Lister Hospital, Coreys Mills Lane, Stevenage, Hertfordshire, United Kingdom.
Clin Cancer Res. 2013 Jul 1;19(13):3591-9. doi: 10.1158/1078-0432.CCR-12-1307. Epub 2013 May 9.
We prospectively examined the role of tumor textural heterogeneity on positron emission tomography/computed tomography (PET/CT) in predicting survival compared with other clinical and imaging parameters in patients with non-small cell lung cancer (NSCLC).
The feasibility study consisted of 56 assessed consecutive patients with NSCLC (32 males, 24 females; mean age 67 ± 9.7 years) who underwent combined fluorodeoxyglucose (FDG) PET/CT. The validation study population consisted of 66 prospectively recruited consecutive consenting patients with NSCLC (37 males, 29 females; mean age, 67.5 ± 7.8 years) who successfully underwent combined FDG PET/CT-dynamic contrast-enhanced (DCE) CT. Images were used to derive tumoral PET/CT textural heterogeneity, DCE CT permeability, and FDG uptake (SUVmax). The mean follow-up periods were 22.6 ± 13.3 months and 28.5± 13.2 months for the feasibility and validation studies, respectively. Optimum threshold was determined for clinical stage and each of the above biomarkers (where available) from the feasibility study population. Kaplan-Meier analysis was used to assess the ability of the biomarkers to predict survival in the validation study. Cox regression determined survival factor independence.
Univariate analysis revealed that tumor CT-derived heterogeneity (P < 0.001), PET-derived heterogeneity (P = 0.003), CT-derived permeability (P = 0.002), and stage (P < 0.001) were all significant survival predictors. The thresholds used in this study were derived from a previously conducted feasibility study. Tumor SUVmax did not predict survival. Using multivariable analysis, tumor CT textural heterogeneity (P = 0.021), stage (P = 0.001), and permeability (P < 0.001) were independent survival predictors. These predictors were independent of patient treatment.
Tumor stage and CT-derived textural heterogeneity were the best predictors of survival in NSCLC. The use of CT-derived textural heterogeneity should assist the management of many patients with NSCLC.
我们前瞻性地研究了肿瘤纹理异质性在预测非小细胞肺癌（NSCLC）患者生存方面的作用，与其他临床和影像学参数相比，PET/CT 在预测生存方面的作用。
该可行性研究包括 56 例连续评估的 NSCLC 患者（32 名男性，24 名女性；平均年龄 67 ± 9.7 岁），他们接受了氟脱氧葡萄糖（FDG）PET/CT 联合检查。验证性研究人群包括 66 例连续招募的 NSCLC 患者（37 名男性，29 名女性；平均年龄 67.5 ± 7.8 岁），他们成功地进行了 FDG PET/CT-动态对比增强（DCE）CT 联合检查。从可行性研究人群中获得肿瘤的 PET/CT 纹理异质性、DCE CT 通透性和 FDG 摄取（SUVmax）。可行性和验证性研究的中位随访时间分别为 22.6±13.3 个月和 28.5±13.2 个月。从可行性研究人群中确定了临床分期和上述每个生物标志物（如果可用）的最佳阈值。Kaplan-Meier 分析用于评估验证性研究中生物标志物预测生存的能力。Cox 回归确定了生存因素的独立性。
单因素分析显示，肿瘤 CT 衍生的异质性（P < 0.001）、PET 衍生的异质性（P = 0.003）、CT 衍生的通透性（P = 0.002）和分期（P < 0.001）都是显著的生存预测因素。本研究中使用的阈值是从之前进行的可行性研究中得出的。肿瘤 SUVmax 不能预测生存。使用多变量分析，肿瘤 CT 纹理异质性（P = 0.021）、分期（P = 0.001）和通透性（P < 0.001）是独立的生存预测因素。这些预测因素独立于患者的治疗。
肿瘤分期和 CT 衍生的异质性是非小细胞肺癌生存的最佳预测因素。CT 衍生的异质性的使用应该有助于许多 NSCLC 患者的管理。
