Lovinfosse Pierre, Janvary Zsolt Levente, Coucke Philippe, Jodogne Sébastien, Bernard Claire, Hatt Mathieu, Visvikis Dimitris, Jansen Nicolas, Duysinx Bernard, Hustinx Roland
Department of Medical Physics, Division of Nuclear Medicine and Oncological Imaging, CHU University of Liège, B35 Domaine Universitaire du Sart Tilman, 4000, Liege, Belgium.
Department of Medical Physics, Division of Radiation Oncology, CHU and University of Liège, Liège, Belgium.
Eur J Nucl Med Mol Imaging. 2016 Jul;43(8):1453-60. doi: 10.1007/s00259-016-3314-8. Epub 2016 Jan 30.
With (18)F-FDG PET/CT, tumor uptake intensity and heterogeneity have been associated with outcome in several cancers. This study aimed at investigating whether (18)F-FDG uptake intensity, volume or heterogeneity could predict the outcome in patients with non-small cell lung cancers (NSCLC) treated by stereotactic body radiation therapy (SBRT).
Sixty-three patients with NSCLC treated by SBRT underwent a (18)F-FDG PET/CT before treatment. Maximum and mean standard uptake value (SUVmax and SUVmean), metabolic tumoral volume (MTV), total lesion glycolysis (TLG), as well as 13 global, local and regional textural features were analysed. The predictive value of these parameters, along with clinical features, was assessed using univariate and multivariate analysis for overall survival (OS), disease-specific survival (DSS) and disease-free survival (DFS). Cutoff values were obtained using logistic regression analysis, and survivals were compared using Kaplan-Meier analysis.
The median follow-up period was 27.1 months for the entire cohort and 32.1 months for the surviving patients. At the end of the study, 25 patients had local and/or distant recurrence including 12 who died because of the cancer progression. None of the clinical variables was predictive of the outcome, except age, which was associated with DFS (HR 1.1, P = 0.002). None of the (18)F-FDG PET/CT or clinical parameters, except gender, were associated with OS. The univariate analysis showed that only dissimilarity (D) was associated with DSS (HR = 0.822, P = 0.037), and that several metabolic measurements were associated with DFS. In multivariate analysis, only dissimilarity was significantly associated with DSS (HR = 0.822, P = 0.037) and with DFS (HR = 0.834, P < 0.01).
The textural feature dissimilarity measured on the baseline (18)F-FDG PET/CT appears to be a strong independent predictor of the outcome in patients with NSCLC treated by SBRT. This may help selecting patients who may benefit from closer monitoring and therapeutic optimization.
在使用（18）F-FDG PET/CT检查时，肿瘤摄取强度和异质性与多种癌症的预后相关。本研究旨在调查（18）F-FDG摄取强度、体积或异质性是否能够预测接受立体定向体部放射治疗（SBRT）的非小细胞肺癌（NSCLC）患者的预后。
63例接受SBRT治疗的NSCLC患者在治疗前接受了（18）F-FDG PET/CT检查。分析了最大和平均标准摄取值（SUVmax和SUVmean）、代谢肿瘤体积（MTV）、总病变糖酵解（TLG）以及13种全局、局部和区域纹理特征。使用单因素和多因素分析评估这些参数以及临床特征对总生存期（OS）、疾病特异性生存期（DSS）和无病生存期（DFS）的预测价值。使用逻辑回归分析获得临界值，并使用Kaplan-Meier分析比较生存期。
整个队列的中位随访期为27.1个月，存活患者为32.1个月。在研究结束时，25例患者出现局部和/或远处复发，其中12例因癌症进展死亡。除年龄与DFS相关（HR 1.1，P = 0.002）外，没有临床变量可预测预后。除性别外，没有（18）F-FDG PET/CT或临床参数与OS相关。单因素分析显示，只有差异度（D）与DSS相关（HR = 0.822，P = 0.037），并且几种代谢测量与DFS相关。在多因素分析中，只有差异度与DSS（HR = 0.822，P = 0.037）和DFS（HR = 0.834，P < 0.01）显著相关。
在基线（18）F-FDG PET/CT上测量的纹理特征差异度似乎是接受SBRT治疗的NSCLC患者预后的有力独立预测指标。这可能有助于选择可能从更密切监测和治疗优化中获益的患者。
