Qiang Guangliang, Xu Rui, Liu Jie, Yan Jue, Xu Yanyan, Di Jinxi, Da Jiping, Liang Chaoyang, Shi Bin, Guo Yongqing, Liu Deruo
Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China.
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Zhonghua Wai Ke Za Zhi. 2015 Jul 1;53(7):502-7.
To analyze the prognostic impact of preoperative (18)F-fluorodeoxyglucose (FDG) PET-CT on postoperative recurrence in patients with completely resected stage I non-small cell lung cancer (NSCLC).
The clinic data of 182 patients with stage I NSCLC who underwent (18)F-FDG PET-CT scan before surgical resection between June 2005 and June 2012 were reviewed retrospectively. There were 121 male and 61 female patients, with an average age of 68 years (range from 34 to 85 years). The pathological stage was I A in 98 patients, I B in 84 patients; the histology were adenocarcinoma in 137 patients, squamous cell carcinoma in 35 patients, and others in 10 patients. Clinicopathological factors including gender, age, smoking history, SUV(max), surgical procedure, pathological features and adjuvant chemotherapy were evaluated to identify the independent factors predicting postoperative recurrences by univariate and multivariate analysis. The survivals were calculated by the Kaplan-Meier method and differences in variables were analyzed by the Log-rank test.
The postoperative recurrence rate was 15.9%. The univariate analysis identified that the SUV(max) (t=3.278, P<0.001), p-stage (χ² =5.204, P=0.026), blood vessel invasion (χ² =5.333, P=0.027) and visceral pleural invasion (χ² =7.697, P=0.009) are factors for predicting postoperative recurrence. Only SUV(max) was found to be a significant independent factor according to multivariate analysis (HR=1.068, 95%CI: 1.015 to 1.123, P=0.001). The study population was stratified into three groups by SUV(max), patients with SUV(max) > 5.0 had significantly higher risk of recurrence (23.9%) than those with 2.5 < SUV(max) ≤ 5.0 (15.0%) and SUV(max) ≤ 2.5 (7.3%) (P=0.043); patients with SUV(max) ≤ 2.5 had significantly better 5-year recurrence-free survival rate (90.9%) than those with 2.5 < SUV(max) ≤ 5.0 (82.7%) and SUV(max) ≤ 2.5 (71.0%) (P=0.030). There was a trend toward higher probability of blood vessel invasion (χ² =20.267, P < 0.001), visceral pleural invasion (χ² =6.185, P=0.045) and pathological stage I B (χ² =13.589, P=0.001) with increased SUV(max).
Preoperative SUV(max) of primary tumor is a predictor of postoperative relapse for stage I NSCLC after surgical resection. Therefore, it can contribute to the risk stratification for patients with the same pathological stage and selecting the optimal postoperative follow-up and therapeutic strategy.
分析术前（18）F-氟脱氧葡萄糖（FDG）PET-CT对完全切除的Ⅰ期非小细胞肺癌（NSCLC）患者术后复发的预后影响。
回顾性分析2005年6月至2012年6月期间182例行手术切除前（18）F-FDG PET-CT扫描的Ⅰ期NSCLC患者的临床资料。男性121例，女性61例，平均年龄68岁（范围34至85岁）。病理分期为ⅠA期98例，ⅠB期84例；组织学类型为腺癌137例，鳞状细胞癌35例，其他10例。通过单因素和多因素分析评估包括性别、年龄、吸烟史、SUV（max）、手术方式、病理特征和辅助化疗等临床病理因素，以确定预测术后复发的独立因素。采用Kaplan-Meier法计算生存率，通过Log-rank检验分析变量差异。
术后复发率为15.9%。单因素分析确定SUV（max）（t = 3.278，P < 0.001）、p分期（χ² = 5.204，P = 0.026）、血管侵犯（χ² = 5.333，P = 0.027）和脏层胸膜侵犯（χ² = 7.697，P = 0.009）是预测术后复发的因素。多因素分析显示只有SUV（max）是显著的独立因素（HR = 1.068，95%CI：1.015至1.123，P = 0.001）。根据SUV（max）将研究人群分为三组，SUV（max）> 5.0的患者复发风险（23.9%）显著高于2.5 < SUV（max）≤ 5.0的患者（15.0%）和SUV（max）≤ 2.5的患者（7.3%）（P = 0.043）；SUV（max）≤ 2.5的患者5年无复发生存率（90.9%）显著高于2.5 < SUV（max）≤ 5.0的患者（82.7%）和SUV（max）> 5.0的患者（71.0%）（P = 0.030）。随着SUV（max）升高，血管侵犯（χ² = 20.267，P < 0.001）、脏层胸膜侵犯（χ² = 6.185, P = 0.045）和病理ⅠB期（χ² = 13.589, P = 0.001）的概率有升高趋势。
原发性肿瘤术前SUV（max）是Ⅰ期NSCLC手术切除后术后复发的预测指标。因此，它有助于对相同病理分期患者进行风险分层，并选择最佳的术后随访和治疗策略。
