Yoo Su Woong, Kim Jahae, Chong Ari, Kwon Seong-Young, Min Jung-Joon, Song Ho-Chun, Bom Hee-Seung
Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-Eup, Hwasun-Gun, Jeollanam-do South Korea.
Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, South Korea.
Nucl Med Mol Imaging. 2012 Dec;46(4):286-93. doi: 10.1007/s13139-012-0165-5. Epub 2012 Sep 5.
This study aimed to further stratify prognostic factors in patients with stage IV non-small cell lung cancer (NSCLC) by measuring their metabolic tumor volume (MTV) using F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT).
The subjects of this retrospective study were 57 patients with stage IV NSCLC. MTV, total lesion glycolysis (TLG), and maximum standardized uptake value (SUVmax) were measured on F-18 FDG PET/CT in both the primary lung lesion as well as metastatic lesions in torso. Optimal cutoff values of PET parameters were measured by receiver operating characteristic (ROC) curve analysis. Kaplan-Meier survival curves were used for evaluation of progression-free survival (PFS). The univariate and multivariate Cox proportional hazards models were used to select the significant prognostic factors.
Univariate analysis showed that both MTV and TLG of primary lung lesion (MTV-lung and TLG-lung) were significant factors for prediction of PFS (P < 0.001, P = 0.038, respectively). Patients showing lower values of MTV-lung and TLG-lung than the cutoff values had significantly longer mean PFS than those with higher values. Hazard ratios (95 % confidence interval) of MTV-lung and TLG-lung measured by univariate analysis were 6.4 (2.5-16.3) and 2.4 (1.0-5.5), respectively. Multivariate analysis revealed that MTV-lung was the only significant factor for prediction of prognosis. Hazard ratio was 13.5 (1.6-111.1, P = 0.016).
Patients with stage IV NSCLC could be further stratified into subgroups of significantly better and worse prognosis by MTV of primary lung lesion.
本研究旨在通过使用F-18氟脱氧葡萄糖（FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）测量IV期非小细胞肺癌（NSCLC）患者的代谢肿瘤体积（MTV），进一步分层其预后因素。
本回顾性研究的对象为57例IV期NSCLC患者。在F-18 FDG PET/CT上测量原发性肺病灶以及躯干转移病灶的MTV、总病灶糖酵解（TLG）和最大标准化摄取值（SUVmax）。通过受试者操作特征（ROC）曲线分析测量PET参数的最佳截断值。采用Kaplan-Meier生存曲线评估无进展生存期（PFS）。使用单因素和多因素Cox比例风险模型选择显著的预后因素。
单因素分析显示，原发性肺病灶的MTV和TLG（MTV-肺和TLG-肺）均是预测PFS的显著因素（分别为P < 0.001，P = 0.038）。MTV-肺和TLG-肺值低于截断值的患者的平均PFS显著长于值较高的患者。单因素分析测量的MTV-肺和TLG-肺的风险比（95%置信区间）分别为6.4（2.5 - 16.3）和2.4（1.0 - 5.5）。多因素分析显示，MTV-肺是预测预后的唯一显著因素。风险比为13.5（1.6 - 111.1，P = 0.016）。
IV期NSCLC患者可根据原发性肺病灶的MTV进一步分层为预后显著较好和较差的亚组。
