Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Keelung, Taiwan.
Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
Eur J Nucl Med Mol Imaging. 2019 Feb;46(2):467-477. doi: 10.1007/s00259-018-4210-1. Epub 2018 Nov 10.
The role of brain FDG-PET in patients with lung cancer and brain metastases remains unclear. Here, we sought to determine the prognostic significance of whole-body PET/CT plus brain PET/MR in predicting the time to neurological progression (nTTP) and overall survival (OS) in this patient group.
Of 802 patients with non-small cell lung cancer who underwent primary staging by a single-day protocol of whole-body PET/CT plus brain PET/MR, 72 cases with adenocarcinoma and brain metastases were enrolled for a prognostic analysis of OS. On the basis of the available follow-up brain status, only 52 patients were eligible for prognostic analysis of nTTP. Metastatic brain tumors were identified on post-contrast MR imaging, and the tumor-to-brain ratio (TBR) was measured on PET images.
Multivariate analysis revealed that FDG-PET findings and eligibility for initial treatment with targeted therapy were significant independent predictors of nTTP and OS. A new index, termed the molecular imaging prognostic (MIP) score, was proposed to define three disease classes. MIP scores were significant predictors of both nTTP and OS (P < 0.001). Pre-existing prognostic indices such as Lung-molGPA scores were significant predictors of OS but did not predict nTTP.
When staging is performed with whole-body PET/CT plus brain PET/MR, our new prognostic index may be helpful to stratify the outcomes of patients with lung adenocarcinoma and brain metastases. The superior prognostic power of this index for nTTP might be used to select appropriate patients for intracranial control and thereby achieve better quality of life.
在肺癌合并脑转移患者中，脑 FDG-PET 的作用仍不明确。本研究旨在确定全身 PET/CT 联合脑 PET/MR 在预测该患者群体的神经进展时间（nTTP）和总生存期（OS）方面的预后意义。
在 802 例接受全身 PET/CT 加脑 PET/MR 一日方案进行初诊分期的非小细胞肺癌患者中，纳入 72 例腺癌合并脑转移患者进行 OS 预后分析。根据现有的脑随访情况，仅有 52 例患者有资格进行 nTTP 的预后分析。脑转移瘤通过增强 MRI 识别，在 PET 图像上测量肿瘤与脑比值（TBR）。
多变量分析显示，FDG-PET 发现和有资格进行初始靶向治疗是 nTTP 和 OS 的独立显著预测因素。提出了一个新的指数，称为分子影像学预后（MIP）评分，用于定义三个疾病类别。MIP 评分是 nTTP 和 OS 的显著预测因素（P<0.001）。现有的预后指标如 Lung-molGPA 评分是 OS 的显著预测因素，但不能预测 nTTP。
当采用全身 PET/CT 联合脑 PET/MR 进行分期时，我们的新预后指数可能有助于分层肺腺癌伴脑转移患者的结局。该指数在预测 nTTP 方面的优越预后能力可用于选择适当的颅内控制患者，从而提高生活质量。
