Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Republic of Korea.
J Thorac Oncol. 2010 Apr;5(4):497-503. doi: 10.1097/JTO.0b013e3181d2efe7.
The purpose of this study was to assess the value of tumor response evaluation using combined interpretation of [18F] fluorodeoxyglucose positron emission tomography (PET) and computed tomography (CT) for the prediction of clinical outcome and pathologic response in patients with stage III non-small cell lung cancer who underwent neoadjuvant chemotherapy followed by surgery.
This study was approved by the Institutional Review Board with a waiver of informed consent. Forty-four consecutive patients (M:F = 32:12; mean age, 60.7 years) with locally advanced non-small cell lung cancer received neoadjuvant chemotherapy followed by curative surgery. Time to recurrence (TTR) was stratified by radiologic, metabolic, and radiologic-metabolic response using the Kaplan-Meier method. The accuracy of radiologic, metabolic, and radiologic-metabolic response criteria for the prediction of pathologic response was evaluated.
Radiologic-metabolic responders had a longer TTR than nonresponders (mean TTR, 58.7 months versus 22.3 months, p = 0.001 with criteria of >or=30% reduction of size and >or=50% reduction of [maximum standardized uptake value] SUVmax and mean TTR, 49.4 months versus 23.5 months, p = 0.022 with criteria of >or=30% reduction of size and >or=25% reduction of SUVmax, respectively). The TTR of radiologic responders (criteria of >or=30% reduction of size) and metabolic responders (criteria of >or=25% reduction of SUVmax) was not different from the TTR of nonresponders (p > 0.05). The accuracy for the prediction of pathologic response was 70% in radiologic responders, 52 to 75% in metabolic responders, and 73 to 82% in radiologic-metabolic responders.
Tumor response evaluation using combined interpretation of [18F] fluorodeoxyglucose-PET and CT was more effective than single interpretation of CT response or PET response alone for the prediction of tumor recurrence and pathologic response.
本研究旨在评估联合解读 [18F] 氟脱氧葡萄糖正电子发射断层扫描（PET）和计算机断层扫描（CT）在预测接受新辅助化疗后接受手术的 III 期非小细胞肺癌患者的临床结局和病理反应方面的价值。
本研究得到机构审查委员会的批准，并豁免了知情同意。44 例连续的局部晚期非小细胞肺癌患者（男：女=32：12；平均年龄 60.7 岁）接受新辅助化疗后行根治性手术。采用 Kaplan-Meier 法按影像学、代谢和影像学代谢反应分层复发时间（TTR）。评估影像学、代谢和影像学代谢反应标准预测病理反应的准确性。
影像学代谢反应者的 TTR 长于无反应者（标准为>30%的大小减少和>50%的[最大标准化摄取值] SUVmax 减少，平均 TTR 为 58.7 个月比 22.3 个月，p=0.001；标准为>30%的大小减少和>25%的 SUVmax 减少，平均 TTR 为 49.4 个月比 23.5 个月，p=0.022）。影像学反应者（标准为>30%的大小减少）和代谢反应者（标准为>25%的 SUVmax 减少）的 TTR 与无反应者无差异（p>0.05）。预测病理反应的准确性在影像学反应者中为 70%，代谢反应者中为 52%至 75%，影像学代谢反应者中为 73%至 82%。
联合解读 [18F] 氟脱氧葡萄糖-PET 和 CT 的肿瘤反应评估比单独解读 CT 反应或 PET 反应更能有效预测肿瘤复发和病理反应。
