Tönnies S, Bauer T T, Misch D, Boch C, Blum T, Bittner R C, Förster G J, Kollmeier J
Lungenklinik Heckeshorn, Klinik für Pneumologie, HELIOS Klinikum Emil von Behring, Walterhöferstrasse 11, Berlin.
Pneumologie. 2012 Apr;66(4):212-7. doi: 10.1055/s-0032-1308916. Epub 2012 Apr 4.
PET/CT investigation with 18F-fluorodeoxyglucose (FDG) has a high sensitivity (89 - 100 %) and good specificity (79 - 95 %) for the diagnosis of NSCLC. Currently, it is mainly used in preoperative staging. This leads in approximately 15 % of these cases to the diagnosis of metastatic disease that was neither clinically suspected nor seen in previously performed conventional imaging. We hypothesised that including these cases in the palliative stage IV group would have an influence on overall survival.
The aim of this study was to compare the overall survival (OS) of patients with stage IV NSCLC who underwent FDG-PET/CT staging with patients in whom conventional imaging procedures were performed.
We analysed the OS of all stage IV NSCLC patients diagnosed in our clinic in 2009 (n = 254), 96/254 (38 %) patients were staged with PET/CT and 158/254 (62 %) with conventional imaging (CT group). Survival data were compared by Kaplan-Meier statistics.
Patients in the PET/CT group were younger (65 ± 11) than in the CT group (68 ± 10 years; p = 0.008). The median OS of all patients was 246 (range: 217 - 275) days; 338 (range: 247 - 429) days in the PET/CT group and 207 (range: 161 - 253) days in the CT group (p = 0.001), stating a difference of 131 days (4.4 months) in median OS.
The use of FDG-PET/CT staging mainly in the preoperative setting leads to stage migration of patients with a better prognosis into the worst stage (IV) and thus longer survival within this subgroup. This survival benefit is unrelated to treatment and needs to be addressed in future studies.
采用18F-氟脱氧葡萄糖（FDG）进行PET/CT检查对非小细胞肺癌（NSCLC）的诊断具有较高的敏感性（89 - 100%）和良好的特异性（79 - 95%）。目前，它主要用于术前分期。这导致在大约15%的此类病例中诊断出转移性疾病，而这些疾病在临床上既未被怀疑，在之前进行的传统影像学检查中也未发现。我们推测将这些病例纳入姑息性IV期组会对总生存期产生影响。
本研究的目的是比较接受FDG-PET/CT分期的IV期NSCLC患者与接受传统影像学检查的患者的总生存期（OS）。
我们分析了2009年在我们诊所诊断的所有IV期NSCLC患者的OS（n = 254），其中96/254（38%）例患者采用PET/CT分期，158/254（62%）例患者采用传统影像学检查（CT组）。通过Kaplan-Meier统计比较生存数据。
PET/CT组患者比CT组患者年轻（65 ± 11岁 vs 68 ± 10岁；p = 0.008）。所有患者的中位OS为246天（范围：217 - 275天）；PET/CT组为338天（范围：247 - 429天），CT组为207天（范围：161 - 253天）（p = 0.001），中位OS相差131天（4.4个月）。
主要在术前使用FDG-PET/CT分期会导致预后较好的患者分期迁移至最差的阶段（IV期），从而使该亚组患者的生存期延长。这种生存获益与治疗无关，需要在未来的研究中加以探讨。
