Obrzut Sebastian, Bykowski Julie, Badran Karam, Hayeri Mohammad Reza, Hoh Carl K
Department of Radiology, University of California San Diego, La Jolla, California, USA.
Nucl Med Commun. 2010 Dec;31(12):1008-15. doi: 10.1097/MNM.0b013e328340438d.
Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) has added positron emission tomography (PET) as an optional complement for the detection of new lesions. In this study, we evaluate the utility of fluorodeoxyglucose (FDG)-PET in the identification of new lesions and progressive disease not recognized on computed tomography (CT) in patients with nonsmall cell lung cancer (NSCLC) undergoing therapy.
Seventy patients (30 female, 40 male; mean age 67±14 years, range, 39-94 years) with NSCLC underwent FDG-PET before and after chemotherapy and/or radiotherapy, whereas 69 patients underwent CT imaging. Overall (OS) and progression-free survivals (PFS) were calculated for RECIST 1.1 with CT alone, RECIST 1.1 with PET for the identification of new lesions, visual PET, and semiquantitative PET using a change in standardized uptake value ranging from -15 to -50%.
PET identified new lesions in 26 patients, resulting in 10 patients (14.5%) being upgraded to progressive disease. The combination of CT and PET for the detection of new lesions improved the prediction of survival (OS: P=0.0491 for all stages and P=0.0033 for stage IV; PFS: P=0.0045 for stage IV) compared with CT imaging alone (OS: P=0.1362 for all stages and P=0.1625 for stage IV; PFS: P=0.0632 for stage IV). Furthermore, a change in standardized uptake value of -35% was the most discriminative for the prediction of survival for the semiquantitative PET approach (OS: P=0.0393 for all stages, P=0.0051 for stage IV; PFS: P=0.0092 for stage IV) and more discriminative than the visual PET approach (OS: P=0.2699 for all stages, P=0.0105 for stage IV; PFS: P=0.014 for stage IV).
FDG-PET is helpful in identifying new lesions in NSCLC patients, resulting in the improved assessment of therapy response with CT imaging combined with FDG-PET compared with CT imaging alone. Although RECIST 1.1 includes FDG-PET only as an optional adjunct, we recommend the implementation of PET imaging in the assessment of therapy response.
实体瘤疗效评价标准1.1版（RECIST 1.1）已将正电子发射断层扫描（PET）作为检测新病灶的一种可选补充手段。在本研究中，我们评估了氟脱氧葡萄糖（FDG）-PET在识别接受治疗的非小细胞肺癌（NSCLC）患者中计算机断层扫描（CT）未发现的新病灶及疾病进展方面的效用。
70例NSCLC患者（30例女性，40例男性；平均年龄67±14岁，范围39 - 94岁）在化疗和/或放疗前后接受了FDG-PET检查，而69例患者接受了CT成像检查。采用仅基于CT的RECIST 1.1、利用PET识别新病灶的RECIST 1.1、视觉PET以及标准化摄取值变化范围为-15%至-50%的半定量PET计算总生存期（OS）和无进展生存期（PFS）。
PET在26例患者中识别出了新病灶，导致10例患者（14.5%）被升级为疾病进展。与单独的CT成像相比，CT和PET联合检测新病灶改善了生存预测（所有分期的OS：P = 0.0491，IV期：P = 0.0033；IV期的PFS：P = 0.0045）（所有分期的OS：P = 0.1362，IV期：P = ？0.1625；IV期的PFS：P = 0.0632）。此外，对于半定量PET方法，标准化摄取值变化-35%在生存预测方面最具判别力（所有分期的OS：P = 0.0393，IV期：P = 0.0051；IV期的PFS：P = 0.0092），且比视觉PET方法更具判别力（所有分期的OS：P = 0.2699，IV期：P = 0.0105；IV期的PFS：P = 0.014）。
FDG-PET有助于识别NSCLC患者中的新病灶，与单独的CT成像相比，CT成像与FDG-PET联合可改善对治疗反应的评估。尽管RECIST 1.1仅将FDG-PET作为一种可选辅助手段，但我们建议在评估治疗反应时采用PET成像。 （注：原文中“P = ？0.1625”疑似有误，未做修改直接翻译）
