Department of Radiation Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan 704, Taiwan.
Eur J Nucl Med Mol Imaging. 2013 Oct;40(10):1478-85. doi: 10.1007/s00259-013-2452-5. Epub 2013 Jun 7.
We aimed to determine whether the increment in the maximal standardized uptake value (SUVmax) of the primary lung tumour between the initial and delayed imaging by dual-phase (18)F-FDG PET has prognostic value in patients with non-small-cell lung cancer (NSCLC).
We reviewed the records of patients with NSCLC who underwent pretreatment dual-phase (18)F-FDG PET/CT scans acquired at 1 h and 2 h after injection. The SUVmax increment (SUVinc) of the primary lung tumour was the 2-h SUVmax minus the 1-h SUVmax. Univariate and multivariate analyses were used to assess the prognostic significance of SUVinc, retention index, whole-body total metabolic tumour volume, whole-body total lesion glycolysis (TLGwb), 1-h SUVmax, 2-h SUVmax, gender, age, performance status, histological subtype, T stage, N stage and clinical stage.
The records of 187 consecutive patients were reviewed. The median follow-up time was 3.9 years. The estimated median progression-free survival (PFS) and overall survival (OS) were 1.3 years and 4.4 years, respectively. An SUVinc cut-off value of >1 had the best discriminative yield for PFS. The 3-year PFS and OS were 61.6 % and 87.8 % in patients with SUVinc ≤ 1 versus 21.1 % and 46.2 % in patients with SUVinc >1 (all P < 0.01). Using the forward stepwise multivariate Cox proportional hazards model, SUVinc, TLGwb, and clinical stage were significant factors for PFS (all P < 0.01). A subgroup analysis of 117 patients treated with surgery showed that SUVinc (P = 0.02) and clinical stage (P < 0.01) were significant prognostic factors for PFS. Furthermore, in stage I patients treated with surgery alone, SUVinc was the only significant prognostic factor (HR 28.07; 95 % CI 2.42 - 326.41).
SUVinc determined from dual-phase (18)F-FDG PET is a promising prognostic factor for NSCLC. It adds to the value of dual-phase (18)F-FDG PET.
本研究旨在确定非小细胞肺癌（NSCLC）患者在接受 18F-FDG 双时相 PET 检查时，原发肿瘤最大标准化摄取值（SUVmax）在初始和延迟成像之间的增加是否具有预后价值。
我们回顾了 187 例连续接受 NSCLC 术前 18F-FDG 双时相 PET/CT 扫描的患者记录。原发肿瘤 SUVmax 的增加（SUVinc）是 2 小时 SUVmax 减去 1 小时 SUVmax。使用单变量和多变量分析来评估 SUVinc、保留指数、全身总代谢肿瘤体积、全身总病变糖酵解（TLGwb）、1 小时 SUVmax、2 小时 SUVmax、性别、年龄、体能状态、组织学亚型、T 分期、N 分期和临床分期的预后意义。
回顾了 187 例连续患者的记录。中位随访时间为 3.9 年。估计的中位无进展生存期（PFS）和总生存期（OS）分别为 1.3 年和 4.4 年。SUVinc ＞1 的截断值对 PFS 的鉴别能力最佳。SUVinc≤1 的患者 3 年 PFS 和 OS 分别为 61.6%和 87.8%，SUVinc＞1 的患者分别为 21.1%和 46.2%（均 P＜0.01）。使用向前逐步多变量 Cox 比例风险模型，SUVinc、TLGwb 和临床分期是 PFS 的显著因素（均 P＜0.01）。对 117 例接受手术治疗的患者进行亚组分析显示，SUVinc（P=0.02）和临床分期（P＜0.01）是 PFS 的显著预后因素。此外，在单独接受手术治疗的 I 期患者中，SUVinc 是唯一显著的预后因素（HR 28.07；95%CI 2.42-326.41）。
18F-FDG 双时相 PET 确定的 SUVinc 是 NSCLC 的一个很有前途的预后因素。它增加了 18F-FDG 双时相 PET 的价值。
