Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
Eur J Nucl Med Mol Imaging. 2015 Feb;42(2):241-51. doi: 10.1007/s00259-014-2903-7. Epub 2014 Sep 6.
We conducted a comprehensive systematic review of the literature on volumetric parameters from (18)F-FDG PET and a meta-analysis of the prognostic value of metabolic tumour volume (MTV) and total lesion glycolysis (TLG) in patients with lung cancer.
A systematic search of MEDLINE and EMBASE was performed using the keywords "positron emission tomography (PET)", "lung cancer", and "volume". Inclusion criteria were: (18)F-FDG PET used as an initial imaging tool; studies limited to non-small-cell lung cancer (NSCLC); volume measurement of lung cancer; patients who had not undergone surgery, chemotherapy, or radiotherapy before the PET scan; and studies that reported survival data. Event-free survival and overall survival were evaluated as outcomes. The impact of MTV and TLG on survival was measured in terms of the hazard ratio (HR) effect size. Data from each study were analysed using Review Manager 5.2.
Thirteen eligible studies including 1,581 patients were analysed. Patients with high MTV showed a worse prognosis with an HR of 2.71 (95% CI 1.82 - 4.02, p < 0.00001) for adverse events and an HR of 2.31 (95% CI 1.54 - 3.47, p < 0.00001) for death. Patients with high TLG also showed a worse prognosis with an HR of 2.35 (95% CI 1.91 - 2.89, p < 0.00001) for adverse events and an HR of 2.43 (95% CI 1.89 - 3.11, p < 0.00001) for death. The prognostic value of MTV and TLG remained significant in a subgroup analysis according to TNM stage as well as the methods for defining cut-off values and tumour delineation.
Volumetric parameters from (18)F-FDG PET are significant prognostic factors for outcome in patients with NSCLC. Patients with a high MTV or TLG are at higher risk of adverse events and death. MTV and TLG were significant prognostic factors in patients with TNM stage I/II and stage III/IV NSCLC.
我们对（18）F-FDG PET 的容积参数进行了全面的系统综述，并对代谢肿瘤体积（MTV）和总病变糖酵解（TLG）在肺癌患者中的预后价值进行了荟萃分析。
使用“正电子发射断层扫描（PET）”、“肺癌”和“体积”等关键词，对 MEDLINE 和 EMBASE 进行了系统搜索。纳入标准为：（18）F-FDG PET 作为初始成像工具；研究仅限于非小细胞肺癌（NSCLC）；肺癌容积测量；在 PET 扫描前未接受手术、化疗或放疗的患者；以及报告生存数据的研究。无病生存和总生存被评估为结局。以危险比（HR）效应大小来衡量 MTV 和 TLG 对生存的影响。使用 Review Manager 5.2 分析每个研究的数据。
共分析了 13 项符合条件的研究，包括 1581 名患者。高 MTV 患者预后较差，不良事件的 HR 为 2.71（95%CI 1.82-4.02，p<0.00001），死亡的 HR 为 2.31（95%CI 1.54-3.47，p<0.00001）。高 TLG 患者预后也较差，不良事件的 HR 为 2.35（95%CI 1.91-2.89，p<0.00001），死亡的 HR 为 2.43（95%CI 1.89-3.11，p<0.00001）。根据 TNM 分期以及定义截断值和肿瘤描绘的方法，MTV 和 TLG 的预后价值在亚组分析中仍然显著。
（18）F-FDG PET 的容积参数是 NSCLC 患者结局的重要预后因素。高 MTV 或 TLG 的患者发生不良事件和死亡的风险更高。MTV 和 TLG 是 TNM 分期 I/II 期和 III/IV 期 NSCLC 患者的重要预后因素。
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