18F-FDG PET-CT在评估局部晚期非小细胞肺癌预后中的应用

冀胜军 付兆懿 张敏 路会玲, Ji Shengjun Fu Zhaoyi Zhang Min Lu Huiling
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Progression-free survival (PFS) and overall survival (OS) were assessed by Kaplan-Meier method and the survival difference between the two groups was estimated by log-rank test. Multivariate survival analysis was performed by Cox proportional hazard model. \n \n \nResults \nAccording to ROC analysis, SUVmax (AUC=0.716, cut-off value was 11.8, P<0.001) had a better predictive value for OS, whereas the predictive values of MTV (AUC=0.580, P=0.101) and TLG (AUC=0.635, P=0.005) were less. There was no significant correlation between SUVmax and patients′ age (χ2=1.222, P=0.269), gender (χ2=0.029, P=0.865), TNM stage (χ2=0.073, P=0.787), pathologic subtype (χ2=0.541, P=0.462), smoking (χ2=0.266, P=0.606), differentiation (χ2=0.285, P=0.593) or tumor location (χ2=0.509, P=0.476). The 1-year, 2-year and 3-year OS rates of low SUVmax group (n=59) were 93.2%, 67.0% and 15.6% respectively, and those of high SUVmax group (n=79) were 77.2%, 25.0% and 5.62% respectively. The OS rate of low SUVmax group was higher than that of high SUVmax group (χ2=19.153, P<0.001). The 1-year and 2-year PFS rates of low SUVmax group were 79.3% and 56.9% respectively, and those of high SUVmax group were 46.2%, 13.0% respectively. The PFS rate of low SUVmax group was higher than that of high SUVmax group (χ2=25.945, P<0.001). Single factor analysis showed that differentiation (HR=1.839, 95%CI: 1.161-2.913, P=0.017), SUVmax (HR=0.357, 95%CI: 0.231-0.550, P<0.001), MTV (HR=0.470, 95%CI: 0.270-0.819, P=0.001) and TLG (HR= 0.508, 95%CI: 0.327-0.789, P=0.002) were independent influencing factors of OS. The degree of differentiation (HR=1.909, 95%CI: 1.167-3.123, P=0.018) and SUVmax (HR=0.250, 95%CI: 0.160-0.410, P<0.001) were the independent influencing factors of PFS. 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引用次数: 0

