Lee Percy, Weerasuriya Dilani K, Lavori Philip W, Quon Andrew, Hara Wendy, Maxim Peter G, Le Quynh-Thu, Wakelee Heather A, Donington Jessica S, Graves Edward E, Loo Billy W
Department of Radiation Oncology, Stanford University, Stanford, CA 94305-5847, USA.
Int J Radiat Oncol Biol Phys. 2007 Oct 1;69(2):328-33. doi: 10.1016/j.ijrobp.2007.04.036.
In lung cancer, stage is an important prognostic factor for disease progression and survival. However, stage may be simply a surrogate for underlying tumor burden. Our purpose was to assess the prognostic value of tumor burden measured by 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) imaging.
We identified 19 patients with lung cancer who had staging PET-CT scans before any therapy, and adequate follow-up (complete to time of progression for 18, and death for 15 of 19). Metabolically active tumor regions were segmented on pretreatment PET scans semi-automatically using custom software. We determined the relationship between times to progression (TTP) and death (OS) and two PET parameters: total metabolic tumor volume (MTV), and standardized uptake value (SUV).
The estimated median TTP and OS for the cohort were 9.3 months and 14.8 months. On multivariate Cox proportional hazards regression analysis, an increase in MTV of 25 ml (difference between the 75th and 25th percentiles) was associated with increased hazard of progression and of death (5.4-fold and 7.6-fold), statistically significant (p = 0.0014 and p = 0.001) after controlling for stage, treatment intent (definitive or palliative), age, Karnofsky performance status, and weight loss. We did not find a significant relationship between SUV and TTP or OS.
In this study, high tumor burden assessed by PET MTV is an independent poor prognostic feature in lung cancer, promising for stratifying patients in randomized trials and ultimately for selecting risk-adapted therapies. These results will need to be validated in larger cohorts with longer follow-up, and evaluated prospectively.
在肺癌中，分期是疾病进展和生存的重要预后因素。然而，分期可能仅仅是潜在肿瘤负荷的一个替代指标。我们的目的是评估通过18F-氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）成像测量的肿瘤负荷的预后价值。
我们确定了19例肺癌患者，他们在接受任何治疗之前都进行了分期PET-CT扫描，并且有足够的随访（19例中有18例随访至疾病进展，15例随访至死亡）。使用定制软件在治疗前的PET扫描上半自动分割代谢活跃的肿瘤区域。我们确定了疾病进展时间（TTP）和死亡时间（OS）与两个PET参数之间的关系：总代谢肿瘤体积（MTV）和标准化摄取值（SUV）。
该队列的估计中位TTP和OS分别为9.3个月和14.8个月。在多变量Cox比例风险回归分析中，MTV增加25 ml（第75百分位数与第25百分位数之间的差异）与疾病进展和死亡风险增加相关（分别为5.4倍和7.6倍），在控制分期、治疗意图（根治性或姑息性）、年龄、卡诺夫斯基功能状态和体重减轻后具有统计学意义（p = 0.0014和p = 0.001）。我们未发现SUV与TTP或OS之间存在显著关系。
在本研究中，通过PET MTV评估的高肿瘤负荷是肺癌中一个独立的不良预后特征，有望在随机试验中对患者进行分层，并最终用于选择风险适应性治疗。这些结果需要在更大的队列中进行更长时间的随访验证，并进行前瞻性评估。
