治疗前 FDG PET/CT 全身总病变糖酵解对非小细胞肺癌的预后价值。
Prognostic value of whole-body total lesion glycolysis at pretreatment FDG PET/CT in non-small cell lung cancer.
机构信息
Department of Radiation Oncology, National Cheng Kung University, Tainan, Taiwan.
出版信息
Radiology. 2012 Aug;264(2):559-66. doi: 10.1148/radiol.12111148. Epub 2012 Jun 12.
PURPOSE
To determine whether whole-body total lesion glycolysis (TLG), which combines volumetric and metabolic information from fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT), can provide a better evaluation of the prognosis for non-small cell lung cancer (NSCLC).
MATERIALS AND METHODS
The institutional review board approved this retrospective study, and the requirement to obtain informed consent was waived. The authors identified 105 consecutive patients with NSCLC who underwent staging FDG PET/CT before any therapy. These patients were free of brain metastasis and underwent standard treatment and subsequent clinical follow-up. Metabolic tumor volume (MTV), mean standardized uptake value (SUV), and maximum SUV of each tumor over the whole body were determined. Whole-body MTV and whole-body TLG are the summation of all the MTVs and summation of individual tumor volume multiplied by its mean SUV, respectively. Univariate and multivariate analyses were performed to assess the prognostic significance of whole-body TLG and other factors, including whole-body MTV, lung TLG, lung MTV, maximum SUV, sex, age, performance status, histologic subtype, T stage, N stage, clinical stage, and treatment method.
RESULTS
The median follow-up time was 3.1 years. The estimated median progression-free survival (PFS) and overall survival (OS) for the cohort was 10.8 months and 2.8 years, respectively. The 1-year PFS was 0.0% for patients with high whole-body TLG (>655) and 50.0% for those with low whole-body TLG (≤655). The 1-year OS was 58.8% for patients with high whole-body TLG and 84.1% for those with low whole-body TLG. Univariate analysis showed that whole-body TLG, whole-body MTV, lung TLG, lung MTV, maximum SUV, performance status, T stage, N stage, clinical stage, and treatment type (surgery vs other) were significant prognostic factors for PFS (P < .01 for all). With use of the forward stepwise multivariate Cox proportional hazards model, whole-body TLG (hazard ratio = 2.92; 95% confidence interval: 1.62, 5.26; P < .01) and surgical treatment (hazard ratio = 4.24; 95% confidence interval: 2.54, 7.07; P < .01) remained significant in PFS.
CONCLUSION
Whole-body TLG is of prognostic value for NSCLC. It may be a promising tool for stratifying patients with NSCLC for risk-adapted therapies.
目的
确定全身总病变糖酵解（TLG）是否可以更好地评估非小细胞肺癌（NSCLC）的预后，全身 TLG 结合了氟 18 氟代脱氧葡萄糖（FDG）正电子发射断层扫描（PET）/计算机断层扫描（CT）的容积和代谢信息。
材料与方法
机构审查委员会批准了这项回顾性研究，免除了获得知情同意的要求。作者确定了 105 例连续接受 NSCLC 分期 FDG PET/CT 检查的患者，这些患者没有脑转移，接受了标准治疗和随后的临床随访。确定了每个肿瘤的代谢肿瘤体积（MTV）、平均标准化摄取值（SUV）和全身最大 SUV。全身 MTV 和全身 TLG 分别是所有 MTV 的总和以及个体肿瘤体积乘以其平均 SUV 的总和。进行单变量和多变量分析，以评估全身 TLG 和其他因素（包括全身 MTV、肺 TLG、肺 MTV、最大 SUV、性别、年龄、表现状态、组织学亚型、T 分期、N 分期、临床分期和治疗方法）的预后意义。
结果
中位随访时间为 3.1 年。该队列的估计中位无进展生存期（PFS）和总生存期（OS）分别为 10.8 个月和 2.8 年。全身 TLG 高（>655）的患者 1 年 PFS 为 0.0%，而全身 TLG 低（≤655）的患者为 50.0%。全身 TLG 高的患者 1 年 OS 为 58.8%，而全身 TLG 低的患者为 84.1%。单变量分析显示，全身 TLG、全身 MTV、肺 TLG、肺 MTV、最大 SUV、表现状态、T 分期、N 分期、临床分期和治疗类型（手术与其他）是 PFS 的显著预后因素（所有因素 P <.01）。使用向前逐步多变量 Cox 比例风险模型，全身 TLG（风险比=2.92；95%置信区间：1.62，5.26；P <.01）和手术治疗（风险比=4.24；95%置信区间：2.54，7.07；P <.01）在 PFS 中仍然具有统计学意义。
结论
全身 TLG 对 NSCLC 具有预后价值。它可能是一种有前途的工具，可以对 NSCLC 患者进行风险适应治疗分层。
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