Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Republic of Korea.
Eur J Nucl Med Mol Imaging. 2014 Jan;41(1):50-8. doi: 10.1007/s00259-013-2530-8. Epub 2013 Aug 16.
We evaluated the prognostic impact of volume-based assessment by (18)F-FDG PET/CT in patients with stage III non-small-cell lung cancer (NSCLC).
We reviewed 194 consecutive patients with stage IIIA NSCLC treated with surgical resection (surgical group) and 115 patients treated with nonsurgical therapy (nonsurgical group: 50 stage IIIA, 65 stage IIIB). Metabolic tumour volume (MTV), total lesion glycolysis (TLG), and maximum standardized uptake value (SUVmax) of primary tumours were measured using pretreatment (18)F-FDG PET/CT. Overall survival was assessed using the Kaplan-Meier method. The prognostic significance of PET parameters and other clinical variables was assessed using Cox proportional hazards regression analyses. To evaluate and compare the predictive performance of PET parameters, time-dependent receiver operating characteristic (ROC) curve analysis was used.
In the Cox proportional hazards models, MTV (HR=1.27 for a doubling of MTV, P=0.008) and TLG (HR=1.22 for a doubling of TLG, P=0.035) were significantly associated with an increased risk of death after adjusting for age, gender, histological cell type, T stage, N stage, and treatment variables in the surgical group. SUVmax was not a significant prognostic factor in either the surgical or nonsurgical group. In the time-dependent ROC curve analysis, volume-based PET parameters predicted survival better than SUVmax.
The volume-based PET parameters (MTV and TLG) are significant prognostic factors for survival independent of tumour stage and better prognostic imaging biomarkers than SUVmax in patients with stage IIIA NSCLC after surgical resection.
我们通过（18）F-FDG PET/CT 评估了 III 期非小细胞肺癌（NSCLC）患者基于体积的评估的预后影响。
我们回顾了 194 例接受手术切除（手术组）治疗的 IIIA 期 NSCLC 患者和 115 例接受非手术治疗（非手术组：50 例 IIIA 期，65 例 IIIB 期）的患者。使用预处理（18）F-FDG PET/CT 测量原发肿瘤的代谢肿瘤体积（MTV）、总病灶糖酵解（TLG）和最大标准化摄取值（SUVmax）。使用 Kaplan-Meier 方法评估总生存期。使用 Cox 比例风险回归分析评估 PET 参数和其他临床变量的预后意义。为了评估和比较 PET 参数的预测性能，使用时间依赖性接收器操作特征（ROC）曲线分析。
在 Cox 比例风险模型中，MTV（MTV 翻倍时的 HR=1.27，P=0.008）和 TLG（TLG 翻倍时的 HR=1.22，P=0.035）在调整年龄、性别、组织学细胞类型、T 分期、N 分期和手术组治疗变量后，与死亡风险增加显著相关。SUVmax 不是手术组或非手术组的显著预后因素。在时间依赖性 ROC 曲线分析中，基于体积的 PET 参数比 SUVmax 更能预测生存。
基于体积的 PET 参数（MTV 和 TLG）是独立于肿瘤分期的生存的显著预后因素，并且在接受手术切除的 IIIA 期 NSCLC 患者中比 SUVmax 更好的预后成像生物标志物。
