MTV of intestinal metastases.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe incidence of intestinal metastasis with clinical evidence of lung cancer is only 0.2%-0.5%. In contrast, the incidence of primary lung cancer with intestinal metastasis has been reported in autopsy studies to be about 0.2%-14% (12, 13). Analysis of these studies has suggested that the incidence of primary lung cancer with intestinal metastasis is clinically not very low. The most common site of metastasis is the small intestine, with isolated cases of large intestine and anus also reported (14). Since lung cancer progresses to intestinal metastasis without apparent symptoms, most cases are detected by examination to exclude common site metastasis (15). It is found that a small percentage of intestinal obstruction is due to intestinal metastasis (16). Generally, the diagnosis of primary lung cancer with intestinal metastasis is late, and the incidence is low (13, 17). There is no unified standard for selecting clinical features and treatment methods for such cases. The overall clinical incidence rate was low, and there was no mature treatment experience for primary lung cancer with intestinal metastasis.\u003c/p\u003e \u003cp\u003eMost patients with intestinal metastasis of primary lung cancer will present with ileus or acute abdomen and require surgical intervention (18). Individualized treatment may improve the survival rate for these patients. Some studies showed no difference in the PFS between the patients who received adjuvant chemotherapy and those who received adjuvant chemo-radiotherapy (7). Our study suggested that patients who underwent surgical resection of the primary lesion or chemotherapy could improve their OS, which was inconsistent with previous studies. The literature reports that the most common metastatic sites of lung cancer were bone (34%), brain (28%), adrenal gland (17%), liver (13%), and other tissues, but intestinal metastasis was rare (19). The intestinal metastasis of primary lung cancer is insidious and lacks specific clinical symptoms, most of which are asymptomatic (20). The most common site of primary lung cancer with intestinal metastasis is the small intestine, and the lesions are primarily located in the ileum and jejunum, followed by the duodenum (14). The data in this study suggest that three-fifths of patients have small intestine metastasis, and nearly two-fifths have extensive intestine metastasis, which is consistent with previous studies.\u003c/p\u003e \u003cp\u003eThe symptoms of intestinal metastasis mainly include acute intestinal obstruction, intestinal perforation, and even acute abdominal diseases such as intestinal bleeding and peritonitis (21). A Conventional endoscopic examination cannot explore the lesion site, but abdominal CT is helpful to identify the lesion (22). Therefore, for lung cancer patients with small bowel obstruction, intestinal metastasis should be highly vigilant, and abdominal CT should be perfected to evaluate the disease as far as possible. They should consider abdominal CT findings of local intestinal wall thickening, intestinal polyps, and surrounding lymph node lesions for intestinal metastasis(23). It has been reported that lung squamous cell carcinoma, large cell carcinoma, and multitype cell carcinoma are prone to intestinal metastasis. Some studies and autopsy data also show that lung adenocarcinoma is more prone to digestive tract metastasis (7). Our data tips pathological subtype of patients with intestinal metastasis of lung cancer are -- small cell carcinoma, poorly differentiated squamous cell carcinoma, poorly differentiated adenosquamous carcinoma, high-medium differentiated adenocarcinoma, invasive adenocarcinoma, moderate to poorly differentiated adenocarcinoma, poorly differentiated adenocarcinoma. The primary pathological type was adenocarcinoma, especially poorly differentiated adenocarcinoma; this is inconsistent with previous studies.\u003c/p\u003e \u003cp\u003eThe relationship between histologic classification of lung cancer and susceptibility to intestinal metastasis is unclear. TTF-1, CDX-2, CK7, and CK20 Immunohistochemistry helps identify cancer cells\u0026rsquo; tissue origin. Primary lung adenocarcinoma was positive for TTF-1, NapsinA, CK7, CK8, CK18 (24\u0026ndash;26). Primary lung squamous cell carcinoma was positive for P40, P63, and CK5/6(26). Primary bowel cancer was positive for CK20 and CDX-2 but negative for CK7 and TTF-1(27). Our results are CK7 in all testing in patients with positive; CK, TTF \u0026minus;\u0026thinsp;1, NapsinA positive and CK20, CDX-2 negative in most patients. The pathological types and molecular marks of intestinal metastasis were consistent with lung primary lesions.\u003c/p\u003e \u003cp\u003eMost patients with intestinal metastases of primary lung cancer have no specific clinical manifestations, only showing positive fecal occult blood test, and a small number of patients present with intestinal symptoms such as abdominal pain, diarrhea, and hemifacial, while some patients present with acute abdominal symptoms such as acute intestinal obstruction and perforation (28). Most of the patients with intestinal metastases of primary lung cancer but without intestinal symptoms were detected by PET/CT whole-body scan. Therefore, for lung cancer patients, we should improve, especially those with distant metastasis to the liver, bone, and brain, fecal occult blood tests, and enhanced abdominal CT to guard against digestive tract metastasis (29). When not explained by the primary disease symptoms such as abdominal pain, diarrhea, or blood, we should think of the possibility of transferring the digestive tract. In recent years, there have been more and more reports of systemic PET/CT scans finding intestinal metastasis. For lung cancer patients without intestinal symptoms, the value of PET/CT in early detection of intestinal metastasis can be seen (30). In the routine diagnosis and treatment process of lung cancer patients, more and more doctors and patients choose PET/CT examination, but its clinical application is far from enough. PET/CT can detect intestinal metastasis, avoid missed diagnosis rates of CT scans and invasive endoscopy, and it's non-invasive. Semi-quantitative parameters of PET/CT can provide metabolic information on lesions. It can be used to understand the patient's condition, to help select treatment options and to assess prognosis. PET/CT examination can improve the efficacy and prognosis of patients with intestinal metastasis of lung cancer. Due to the limited data, this study could not explain the relationship between the semi-quantitative parameters of PET/CT and prognosis. However, our study showed that the SUV\u003csub\u003emax\u003c/sub\u003e of intestinal metastasis was higher than primary lung lesions, which improved our understanding of the diagnosis of primary lung cancer with intestinal metastasis.