在预测未经治疗的晚期非小细胞肺癌患者的临床结局方面，基于¹⁸F-氟脱氧葡萄糖正电子发射断层扫描的代谢反应在铂类化疗两个周期后是否优于基于实体瘤疗效评价标准的反应？

Is ¹⁸F-fluorodeoxyglucose positron emission tomography-based metabolic response superior to Response Evaluation Criteria In Solid Tumors-based response after two cycles of platinum-based chemotherapy in predicting clinical outcome of untreated patients with advanced non-small cell lung cancer?

作者信息

Yang Jin-Ji, Wang Shu-Xia, Zhong Wen-Zhao, Xu Chong-Rui, Yan Hong-Hong, Wu Yi-Long

机构信息

Division of Pulmonary Oncology, Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China.

出版信息

Nucl Med Commun. 2011 Dec;32(12):1113-20. doi: 10.1097/MNM.0b013e32834a8341.

DOI:10.1097/MNM.0b013e32834a8341

PMID:21934546

Abstract

OBJECTIVE

This prospective observational study aimed to compare ¹⁸F-fluorodeoxyglucose positron emission tomography-based metabolic response with Response Evaluation Criteria In Solid Tumors (RECIST)-based response after two cycles of platinum-based chemotherapy in predicting clinical outcome of patients with advanced non-small cell lung cancer (NSCLC).

METHODS

Untreated patients with advanced NSCLC scheduled to receive platinum-based chemotherapy were enrolled for this study. They underwent spiral computed tomography and ¹⁸F-fluorodeoxyglucose positron emission tomography concurrently before and after two cycles of chemotherapy. An optimal maximum standardized uptake value reduction of primary lesion was investigated retrospectively for a metabolic response.

RESULTS

A total of 43 patients were eligible for final analysis from August 2003 to May 2007. Objective response rate (ORR) was significantly higher in RECIST-based responders compared with RECIST-based nonresponders after two cycles of platinum-based chemotherapy [85.0% (17/20) vs. 4.3% (1/23), respectively; P=0.000], but median progression-free survival (PFS) and median overall survival (OS) were similar [5.8 95% confidence interval (CI): 3.6-8.0) vs. 5.0 (95% CI: 3.3-6.7) months, respectively, P=0.761; 13.7 (95% CI: 7.3-20.1) vs. 15.5 (95% CI: 3.8-27.2) months, respectively, P=0.356]. At the optimal cut-off value (maximum standardized uptake value reduction of primary lesion by 31%) for a metabolic response after two cycles of chemotherapy, metabolic responders had a significantly higher ORR [66.7% (16/24) vs. 10.5% (2/19), P=0.000] and a longer median PFS [6.5 (95% CI: 5.2-7.8) vs. 4.8 (95% CI: 2.9-6.7) months, P=0.041]; median OS was 17.7 months (95% CI: 9.2-26.2) in metabolic responders and 12.0 months (95% CI: 3.3-20.7) in metabolic nonresponders (P=0.799).

CONCLUSION

Metabolic response could be superior to RECIST-based response after two cycles of platinum-based chemotherapy in predicting PFS of untreated patients with advanced NSCLC. Both of them could be predictive for ORR, but neither of them could predict OS.

摘要

目的

本前瞻性观察性研究旨在比较基于¹⁸F-氟脱氧葡萄糖正电子发射断层扫描的代谢反应与基于实体瘤疗效评价标准（RECIST）的反应，在接受两周期铂类化疗后预测晚期非小细胞肺癌（NSCLC）患者的临床结局。

方法

计划接受铂类化疗的未经治疗的晚期NSCLC患者纳入本研究。他们在化疗两周期前后同时接受螺旋计算机断层扫描和¹⁸F-氟脱氧葡萄糖正电子发射断层扫描。回顾性研究原发灶最佳最大标准化摄取值降低情况以评估代谢反应。

结果

2003年8月至2007年5月共有43例患者符合最终分析条件。在两周期铂类化疗后，基于RECIST标准的反应者的客观缓解率（ORR）显著高于基于RECIST标准的无反应者[分别为85.0%（17/20）和4.3%（1/23）；P = 0.000]，但中位无进展生存期（PFS）和中位总生存期（OS）相似[分别为5.8（95%置信区间（CI）：3.6 - 8.0）个月和5.0（95% CI：3.3 - 6.7）个月，P = 0.761；分别为13.7（95% CI：7.3 - 20.1）个月和15.5（95% CI：3.8 -至27.2）个月，P = 0.356]。在化疗两周期后代谢反应的最佳临界值（原发灶最大标准化摄取值降低31%）时，代谢反应者的ORR显著更高[66.7%（16/24）对10.5%（2/19），P = 0.000]，中位PFS更长[6.5（95% CI：5.2 - 7.8）个月对4.8（95% CI：2.9 - 6.7）个月，P = 0.041]；代谢反应者的中位OS为17.7个月（95% CI：9.2 - 26.2），代谢无反应者为12.0个月（95% CI：3.3至20.7）（P = 0.799）。