术前 PET-CT 代谢肿瘤体积对预测 I 期非小细胞肺癌患者无病生存的预后价值。
Prognostic value of preoperative metabolic tumor volumes on PET-CT in predicting disease-free survival of patients with stage I non-small cell lung cancer.
机构信息
Department of Nuclear Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
出版信息
Anticancer Res. 2012 Nov;32(11):5087-91.
BACKGROUND
This study aimed to determine the relationship between the pre-operative metabolic tumor volume (MTV) and the disease-free survival (DFS) of patients with stage I non-small cell lung cancer (NSCLC) using F-18 2-fluoro-2-deoxy-D-glucose (FDG) positron-emission tomography-computed tomography (PET-CT) scanning.
MATERIALS AND METHODS
Data from sixty patients with stage I NSCLC who had undergone preoperative F-18 FDG PET-CT scanning were retrospectively analyzed. The early and late maximum standardized uptake values (eSUVm and lSUVm, respectively) were measured from attenuation-corrected F-18 FDG PET-CT images. Three MTV segmentation methods were applied as an isocontour at an early SUV of 2.5 (MTV2.5) or using fixed thresholds of either 40% (MTV40%) or 50% (MTV50%) of the maximum intratumoral F-18 FDG activity. DFS was compared by employing the Kaplan-Meier method, using the median values as cutoffs for each parameter. The log-rank test and Cox regression were performed to explore the effect of the different MTV variables on DFS. Time-dependent receiver operating characteristic (ROC) curves were created to evaluate the predictive performance.
RESULTS
During a median follow-up duration of 24 months, two patients died of disease progression, and 11 experienced recurrent tumors (eight intrathoracic tumors, two distant metastasis, and one both types of recurrences). The univariate analyses showed that pathological stage 1B, histological type of squamous cell carcinoma, male sex, maximum tumor size over 2 cm, eSUVm, lSUVm, and MTV2.5 were associated with reduced DFS. Patients who had tumors with large eSUVm or large lSUVm had a significantly lower 2-year DFS, compared with patients who had smaller tumors (65% vs. 96%, p=0.002; 63% vs. 96%, p=0.000). Patients with an MTV2.5 greater than 9.8 ml had a lower 2-year DFS than those with an MTV of 9.8 ml or greater (59 vs. 85%, p=0.02). However, multivariate analysis showed that lSUVm over 3.4 was the only parameter that exhibited an impact on DFS (p=0.05, hazard ratio=10.7), and the observed influence was marginal.
CONCLUSION
For patients with stage I NSCLC treated with surgery, preoperative MTV parameters have a limited prognostic value for predicting DFS.
背景
本研究旨在通过 F-18 氟-2-脱氧-D-葡萄糖（FDG）正电子发射断层扫描-计算机断层扫描（PET-CT）扫描，确定术前代谢肿瘤体积（MTV）与Ⅰ期非小细胞肺癌（NSCLC）患者无病生存（DFS）之间的关系。
材料和方法
回顾性分析了 60 例接受Ⅰ期 NSCLC 术前 F-18 FDG PET-CT 扫描的患者数据。从衰减校正的 F-18 FDG PET-CT 图像中测量早期和晚期最大标准化摄取值（eSUVm 和 lSUVm）。应用三种 MTV 分割方法，即早期 SUV 为 2.5 时的等轮廓（MTV2.5）或使用 40%（MTV40%）或 50%（MTV50%）最大肿瘤内 F-18 FDG 活性的固定阈值。采用 Kaplan-Meier 法比较 DFS，以每个参数的中位数作为截止值。采用对数秩检验和 Cox 回归分析不同 MTV 变量对 DFS 的影响。创建时间依赖性受试者工作特征（ROC）曲线以评估预测性能。
结果
在中位随访 24 个月期间，两名患者死于疾病进展，11 名患者出现肿瘤复发（8 例为胸内肿瘤，2 例为远处转移，1 例为两种类型的复发）。单因素分析显示，ⅠB 期病理、鳞状细胞癌组织学类型、男性、最大肿瘤直径>2cm、eSUVm、lSUVm 和 MTV2.5 与 DFS 降低相关。与肿瘤较小的患者相比，eSUVm 或 lSUVm 较大的患者 2 年 DFS 显著降低（65%vs.96%，p=0.002；63%vs.96%，p=0.000）。MTV2.5 大于 9.8ml 的患者 2 年 DFS 低于 MTV 为 9.8ml 或更大的患者（59%vs.85%，p=0.02）。然而，多因素分析显示，lSUVm 超过 3.4 是唯一对 DFS 有影响的参数（p=0.05，风险比=10.7），且影响为边缘性的。
结论
对于接受手术治疗的Ⅰ期 NSCLC 患者，术前 MTV 参数对预测 DFS 的预后价值有限。
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