Department of Radiation Oncology, Stanford Cancer Institute, Stanford, CA.
Department of Radiology, Stanford University, Stanford, CA.
Clin Lung Cancer. 2018 Sep;19(5):e581-e588. doi: 10.1016/j.cllc.2018.04.003. Epub 2018 Apr 19.
Emerging data support aggressive local treatment of oligometastatic non-small-cell lung cancer (NSCLC) patients. We sought to determine whether the metabolic burden of disease found by fluorodeoxyglucose positron emission tomography at the time of high-dose radiotherapy (RT) for oligometastatic NSCLC can serve as a prognostic biomarker.
We conducted a retrospective cohort study of 67 RT treatment courses in 55 patients with oligometastatic NSCLC who had undergone high-dose RT to all sites of active disease at our institution. The metabolic tumor volume, total lesion glycolysis (TLG), and maximum standardized uptake value of all lesions were measured on the pretreatment fluorodeoxyglucose positron emission tomography scans. Cox regression analysis was used to assess the influence of imaging and clinical factors on overall survival (OS).
On univariate analysis, a greater metabolic tumor volume and TLG were predictive of shorter OS (hazard ratio of death, 2.42 and 2.14, respectively; P = .009 and P = .004, respectively). The effects remained significant on multivariate analysis. Neither the maximum standardized uptake value nor the number of lesions was significantly associated with OS. Patients within the highest quartile of TLG values (> 86.8 units) had a shorter median OS than those within the lower 3 quartiles (12.4 vs. 30.1 months; log-rank P = .014).
The metabolic tumor burden was prognostic of OS and might help to better select oligometastatic NSCLC patients for locally ablative therapy.
越来越多的数据支持对寡转移非小细胞肺癌（NSCLC）患者进行积极的局部治疗。我们旨在确定在寡转移 NSCLC 患者接受大剂量放疗（RT）时，正电子发射断层扫描（PET）检测到的疾病代谢负担是否可以作为预后生物标志物。
我们对在我院接受大剂量 RT 治疗的 55 例寡转移 NSCLC 患者的 67 个 RT 治疗疗程进行了回顾性队列研究。在所有病变的预处理氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）扫描上测量代谢肿瘤体积、总病变糖酵解（TLG）和所有病变的最大标准化摄取值。Cox 回归分析用于评估影像学和临床因素对总生存期（OS）的影响。
单因素分析显示，较大的代谢肿瘤体积和 TLG 与较短的 OS 相关（死亡风险比分别为 2.42 和 2.14；P 值分别为.009 和.004）。多因素分析结果仍然具有统计学意义。最大标准化摄取值和病变数量均与 OS 无显著相关性。TLG 值最高四分位数（>86.8 单位）的患者中位 OS 短于较低四分位数的患者（12.4 个月与 30.1 个月；对数秩检验 P 值为.014）。
代谢肿瘤负担与 OS 相关，可能有助于更好地选择寡转移 NSCLC 患者进行局部消融治疗。
