Department of Nuclear Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200433, China.
Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200433, China.
Eur J Nucl Med Mol Imaging. 2021 Sep;48(10):3250-3259. doi: 10.1007/s00259-021-05260-z. Epub 2021 Feb 25.
This study retrospectively investigated the clinical utility of 2-deoxy-18F-fluorodeoxyglucose (F-FDG) positron emission tomography/computed tomography (PET/CT) and circulating tumor cells (CTCs) in the diagnosis and prognosis of treatment-naive patients with non-small-cell lung cancer (NSCLC).
The blood samples of treatment-naive patients with NSCLC were collected for CTCs detection, and the tumor metabolic parameters of F-FDG PET/CT, including maximum standard uptake value (SUVmax), metabolic tumor volume of primary lesion (MTV-P) and combination of primary lesion and metastases (MTV-C), and total lesion glycolysis of primary lesion (TLG-P) and combination of primary lesion and metastases (TLG-C), were analyzed. Age, sex, smoking, serum tumor markers, tumor size, location, TNM stage, and genetic mutations were also reviewed. Moreover, progression-free survival (PFS) and overall survival (OS) of these patients were analyzed.
A total of 309 patients with NSCLC (200 men, 109 women; mean age: 61 ± 9 years) were enrolled in this study, including 217 patients with adenocarcinoma and 92 with squamous cell carcinoma. Of the 309 cases, 11 were misdiagnosed with benign diseases by F-FDG PET/CT. CTCs positivity was detected in 234 cases. The sensitivity of F-FDG PET/CT and CTCs in NSCLC were 96.4% and 75.7%, respectively. SUVmax, MTV-P, TLG-P, MTV-C, TLG-C, tumor size, and serum CYFRA211 levels were significantly higher in CTCs positive group than negative group; and advanced TNM stage, squamous cell carcinoma, and EGFR wild type presented higher CTCs positivity. Multivariate logistic regression analysis revealed that SUVmax was significantly associated with CTCs positivity. Multivariate cox regression analysis showed that TLG-P, TLG-C, and CTCs were independent predictors of PFS in patients with NSCLC, and TLG-C and CTCs were independent predictors of OS.
F-FDG PET/CT was superior to CTCs in the diagnosis of treatment-naive patients with NSCLC. The levels of CTCs in the peripheral blood were associated with tumor glucose metabolism in NSCLC. Metabolic parameters of F-FDG PET/CT and CTCs could separately predict the outcomes of treatment-naive patients with NSCLC.
本研究回顾性分析了 2-脱氧-18F-氟代脱氧葡萄糖（F-FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）和循环肿瘤细胞（CTC）在初治非小细胞肺癌（NSCLC）患者诊断和预后中的临床应用价值。
收集初治 NSCLC 患者的血样进行 CTC 检测，并分析 F-FDG PET/CT 的肿瘤代谢参数，包括最大标准摄取值（SUVmax）、原发肿瘤代谢体积（MTV-P）和原发肿瘤与转移灶联合（MTV-C）、原发肿瘤总体糖酵解（TLG-P）和原发肿瘤与转移灶联合（TLG-C）。还回顾了患者的年龄、性别、吸烟史、血清肿瘤标志物、肿瘤大小、位置、TNM 分期和基因突变。此外，分析了这些患者的无进展生存期（PFS）和总生存期（OS）。
本研究共纳入 309 例 NSCLC 患者（200 例男性，109 例女性；平均年龄 61±9 岁），其中 217 例为腺癌，92 例为鳞癌。309 例患者中，11 例 F-FDG PET/CT 误诊为良性疾病。309 例患者中，234 例 CTCs 阳性。F-FDG PET/CT 和 CTCs 对 NSCLC 的灵敏度分别为 96.4%和 75.7%。CTC 阳性组 SUVmax、MTV-P、TLG-P、MTV-C、TLG-C、肿瘤大小和血清 CYFRA211 水平明显高于阴性组；晚期 TNM 分期、鳞癌和 EGFR 野生型 CTCs 阳性率较高。多因素 logistic 回归分析显示，SUVmax 与 CTCs 阳性显著相关。多因素 Cox 回归分析显示，TLG-P、TLG-C 和 CTCs 是 NSCLC 患者 PFS 的独立预测因子，TLG-C 和 CTCs 是 OS 的独立预测因子。
F-FDG PET/CT 在诊断初治 NSCLC 患者方面优于 CTCs。外周血中 CTCs 的水平与 NSCLC 肿瘤的葡萄糖代谢有关。F-FDG PET/CT 的代谢参数和 CTCs 可分别预测初治 NSCLC 患者的预后。
