Zhang Shanyuan, Li Shaolei, Pei Yuquan, Huang Miao, Lu Fangliang, Zheng Qingfeng, Li Nan, Yang Yue
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing 100142, China.
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing 100142, China.
J Thorac Dis. 2017 Apr;9(4):1023-1031. doi: 10.21037/jtd.2017.03.71.
The retrospective study investigated the association between the maximum standardized uptake value (SUV) of primary tumor and lymph node involvement in potential stereotactic body radiotherapy (SBRT) candidates.
A total of 185 patients with clinical stage I NSCLC were enrolled in the current study. All patients underwent lobectomy with systematic lymph node dissection following preoperative FDG-PET/CT scanning. The association between clinicopathological variables and lymph node involvement was analyzed by univariate and multivariate analysis. Spearman's correlation test was used to evaluate the correlation between them. Receiver operating characteristic (ROC) analysis was performed to calculate the area under the curve.
Among these patients, 22.1% had occult lymph node involvement, 15.1% were N1 and 7.0% were N2. Greater tumor size (P=0.007), elevated CEA (P=0.006), central location (P=0.002), higher SUV (P<0.001), solid nodule type (P=0.002), visceral pleural invasion (P=0.001) and presence of micropapillary and solid patterns (P=0.002) were significantly associated with lymph node involvement. In multivariate analysis, lymph node involvement was associated with central location (OR 5.784, 95% CI: 1.584-21.114, P=0.008), SUV (increase of 1 unite, OR 1.147, 95% CI: 1.035-1.272, P=0.009) and visceral pleural invasion (OR 3.044, 95% CI: 1.369-6.769, P=0.006). ROC area under the curve of SUV for lymph node involvement was 0.770 (95% CI: 0.698-0.841), the sensitivity and specificity were 85.4% and 63.2%, respectively. Spearman's correlation test showed that SUV of tumor mostly depended on tumor size and nodule type.
SUV of primary tumor was a predictor of lymph node involvement for potential SBRT candidates. Centrally located tumor and visceral pleural invasion were related to higher rate of nodal metastasis. Lobectomy and systemic lymph node dissection should be performed in these patients, instead of SBRT.
这项回顾性研究调查了潜在的立体定向体部放疗（SBRT）候选患者的原发肿瘤最大标准化摄取值（SUV）与淋巴结受累之间的关联。
本研究共纳入185例临床I期非小细胞肺癌患者。所有患者在术前进行FDG-PET/CT扫描后均接受了肺叶切除术及系统性淋巴结清扫术。通过单因素和多因素分析来分析临床病理变量与淋巴结受累之间的关联。采用Spearman相关性检验来评估它们之间的相关性。进行受试者操作特征（ROC）分析以计算曲线下面积。
在这些患者中，22.1%有隐匿性淋巴结受累，15.1%为N1期，7.0%为N2期。肿瘤体积较大（P = 0.007）、癌胚抗原升高（P = 0.006）、肿瘤位于中央（P = 0.002）、SUV较高（P < 0.001）、实性结节类型（P = 0.002）、脏层胸膜侵犯（P = 0.001）以及存在微乳头和实性模式（P = 0.002）均与淋巴结受累显著相关。在多因素分析中，淋巴结受累与肿瘤位于中央（比值比5.784，95%可信区间：1.584 - 21.114，P = 0.008）、SUV（每增加1个单位，比值比1.147，95%可信区间：1.035 - 1.272，P = 0.009）和脏层胸膜侵犯（比值比3.044，95%可信区间：1.369 - 6.769，P = 0.006）相关。SUV预测淋巴结受累的ROC曲线下面积为0.770（95%可信区间：0.698 - 0.841），敏感性和特异性分别为85.4%和63.2%。Spearman相关性检验表明肿瘤的SUV主要取决于肿瘤大小和结节类型。
原发肿瘤的SUV是潜在SBRT候选患者淋巴结受累的一个预测指标。肿瘤位于中央和脏层胸膜侵犯与较高的淋巴结转移率相关。这些患者应进行肺叶切除术及系统性淋巴结清扫术，而不是SBRT。
