Department of Biotherapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, People's Republic of China.
National Clinical Research Center for Cancer, Tianjin, 300060, People's Republic of China.
J Cancer Res Clin Oncol. 2020 Oct;146(10):2595-2605. doi: 10.1007/s00432-020-03240-8. Epub 2020 Jun 3.
The combined small-cell lung cancer (c-SCLC) is rare and has unique clinicopathological futures. The aim of this study is to investigate F-FDG PET/CT parameters and clinicopathological factors that influence the prognosis of c-SCLC.
Between November 2005 and October 2014, surgical-resected tumor samples from c-SCLC patients who received preoperative F-FDG PET/CT examination were retrospectively reviewed. The maximum standardized uptake value (SUV), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were used to evaluate metabolic parameters in primary tumors. The survivals were evaluated with the Kaplan-Meier method. Univariate and multivariate analyses were used to evaluate potential prognostic factors.
Thirty-one patients were enrolled, with a median age of 62 (range: 35 - 79) years. The most common mixed component was squamous cell carcinoma (SCC, n = 12), followed by large-cell carcinoma (LCC, n = 7), adenocarcinoma (AC, n = 6), spindle cell carcinoma (n = 4), adenosquamous carcinoma (n = 1) and atypical carcinoid (n = 1). The median follow-up period was 53.0 (11.0-142.0) months; the 5-year overall survival (OS) and progression-free survival(PFS) rate were 48.4% and 35.5%, respectively. Univariate survival analysis showed that gender, smoking history, tumor location were associated with PFS (P = 0.036, P = 0.043, P = 0.048), SUVmax and TNM stage were closely related to PFS in both Mixed SCC and non-SCC component groups (P = 0.007, P = 0.048). SUV, smoking history, tumor size and mixed SCC component were influencing factors of OS in patients (P = 0.040, P = 0.041, P = 0.046, P = 0.029). Multivariate survival analysis confirmed that TNM stage (HR = 2.885, 95%CI: 1.323-6.289, P = 0.008) was the most significantly influential factor for PFS. High SUV value (HR = 9.338, 95%CI: 2.426-35.938, P = 0.001) and mixed SCC component (HR = 0.155, 95%CI: 0.045-0.530, P = 0.003) were poor predictors for OS.
Surgical-resected c-SCLCs have a relatively good prognosis. TNM stage is the most significant factor influencing disease progression in surgical-resected c-SCLCs. SUVmax and mixed NSCLC components within c-SCLCs had a considerable influence on the survival. Both high SUVmax and mixed SCC component are poor predictors for patients with c-SCLCs.
小细胞肺癌（SCLC）合并肿瘤较为罕见，具有独特的临床病理特征。本研究旨在探讨影响小细胞肺癌（SCLC）预后的 F-FDG PET/CT 参数和临床病理因素。
回顾性分析 2005 年 11 月至 2014 年 10 月间接受术前 F-FDG PET/CT 检查并接受手术切除的小细胞肺癌患者的肿瘤样本。采用最大标准化摄取值（SUV）、代谢肿瘤体积（MTV）和总病灶糖酵解（TLG）评估原发肿瘤的代谢参数。采用 Kaplan-Meier 法评估生存率。采用单因素和多因素分析评估潜在的预后因素。
共纳入 31 例患者，中位年龄为 62（范围：35-79）岁。最常见的混合成分是鳞状细胞癌（SCC，n=12），其次是大细胞癌（LCC，n=7）、腺癌（AC，n=6）、梭形细胞癌（n=4）、腺鳞癌（n=1）和不典型类癌（n=1）。中位随访时间为 53.0（11.0-142.0）个月；5 年总生存率（OS）和无进展生存率（PFS）分别为 48.4%和 35.5%。单因素生存分析显示，性别、吸烟史、肿瘤位置与 PFS 相关（P=0.036，P=0.043，P=0.048），SUVmax 和 TNM 分期与混合 SCC 成分和非 SCC 成分组的 PFS 密切相关（P=0.007，P=0.048）。SUV、吸烟史、肿瘤大小和混合 SCC 成分是影响患者 OS 的因素（P=0.040，P=0.041，P=0.046，P=0.029）。多因素生存分析证实，TNM 分期（HR=2.885，95%CI：1.323-6.289，P=0.008）是影响 PFS 的最显著因素。高 SUV 值（HR=9.338，95%CI：2.426-35.938，P=0.001）和混合 SCC 成分（HR=0.155，95%CI：0.045-0.530，P=0.003）是 OS 不良的预测因素。
手术切除的小细胞肺癌具有较好的预后。TNM 分期是影响手术切除小细胞肺癌疾病进展的最显著因素。SCLC 中的 SUVmax 和混合非小细胞肺癌成分对生存有较大影响。高 SUVmax 和混合 SCC 成分均是小细胞肺癌患者预后不良的预测因素。
