Minamimoto Ryogo, Takeda Yuichiro, Hotta Masatoshi, Toyohara Jun, Nakajima Kazuhiko, Naka Go, Sugiyama Haruhito
Division of Nuclear Medicine, Department of Radiology, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjyuku-ku, Tokyo, 162-8655, Japan.
Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjyuku-ku, Tokyo, 162-8655, Japan.
EJNMMI Res. 2019 Jan 16;9(1):4. doi: 10.1186/s13550-019-0472-2.
4'-[Methyl-C] thiothymidine (4DST) PET/CT provides DNA synthesis imaging, which represented a higher correlation with the proliferation in advanced non-small cell lung cancer (NSCLC) than that from imaging with FDG. The aim of this prospective study was to evaluate the potential of 4DST in early therapy monitoring for advanced NSCLC, and to compare the results with those from CT and FDG PET/CT.
Patients who had been pathologically diagnosed with advanced NSCLC and were scheduled to receive platinum-doublet chemotherapy (PT-DC) were eligible. PET/CT imaging with 4DST and with FDG, and CT were performed at baseline and after 2 cycles of PT-DC (interim). Patients were evaluated semi-quantitatively after the 2 cycles of PT-DC using several PET parameters, response evaluation criteria in solid tumors (RECIST) 1.1 based on CT measurements, European Organization for Research and Treatment of Cancer (EORTC) criteria and PET Response Criteria in Solid Tumors (PERCIST) 1.0 based on PET/CT measurements. Baseline measurement data and metabolic response were compared between patients with progression-free survival (PFS) > 4 months and ≤ 4 months, and PFS and overall survival (OS) were compared between patients with and without metabolic response measured with each of the different parameters, using Kaplan-Meier statistics and log-rank testing. A total of 22 patients were included in this study. For predicting PFS > 4 months and ≤ 4 months, metabolic tumor volume (MTV) of baseline 4DST showed the highest area under the curve (0.73), positive predictive value (80.0%), negative predictive value (66.7%), and accuracy (72.7%) among baseline measurement data and metabolic responses from 4DST PET/CT, FDG PET/CT, and CT. Kaplan-Meier curves and log-rank tests for PFS with MTV of baseline FDG and baseline 4DST, and for OS with MTV of baseline FDG and baseline TLG, and MTV of baseline 4DST revealed significant results.
MTV of baseline 4DST PET/CT along with MTV of baseline FDG PET/CT represent promising predictors of PFS, and MTV of baseline 4DST PET/CT along with MTV and TLG of baseline FDG PET/CT are possible predictors of OS in patients with advanced NSCLC.
4'-[甲基-C]硫代胸苷（4DST）PET/CT可提供DNA合成成像，与晚期非小细胞肺癌（NSCLC）增殖的相关性高于FDG成像。这项前瞻性研究的目的是评估4DST在晚期NSCLC早期治疗监测中的潜力，并将结果与CT和FDG PET/CT的结果进行比较。
经病理诊断为晚期NSCLC且计划接受铂类双药化疗（PT-DC）的患者符合条件。在基线和PT-DC 2个周期后（中期）进行4DST和FDG的PET/CT成像以及CT检查。在PT-DC的2个周期后，使用几个PET参数、基于CT测量的实体瘤疗效评价标准（RECIST）1.1、欧洲癌症研究与治疗组织（EORTC）标准以及基于PET/CT测量的实体瘤PET反应标准（PERCIST）1.0对患者进行半定量评估。使用Kaplan-Meier统计和对数秩检验，比较无进展生存期（PFS）>4个月和≤4个月的患者之间的基线测量数据和代谢反应，以及使用不同参数测量的有和无代谢反应的患者之间的PFS和总生存期（OS）。本研究共纳入22例患者。对于预测PFS>4个月和≤4个月，基线4DST的代谢肿瘤体积（MTV）在4DST PET/CT、FDG PET/CT和CT的基线测量数据和代谢反应中显示出最高的曲线下面积（0.73）、阳性预测值（80.0%）、阴性预测值（66.7%）和准确性（72.7%）。基线FDG和基线4DST的MTV对PFS以及基线FDG和基线总病变糖酵解（TLG）的MTV和基线4DST的MTV对OS的Kaplan-Meier曲线和对数秩检验显示出显著结果。
基线4DST PET/CT的MTV以及基线FDG PET/CT的MTV是PFS的有前景的预测指标，基线4DST PET/CT的MTV以及基线FDG PET/CT的MTV和TLG是晚期NSCLC患者OS的可能预测指标。
