Yaprak Gokhan, Ozcelik Melike, Gemici Cengiz, Seseogullari Ozgur
Department of Radiation Oncology, University of Health Sciences, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey.
Department of Medical Oncology, Adiyaman University, Training and Research Hospital, Adiyaman, Turkey.
North Clin Istanb. 2019 Jun 12;6(2):129-133. doi: 10.14744/nci.2019.02212. eCollection 2019.
Stage III disease accounts for approximately one-fourth of all non-metastatic non-small cell lung cancer (NSCLC). The patients who are not candidates for curative resection are offered concomitant chemoradiotherapy. In this subgroup, which is difficult to manage, studies that address the role of PET-CT to predict outcome measures specifically for stage III NSCLC receiving concurrent chemoradiotherapy may help better risk stratification. This study aimed to assess whether baseline PET maximum standardized uptake value (SUV) value in stage III NSCLC treated with concurrent chemoradiotherapy would independently identify patients with high risk of progression and death.
The study population consisted of patients aged 18 years or more with unresectable stage III histologically or cytologically proven NSCLC who received concurrent chemoradiotherapy. From 2007 to 2014, medical records of patients admitted to our institution were retrospectively analyzed. Pretreatment PET-CT SUV values were recorded for each patient. These values were categorized as low or high according to the median SUV measure of the study population.
A total of 175 patients were analyzed. The median follow-up time was 23 months (range 6-109). The PET-CT SUV values ranged from 3.5 to 46 with a median value of 14. The median overall survival was 25 months in SUV <14 and 18 months in SUV ≥14 group (p=0.023). The median progression-free survival was 16 months in SUV <14 and 11 months in SUV ≥14 group (p=0.033). Multivariate analysis revealed that both PET-CT SUV value (p<0.001) and age (p=0.016) were independent significant predictors for overall survival (OS).
The results of this study involving patients with stage III NSCLC receiving concurrent chemoradiotherapy provide evidence that suggests that high values of pretreatment SUV, an indicator of metabolic tumor burden, predicted a higher risk of disease progression and death.
Ⅲ期疾病约占所有非转移性非小细胞肺癌（NSCLC）的四分之一。对于不适合进行根治性切除的患者，会给予同步放化疗。在这个难以管理的亚组中，针对PET-CT在预测接受同步放化疗的Ⅲ期NSCLC患者结局指标方面作用的研究，可能有助于更好地进行风险分层。本研究旨在评估同步放化疗治疗的Ⅲ期NSCLC患者的基线PET最大标准化摄取值（SUV）是否能独立识别出进展和死亡风险高的患者。
研究人群包括年龄18岁及以上、组织学或细胞学确诊为不可切除Ⅲ期NSCLC且接受同步放化疗的患者。对2007年至2014年期间我院收治患者的病历进行回顾性分析。记录每位患者治疗前的PET-CT SUV值。根据研究人群的SUV中位数测量值，将这些值分为低或高两类。
共分析了175例患者。中位随访时间为23个月（范围6 - 109个月）。PET-CT SUV值范围为3.5至46，中位数为14。SUV<14组的中位总生存期为25个月，SUV≥14组为18个月（p = 0.023）。SUV<14组的中位无进展生存期为16个月，SUV≥14组为11个月（p = 0.033）。多因素分析显示，PET-CT SUV值（p<0.001）和年龄（p = 0.016）都是总生存期（OS）的独立显著预测因素。
这项针对接受同步放化疗的Ⅲ期NSCLC患者的研究结果表明，预处理SUV值高，即代谢肿瘤负荷的指标，预示着疾病进展和死亡风险更高。