摘要

目的探讨18F-FDG PET-CT在评价局部晚期非小细胞肺癌(NSCLC)患者预后中的价值。方法回顾性分析2013 - 2016年苏州市市直医院及苏州新区人民医院138例局部晚期非小细胞肺癌患者的临床特征及18F-FDG PET-CT参数。测定最大标准化摄取值(SUVmax)、代谢肿瘤体积(MTV)和病灶糖酵解总量(TLG)。计算SUVmax、MTV和TLG的曲线下面积(AUC),确定患者分组的最佳截断值,并进行受试者-工作特征曲线(ROC)分析。采用Kaplan-Meier法评估无进展生存期(PFS)和总生存期(OS),采用log-rank检验估计两组间的生存差异。采用Cox比例风险模型进行多因素生存分析。结果经ROC分析,SUVmax (AUC=0.716,临界值为11.8,P<0.001)对OS的预测值较好,而MTV (AUC=0.580, P=0.101)和TLG (AUC=0.635, P=0.005)的预测值较差。SUVmax与患者年龄(χ2=1.222, P=0.269)、性别(χ2=0.029, P=0.865)、TNM分期(χ2=0.073, P=0.787)、病理亚型(χ2=0.541, P=0.462)、吸烟(χ2=0.266, P=0.606)、分化程度(χ2=0.285, P=0.593)、肿瘤部位(χ2=0.509, P=0.476)均无显著相关。低SUVmax组(n=59) 1年、2年、3年OS率分别为93.2%、67.0%、15.6%,高SUVmax组(n=79) 1年、2年、3年OS率分别为77.2%、25.0%、5.62%。低SUVmax组的总生存率高于高SUVmax组(χ2=19.153, P<0.001)。低SUVmax组1年、2年PFS率分别为79.3%、56.9%,高SUVmax组1年、2年PFS率分别为46.2%、13.0%。低SUVmax组的PFS率高于高SUVmax组(χ2=25.945, P<0.001)。单因素分析显示,分化(HR=1.839, 95%CI: 1.161 ~ 2.913, P=0.017)、SUVmax (HR=0.357, 95%CI: 0.231 ~ 0.550, P<0.001)、MTV (HR=0.470, 95%CI: 0.270 ~ 0.819, P=0.001)和TLG (HR= 0.508, 95%CI: 0.327 ~ 0.789, P=0.002)是OS的独立影响因素。分化程度(HR=1.909, 95%CI: 1.167 ~ 3.123, P=0.018)和SUVmax (HR=0.250, 95%CI: 0.160 ~ 0.410, P<0.001)是PFS的独立影响因素。多因素分析显示,只有SUVmax是OS (HR=2.189, 95%CI: 1.222 ~ 3.189, P=0.008)和PFS (HR=4.412, 95%CI: 2.318 ~ 8.398, P<0.001)的独立影响因素。结论原发肿瘤的PET-CT SUVmax与患者的OS和PFS有显著相关。对局部晚期NSCLC患者的预后判断和治疗方案选择具有重要的指导价值。关键词:肺癌,非小细胞肺;pet - ct机18 f-fdg;预后
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18F-FDG PET-CT在评估局部晚期非小细胞肺癌预后中的应用
Objective To explore the value of 18F-FDG PET-CT in evaluating the prognosis of locally advanced non-small cell lung cancer (NSCLC) patients. Methods The clinical characteristics and 18F-FDG PET-CT parameters of 138 locally advanced NSCLC patients from 2013 to 2016 in Suzhou Municipal Hospital and People′s Hospital of Suzhou New District were analyzed retrospectively. The maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were measured. Area under the curve (AUC) of SUVmax, MTV and TLG were calculated to determine optimal cut-off value for patients grouping, with receiver-operating characteristic curve (ROC) analysis. Progression-free survival (PFS) and overall survival (OS) were assessed by Kaplan-Meier method and the survival difference between the two groups was estimated by log-rank test. Multivariate survival analysis was performed by Cox proportional hazard model. Results According to ROC analysis, SUVmax (AUC=0.716, cut-off value was 11.8, P<0.001) had a better predictive value for OS, whereas the predictive values of MTV (AUC=0.580, P=0.101) and TLG (AUC=0.635, P=0.005) were less. There was no significant correlation between SUVmax and patients′ age (χ2=1.222, P=0.269), gender (χ2=0.029, P=0.865), TNM stage (χ2=0.073, P=0.787), pathologic subtype (χ2=0.541, P=0.462), smoking (χ2=0.266, P=0.606), differentiation (χ2=0.285, P=0.593) or tumor location (χ2=0.509, P=0.476). The 1-year, 2-year and 3-year OS rates of low SUVmax group (n=59) were 93.2%, 67.0% and 15.6% respectively, and those of high SUVmax group (n=79) were 77.2%, 25.0% and 5.62% respectively. The OS rate of low SUVmax group was higher than that of high SUVmax group (χ2=19.153, P<0.001). The 1-year and 2-year PFS rates of low SUVmax group were 79.3% and 56.9% respectively, and those of high SUVmax group were 46.2%, 13.0% respectively. The PFS rate of low SUVmax group was higher than that of high SUVmax group (χ2=25.945, P<0.001). Single factor analysis showed that differentiation (HR=1.839, 95%CI: 1.161-2.913, P=0.017), SUVmax (HR=0.357, 95%CI: 0.231-0.550, P<0.001), MTV (HR=0.470, 95%CI: 0.270-0.819, P=0.001) and TLG (HR= 0.508, 95%CI: 0.327-0.789, P=0.002) were independent influencing factors of OS. The degree of differentiation (HR=1.909, 95%CI: 1.167-3.123, P=0.018) and SUVmax (HR=0.250, 95%CI: 0.160-0.410, P<0.001) were the independent influencing factors of PFS. Multivariate analysis showed that only SUVmax was an independent influencing factor of OS (HR=2.189, 95%CI: 1.222-3.189, P=0.008)and PFS (HR=4.412, 95%CI: 2.318-8.398, P<0.001). Conclusion PET-CT SUVmax of primary tumor is significantly correlated with OS and PFS of patients. It has important guiding value for prognosis judgment and treatment plan selection of patients with locally advanced NSCLC. Key words: Carcinoma, non-small-cell lung; 18F-FDG PET-CT; Prognosis
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