Anwar Hoda, Vogl Thomas J, Abougabal Mahasen A, Grünwald Frank, Kleine Peter, Elrefaie Sherif, Nour-Eldin Nour-Eldin A
Nuclear Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology and Nuclear Medicine, Faculty of Medicine-Cairo University, Cairo, Egypt.
Institute for Diagnostic and Interventional Radiology, Johann Wolfgang von Goethe University Hospital, Frankfurt am Main, Germany.
Ann Nucl Med. 2018 Dec;32(10):687-694. doi: 10.1007/s12149-018-1301-9. Epub 2018 Sep 15.
Administration of postoperative chemotherapy to patients with completely resected stage I NSCLC is still a matter of debate. The aim of the present study was to evaluate the value of different baseline F-FDG PET parameters in identifying surgical stage I NSCLC patients who are at high risk of recurrence, and thus are indicated for further postoperative treatment.
This is a retrospective study, which included 49 patients (28 males, 21 females) with the median age of 69 years (range 28-84), who had pathologically proven stage I NSCLC. All patients underwent F-FDG PET/CT at baseline followed by complete surgical resection of the tumor (R0). Baseline SUV, MTV and TLG were measured. Patients' follow-up records were retrospectively reviewed, and DFS (disease-free survival) was assessed. For each parameter, the most accurate cut-off value for the prediction of recurrence was calculated using the ROC curve analysis and the Youden index. DFS was evaluated for patients above and below the calculated cut-off value using the Kaplan-Meier method and the difference in survival between the two groups was estimated using the log-rank test.
Median observation time of the patients after surgery was 28.7 months (range 3.5-58.8 months). 9 patients developed recurrence. The calculated cut-off values for SUV, MTV and TLG were 6, 6.6 and 33.6, respectively. Using these cut-offs, the observed sensitivity for SUV, MTV and TLG for prediction of recurrence was 100%, 89% and 89%, respectively, while the observed specificity was 43%, 73% and 65%, respectively. The difference in survival between patients below and above the cut-off value was statistically significant in all three studied parameters. The highest AUC was observed for MTV (AUC = 0.825, p = 0.003), followed by TLG (AUC = 0.789, p = 0.007), and lastly SUV (AUC = 0.719, p = 0.041). ROC curve analysis showed that volumetric parameters had better predictive performance than SUV as regards recurrence.
PET-derived parameters at baseline were predictive of recurrence in stage I surgical NSCLC patients. Moreover, the metabolic volume of the tumor was the most significant parameter for this purpose among the studied indices.
对于I期非小细胞肺癌（NSCLC）完全切除术后的患者，给予术后化疗仍存在争议。本研究的目的是评估不同的基线F-FDG PET参数在识别具有高复发风险的I期手术NSCLC患者中的价值，从而确定哪些患者适合进一步的术后治疗。
这是一项回顾性研究，纳入了49例经病理证实为I期NSCLC的患者（28例男性，21例女性），中位年龄69岁（范围28 - 84岁）。所有患者在基线时接受F-FDG PET/CT检查，随后进行肿瘤的完整手术切除（R0）。测量基线SUV、MTV和TLG。回顾性审查患者的随访记录，并评估无病生存期（DFS）。对于每个参数，使用ROC曲线分析和尤登指数计算预测复发的最准确临界值。使用Kaplan-Meier方法评估高于和低于计算临界值的患者的DFS，并使用对数秩检验估计两组之间的生存差异。
患者术后的中位观察时间为28.7个月（范围3.5 - 58.8个月）。9例患者出现复发。SUV、MTV和TLG的计算临界值分别为6、6.6和33.6。使用这些临界值，观察到SUV、MTV和TLG预测复发的敏感性分别为100%、89%和89%，而观察到的特异性分别为43%、73%和65%。在所有三个研究参数中，低于和高于临界值的患者之间的生存差异具有统计学意义。MTV的AUC最高（AUC = 0.825，p = 0.003），其次是TLG（AUC = 0.789，p = 0.007），最后是SUV（AUC = 0.719，p = 0.041）。ROC曲线分析表明，就复发而言，体积参数比SUV具有更好的预测性能。
基线时PET衍生参数可预测I期手术NSCLC患者的复发。此外，在所研究的指标中，肿瘤的代谢体积是用于此目的的最显著参数。
