Lin Xiaoping, Xiao Zizheng, Hu Yingying, Zhang Xu, Fan Wei
Department of Nuclear Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.
State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.
Front Pharmacol. 2020 Oct 28;11:592768. doi: 10.3389/fphar.2020.592768. eCollection 2020.
To investigate the value of using F-FDG PET/CT in combination with serum lactate dehydrogenase (LDH) for prognostic evaluation of newly diagnosed small cell lung cancer (SCLC). We reviewed 118 patients with pathologically proven SCLC who underwent F-FDG PET/CT imaging evaluation in our hospital. Among these patients, 64 patients had extensive disease (ED) and 54 patients had limited disease (LD). The maximum standardized uptake value (SUV) of primary tumor was measured. A Cox proportional hazards model was used to evaluate age, sex, performance status, serum LDH, tumor stage and SUV on the prediction of overall survival (OS) and median survival time (MST) of patients. Subgroup analysis was performed based on the SUV in combination with serum LDH. According to the Receiver Operating Characteristic (ROC) curve, the optimal cut-off value of SUV was 10.95. The AUC was 0.535 (95% CI: 0.407-0.663). The patients were divided into four groups according to the SUV (higher or lower than 10.95) and LDH (higher or lower than 245 U/L). The univariate and multivariate analyses showed that curative thoracic radiotherapy, Prophylactic Cranial Irradiation (PCI) and the combination of primary tumor SUV ≤ 10.95 and LDH ≤ 245 U/L were prognostic factors of OS in patients with all patients ( 0.05). Smoking status, PCI, the combination of primary tumor SUV ≤ 10.95 and LDH ≤ 245 U/L were prognostic factors of OS in patients with LD ( 0.05). N stage and PCI were significant predictors in both of univariate and multivariate analysis of OS for ED SCLC ( 0.05). Among all patients, 27 had low SUV and normal LDH, and their MST was 36 months (95% CI: 12.98-59.02). Ninety-one patients had high SUV and/or high LDH, and their MST was 20 months (95% CI: 15.47-24.53). The difference between these two groups was significant ( = 0.045). In patients with LD, 16 patients had low SUV and normal LDH, and their MST was 72 months (95% CI: 26.00-118.0). Thirty-eight patients had high SUV and/or high LDH, and their MST was 27 months (95% CI: 20.80-33.21). The difference between these two groups was significant ( = 0.012). In patients with ED SCLC, 10 patients had low SUV and normal LDH, with an MST of 18 months (95% CI: 13.69-22.32. Fifty-four patients had high SUV and/or high LDH, and their MST was 12 months (95% CI: 10.61-13.39). The difference of MST between these two groups was not statistically significant ( = 0.686). F-FDG PET/CT in combination with serum LDH were prognostic factors of overall survival in patients with SCLC. The prognosis of patients with LD SCLC who had low SUV of primary tumor and normal LDH was better than those with high SUV and/or high LDH.
探讨¹⁸F-氟代脱氧葡萄糖正电子发射断层显像/X线计算机体层成像（¹⁸F-FDG PET/CT）联合血清乳酸脱氢酶（LDH）对新诊断小细胞肺癌（SCLC）预后评估的价值。我们回顾性分析了我院118例经病理证实的SCLC患者，均接受了¹⁸F-FDG PET/CT影像评估。其中，广泛期疾病（ED）患者64例，局限期疾病（LD）患者54例。测量原发肿瘤的最大标准化摄取值（SUV）。采用Cox比例风险模型评估年龄、性别、体能状态、血清LDH、肿瘤分期和SUV对患者总生存期（OS）和中位生存时间（MST）的预测价值。基于SUV联合血清LDH进行亚组分析。根据受试者工作特征（ROC）曲线，SUV的最佳截断值为10.95。曲线下面积（AUC）为0.535（95%CI：0.407-0.663）。根据SUV（高于或低于10.95）和LDH（高于或低于245 U/L）将患者分为四组。单因素和多因素分析显示，根治性胸部放疗、预防性颅脑照射（PCI）以及原发肿瘤SUV≤10.95且LDH≤245 U/L的联合情况是所有患者OS的预后因素（P<0.05）。吸烟状态、PCI以及原发肿瘤SUV≤10.95且LDH≤245 U/L的联合情况是LD患者OS的预后因素（P<0.05）。N分期和PCI是ED SCLC患者OS单因素和多因素分析的显著预测因素（P<0.05）。所有患者中，27例SUV低且LDH正常，其MST为36个月（95%CI：12.98-59.02）。91例患者SUV高和/或LDH高，其MST为20个月（95%CI：15.47-24.53）。两组间差异有统计学意义（P=0.045）。LD患者中，16例SUV低且LDH正常，其MST为72个月（95%CI：26.00-118.0）。38例患者SUV高和/或LDH高，其MST为27个月（95%CI：20.80-33.21）。两组间差异有统计学意义（P=0.012）。ED SCLC患者中，10例SUV低且LDH正常，MST为18个月（95%CI：13.69-22.32）。54例患者SUV高和/或LDH高，其MST为12个月（95%CI：10.61-13.39）。两组MST差异无统计学意义（P=0.686）。¹⁸F-FDG PET/CT联合血清LDH是SCLC患者总生存期的预后因素。原发肿瘤SUV低且LDH正常的LD SCLC患者预后优于SUV高和/或LDH高的患者。
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