Barnett Stephen A, Downey Robert J, Zheng Junting, Plourde Gabriel, Shen Ronglai, Chaft Jamie, Akhurst Timothy, Park Bernard J, Rusch Valerie W
Thoracic Service, Department of Surgery, Memorial Hospital, Memorial Sloan Kettering Cancer Center, New York.
Thoracic Service, Department of Surgery, Memorial Hospital, Memorial Sloan Kettering Cancer Center, New York; Weill Cornell Medical College, New York, New York.
Ann Thorac Surg. 2016 Mar;101(3):1052-9. doi: 10.1016/j.athoracsur.2015.09.099. Epub 2016 Jan 12.
Data from clinical trials suggest that changes in the glucose avidity of the primary site of lung cancer during induction therapy, measured by changes in (18)F-fluorodeoxyglucose positron emission tomography, correlate with tumor response. Little information about the utility of changes in positron emission tomography imaging of involved lymph nodes during induction chemotherapy is available. The utility of positron emission tomography imaging of either the primary site or nodal metastases, obtained during routine clinical care outside of a clinical trial setting, to predict response has also not been examined.
A retrospective review of all surgical patients with non-small cell lung cancer at a single institution imaged between 2000 and 2006 with (18)F-fluorodeoxyglucose positron emission tomography before or after induction therapy was performed.
An increase in standardized uptake value in the primary site of disease during induction therapy was associated with reduced overall survival after resection. Neither pretreatment standardized uptake value nor percentage change in the primary site was associated with overall survival after resection. A decrease in standardized uptake value of greater than 60% in the involved N2 mediastinal nodes was the best predictor of overall survival, better than changes seen in the primary site of disease.
An increase in glucose avidity of non-small cell lung cancers during induction therapy was associated with a worse prognosis compared with stable or any decrease in standardized uptake value. Changes in the glucose avidity of mediastinal nodal metastases may be a stronger predictor of survival than changes in the primary site of disease.
临床试验数据表明，诱导治疗期间肺癌原发部位的葡萄糖摄取率变化（通过（18）F-氟脱氧葡萄糖正电子发射断层扫描的变化来测量）与肿瘤反应相关。关于诱导化疗期间受累淋巴结正电子发射断层扫描成像变化的效用的信息很少。在临床试验环境之外的常规临床护理期间获得的原发部位或淋巴结转移的正电子发射断层扫描成像用于预测反应的效用也尚未得到研究。
对一家机构在2000年至2006年期间接受诱导治疗前后进行（18）F-氟脱氧葡萄糖正电子发射断层扫描成像的所有非小细胞肺癌手术患者进行回顾性研究。
诱导治疗期间疾病原发部位的标准化摄取值增加与切除术后总体生存率降低相关。术前标准化摄取值和原发部位的百分比变化均与切除术后总体生存率无关。受累N2纵隔淋巴结的标准化摄取值降低大于60%是总体生存的最佳预测指标，优于疾病原发部位的变化。
与标准化摄取值稳定或任何降低相比，诱导治疗期间非小细胞肺癌的葡萄糖摄取率增加与预后较差相关。纵隔淋巴结转移的葡萄糖摄取率变化可能比疾病原发部位的变化更能预测生存。
