Prognosis of metabolic volume parameters by 18F-FDG PET/CT in stageⅡ—Ⅲ non-small cell lung cancer

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(Department of Nuclear Medicine, the First Affiliated Hospital ofChongqing Medical University, Chongqing 400016, China)

Prognosis of metabolic volume parameters by18F-FDG PET/CT in stageⅡ—Ⅲ non-small cell lung cancer

LIUYing,XULu,ZHOUJing,LIUQian,LIWenbo,PANGHua*

(DepartmentofNuclearMedicine,theFirstAffiliatedHospitalofChongqingMedicalUniversity,Chongqing400016,China)

Objective To evaluate the prognostic value of18F-FDG PET/CT-based metabolic tumor volume (MTV) and total lesion glycolysis (TLG) in stage Ⅱ—Ⅲ non-small cell lung cancer (NSCLC). Methods All of 47 patients with pathological stage on Ⅱ or Ⅲ NSCLC who underwent PET/CT before treatment were retrospectively reviewed.Kaplan-Meiermethod,Log-ranktest andCOXproportional hazard model were used to analyze the relationship between metabolic parameters and overall survival (OS), progression free survival (PFS). MTV were measured using a cutoff of 40% maximum standard uptake value (SUVmax). Results The median OS and PFS was 28.93 and 17.37 months, and the 1-, 2- and 3-year overall survival rate was 80.85% (38/47), 59.57% (28/47), 38.30% (18/47), respectively. Univariate analysis suggested that SUVmax, MTV and TLG had significant differences on OS and PFS (allP<0.05). On multivariate analysis, TLG was a risk factor for PFS (HR=5.591,P<0.001), and MTV was a risk factor for OS (HR=4.369,P<0.001). MTV was correlated with TNM-staging (r=0.449,P=0.012). Conclusion In patients with stage Ⅱ or Ⅲ NSCLC, MTV is a independent significant prognostic factor for OS, and TLG is able to predict the progression.

Carcinoma, non-small-cell lung; Radionuclide imaging; Tomography, X-ray computed; Prognosis

肺癌是全球肿瘤中发病率和死亡率最高的恶性肿瘤之一，而非小细胞肺癌(non-small cell lung cancer, NSCLC)占肺癌总数的80%～85%[1]。目前，国际抗癌联盟(Union for International Cancer Control, UICC)的TNM分期系统是对NSCLC患者预后评估的最常用方法，但相同分期患者间仍存在较大生存差异。近年来，具有解剖定位和功能显像双重优势的18F-FDG PET/CT广泛地应用于肿瘤诊治过程中[2]，最大标准化摄取值(maximum standard uptake value, SUVmax)在NSCLC的诊断、分期、疗效评估方面有较高的价值[3]，但有研究[4-5]证明其不是NSCLC的独立预后因素；可代表肿瘤代谢负荷的代谢体积参数，如肿瘤代谢体积(metabolic tumor volume, MTV)[5-8]和糖酵解总量(total lesion glycolysis, TLG)[4-5,9-10]亦具有一定的预后评估价值。本研究探讨MTV和TLG评估Ⅱ～Ⅲ期NSCLC患者的预后价值。

1 资料与方法

1.1 一般资料 回顾性分析2012年4月—2013年10月于我院PET/CT中心接受18F-FDG PET/CT检查的治疗前NSCLC患者47例，男38例，女9例，年龄48～83岁，中位年龄63.0岁；其中手术治疗10例，非手术治疗37例；腺癌25例，非腺癌22例；TNM分期Ⅱ期20例，Ⅲ期27例。

纳入标准：①经细胞学或组织病理学确诊为NSCLC；②根据UICC的TNM分期标准，肿瘤分期为Ⅱ或Ⅲ期；③无严重肺功能障碍及其他系统疾病；④积极治疗，接受手术或放、化疗等综合治疗；⑤长期规律随访，资料完整。

1.2 仪器与方法 采用Philips Gemini TF 64 PET/CT机；18F- FDG由我科医用回旋加速器生产，放化纯度>95%。检查前患者空腹6 h以上，空腹血糖≤7.0 mmol/L。静脉注射18F-FDG显像剂，剂量3.70～5.55 MBq/kg体质量，安静休息1 h，饮水、排尿，行PET/CT显像，扫描范围为颅顶至大腿根部。CT扫描参数：电压120 kV，电流100 mA，层厚4.0 mm，PET扫描参数：4D采集，层厚4.0 mm，头颈部扫描 5 min/床位，头颈部以下部位3 min/床位；CT扫描数据采用衰减校正，迭代法重建图像，获得的矢状位、冠状位、轴位图像传至EBW工作站。

1.3 图像分析 由2名PET/CT诊断经验丰富的医师结合视觉判读和半定量分析法，目测病灶18F-FDG摄取程度。以……