Higashi Kotaro, Ueda Yoshimichi, Arisaka Yukiko, Sakuma Tsutomu, Nambu Yoshihiro, Oguchi Manabu, Seki Hiroyasu, Taki Suzuka, Tonami Hisao, Yamamoto Itaru
Department of Radiology, Kanazawa Medical University, Ishikawa, Japan.
J Nucl Med. 2002 Jan;43(1):39-45.
Among patients with resected non-small cell lung cancer (NSCLC), approximately 50% present with a recurrent tumor. The clinical or pathologic TNM staging does not always provide a satisfactory explanation for differences in relapse and survival. Thus, it is of major importance to be able to predict these relapses and to prevent them with an active chemotherapy or radiotherapy program (or both). 18F-FDG uptake on PET could be of prognostic significance in patients with resected NSCLC. The goal of this study was to determine whether the level of metabolic activity observed with 18F-FDG uptake correlates with the probability of postoperative recurrence in patients with NSCLC.
Fifty-seven patients with NSCLC were examined with 18F-FDG PET. For semiquantitative analysis, standardized uptake values (SUVs) were calculated. Patients were classified into high-SUV (> 5.0) and low-SUV (< or = 5.0) groups. All patients underwent thoracotomy within 4 wk after the 18F-FDG PET study. Tumor 18F-FDG uptake (SUV), pathologic stage, and lesion size were analyzed for their possible association with disease-free survival.
Forty-six patients had pathologic stage I NSCLC and 11 had pathologic stage II or stage III NSCLC. In a univariate analysis, patients with an SUV of < or = 5 had a much better disease-free survival than did patients with an SUV of > 5 (P < 0.0001). In patients with pathologic stage I and stage IA NSCLC, the SUV was also correlated with disease-free survival (P < 0.0001 and P = 0.0012, respectively). Patients with pathologic stage I disease had an expected 5-y disease-free survival rate of 88% if the SUV was < or = 5 and a survival rate of < or = 17% if the SUV was > 5. A multivariate Cox analysis identified the SUV as the most significant independent factor for disease-free survival.
We conclude that the 18F-FDG uptake in primary NSCLC determined by PET has a significant independent postoperative prognostic value for recurrence, especially in patients with pathologic stage I NSCLC. 18F-FDG uptake was superior to pathologic stage in predicting relapse of patients with NSCLC.
在接受手术切除的非小细胞肺癌（NSCLC）患者中，约50%会出现肿瘤复发。临床或病理TNM分期并不总能令人满意地解释复发和生存差异。因此，能够预测这些复发并通过积极的化疗或放疗方案（或两者结合）加以预防至关重要。18F-FDG在PET上的摄取情况对于接受手术切除的NSCLC患者可能具有预后意义。本研究的目的是确定18F-FDG摄取所观察到的代谢活性水平是否与NSCLC患者术后复发的可能性相关。
对57例NSCLC患者进行了18F-FDG PET检查。为进行半定量分析，计算了标准化摄取值（SUV）。患者被分为高SUV（>5.0）组和低SUV（≤5.0）组。所有患者在18F-FDG PET检查后4周内接受了开胸手术。分析肿瘤18F-FDG摄取（SUV）、病理分期和病变大小与无病生存期的可能关联。
46例患者为病理I期NSCLC，11例为病理II期或III期NSCLC。单因素分析显示，SUV≤5的患者无病生存期明显优于SUV>5的患者（P<0.0001）。在病理I期和IA期NSCLC患者中，SUV也与无病生存期相关（分别为P<0.0001和P = 0.0012）。病理I期疾病患者若SUV≤5，预期5年无病生存率为88%，若SUV>5，生存率≤17%。多因素Cox分析确定SUV是无病生存期最重要的独立因素。
我们得出结论，PET测定的原发性NSCLC中18F-FDG摄取对复发具有显著的独立术后预后价值，尤其是在病理I期NSCLC患者中。18F-FDG摄取在预测NSCLC患者复发方面优于病理分期。