\u003c/p\u003e \u003cp\u003eSystemic therapy (systemic chemotherapy, radiotherapy, targeted therapy, monoclonal antibody therapy) is the first choice for primary lung cancer with intestinal metastasis (31). If intestinal metastasis causes bleeding, obstruction, perforation, and other complications, emergency surgical treatment or immediate treatment is preferred (32). Our data suggest pneumonectomy, chemotherapy, and anti-PD-1 therapy improve patient outcomes. For patients who cannot tolerate surgical treatment, they can adopt other methods to relieve symptoms as much as possible.\u003c/p\u003e \u003cp\u003eDue to the continuous improvement of early diagnosis of tumors, the incidence of primary lung cancer with intestinal metastasis is increasing (33). However, there are few clinical cases and no complete diagnosis and treatment guidelines. The use of PET/CT in tumor patients provides strong evidence for screening and timely detection of primary lung cancer with intestinal metastasis. Previous studies have shown that the time interval between the diagnosis of primary lung cancer and intestinal metastasis is between 2 weeks and 4 years, it should improve the follow-up during the treatment process. Combined with the experience of advanced lung cancer treatment for comprehensive and individual treatment. The early detection of intestinal metastasis will contribute to timely treatment and improve the prognosis. Therefore, PET/CT can improve the diagnosis rate of primary lung cancer with intestinal metastasis, timely treatment, and avoiding the occurrence of intestinal obstruction can improve the prognosis of patients.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eClinical features and treatment modalities affect the prognosis of primary lung cancer with intestinal metastasis. The SUV\u003csub\u003emax\u003c/sub\u003e of intestinal metastasis was higher than that of the lung primary lesion. PET/CT plays a vital role in the diagnosis of primary lung cancer with intestinal metastasis.\u003c/p\u003e "},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis work was supported by the Science and Technology Project of Henan Province(242102311045).\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConflicts of interest/Competing interests\u003c/strong\u003e \u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthics approval\u003c/strong\u003e \u003cp\u003e This study was approved by the Institutional Animal Care and Use Committee (IACUC) at Sun Yat-sen University Cancer Center, and the number of Ethics is SL-B2022-435-01.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent to participate\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003e All authors approved of the manuscript and consented to its publication.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors contributed to the study conception and design. Data collection and analysis were performed by Li, R. Mo, Y mainly help with data processing and article modification. Zhou, S and Ma, X mainly help with data processing. Zhang, F, Ding, X and Zhang, Y mainly help with article modification. Ding, Y mainly help with data collection. The whole manuscript was completed under the guidance of Yang, H and Li, W. The first draft of the manuscript was written by Li, R. All authors commented on previous versions of the manuscript and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAvailability of data and material.\u003c/h2\u003e \u003cp\u003eAll data are included in the manuscript.\u003c/p\u003e\u003ch2\u003eCode availability\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBrownmiller T, Juric JA, Ivey AD, Harvey BM, Westemeier ES, Winters MT, et al. Y Chromosome LncRNA Are Involved in Radiation Response of Male Non-Small Cell Lung Cancer Cells. 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DOI:10.14740/wjon1129w\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Lung cancer with intestinal metastasis, intestinal obstruction, anti-PD-1 therapy, PET/CT, SUVmax","lastPublishedDoi":"10.21203/rs.3.rs-4679252/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4679252/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eThis study aimed to analyze the influence of clinical manifestation, PET/CT parameters, and treatment on the prognosis of patients with primary lung cancer who developed intestinal metastasis.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eWe collected data from 21 cases of primary lung cancer with intestinal metastasis. The data included basic information, examination results, treatment processes, and prognosis. We employed Kaplan-Meier (K-M) analysis, multivariate Cox regression analysis, and t-test for prognosis analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIntestinal obstruction and advanced stage were associated with poor progression-free survival (PFS) (P\u0026thinsp;=\u0026thinsp;0.017 and 0.038, respectively). Smoking, intestinal obstruction, and the lack of chemotherapy were associated with worse overall survival (OS) (P\u0026thinsp;=\u0026thinsp;0.043, 0.021, 0.013, respectively). Anti-PD-1 therapy (P\u0026thinsp;=\u0026thinsp;0.006) and pneumonectomy (P\u0026thinsp;=\u0026thinsp;0.007) improved patient outcomes. The immunohistochemical results showed no correlation between these markers and prognosis (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The mean SUVmax of intestinal metastases (10.23\u0026thinsp;\u0026plusmn;\u0026thinsp;3.59) was higher than that of primary lung cancer (7.57\u0026thinsp;\u0026plusmn;\u0026thinsp;3.42), and the former was also higher than the latter in both death and survival groups. There was no significant correlation between PET parameters (SUVmax, TLG, MTV) and prognosis (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eSmoking, intestinal obstruction, advanced stage, and lack of chemotherapy were risk factors for poor outcomes in primary lung cancer with intestinal metastasis. Patients treated with anti-PD-1 therapy and pneumonectomy tended to have better outcomes. The mean SUVmax of intestinal metastases was higher than that of primary lung cancer.\u003c/p\u003e","manuscriptTitle":"The summary and preliminary analysis of clinical and PET/CT features of patients with intestinal metastasis of primary lung cancer","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-29 21:05:56","doi":"10.21203/rs.3.rs-4679252/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b0188278-04b4-4a98-90ab-12519d85fbe4","owner":[],"postedDate":"July 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-14T04:53:22+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-29 21:05:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4679252","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4679252","identity":"rs-4679252","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}