Liao X H, Wang R F, Liu M, Chen X Q, Xiong Y, Nong L, Yin L, Zhang B Y, DU Y J
Department of Nuclear Medicine, Peking University First Hospital, Beijing 100034, China.
Department of Pathology, Peking University First Hospital, Beijing 100034, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2020 Oct 20;53(2):246-254. doi: 10.19723/j.issn.1671-167X.2021.02.003.
To explore the valuable predictors for evaluating progression-free survival (PFS) in patients with lung adenocarcinoma, we analyzed the potential roles of standardized uptake value (SUV)-derived parameters from F-FDG PET/CT, combining with the gene mutation states of epidermal growth factor receptor () and anaplastic lymphoma kinase (), and other clinical characteristics.
Data of 84 lung adenocarcinoma patients pre-treated, who underwent F-FDG PET/CT scans, gene mutations test, rearrangement assay and other relative tests, were retrospectively collected. Then a series of clinical parameters including / mutation status and SUV-derived features [maximum standardized uptake value (SUVmax), average of standardized uptake value (SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG)] were evaluated. Best possible cutoff points for all measuring parameters were calculated using receiver operating characteristic curve (ROC) analysis. Survival analysis was performed using Cox proportional hazards model to determine the prognostic markers for progression-free survival (PFS). Survival curves were obtained through Log-rank test and Kaplan-Meier curve.
The median follow-up period was 31 months (24 to 58 months). It was found that SUVmax (≥3.01), SUVmean (≥2.25), MTV (≥25.41 cm), and TLG (≥55.02) of the primary tumors were significantly associated with PFS in univariate Cox proportional hazards regression. Then regardless of age, gender, co-morbidity, / mutation status, and treatment program, TLG (≥ 55.02, =4.965, 95%: 1.360-18.133), TNM stage (Ⅲ/Ⅳ, =7.811, 95%: 2.977-20.489), pro-gastrin releasing peptide (proGRP) (≥45.65 ng/L, =4.070, 95%: 1.442-11.487), tissue polypeptide antigen (TPA) (≥68.20 U/L, =6.996, 95%: 1.458-33.574), alkaline phosphatase (ALP) (≥82.50 IU/L, =4.160, 95%: 1.416-12.219) and ratio of activated partial thromboplastin time (aPTTR) (≥1.16: =4.58, 95%: 1.913-10.946) showed the independently relevant to PFS through multivariate Cox proportional hazards analysis. The mutant (=0.343) and rearrangement (=0.608) were not significant either in survival analysis.
High SUV-derived parameters (SUVmax, SUVmean, MTV and TLG) might provide prognostic value to some extent. Especially, TLG, and other clinical features [TNM stage, proGRP, TPA, ALP, and aPTTR] could be independently and significantly associated with PFS of lung adenocarcinoma patients. However, / gene status could not be effectively relevant to PFS in lung adenocarcinoma patients.
为了探索评估肺腺癌患者无进展生存期（PFS）的有价值预测指标，我们分析了F-FDG PET/CT衍生的标准化摄取值（SUV）参数的潜在作用，并结合表皮生长因子受体（EGFR）和间变性淋巴瘤激酶（ALK）的基因突变状态以及其他临床特征。
回顾性收集84例接受过F-FDG PET/CT扫描、EGFR基因突变检测、ALK重排检测及其他相关检测的初治肺腺癌患者的数据。然后评估一系列临床参数，包括EGFR/ALK突变状态和SUV衍生特征[最大标准化摄取值（SUVmax）、标准化摄取值平均值（SUVmean）、代谢肿瘤体积（MTV）和总病变糖酵解（TLG）]。使用受试者工作特征曲线（ROC）分析计算所有测量参数的最佳截断点。采用Cox比例风险模型进行生存分析，以确定无进展生存期（PFS）的预后标志物。通过对数秩检验和Kaplan-Meier曲线获得生存曲线。
中位随访期为31个月（24至58个月）。单因素Cox比例风险回归分析发现，原发肿瘤的SUVmax（≥3.01）、SUVmean（≥2.25）、MTV（≥25.41 cm³）和TLG（≥55.02）与PFS显著相关。然后，无论年龄、性别、合并症、EGFR/ALK突变状态和治疗方案如何，多因素Cox比例风险分析显示，TLG（≥55.02，P = 4.965，95%CI：1.360 - 18.133）、TNM分期（Ⅲ/Ⅳ期，P = 7.811，95%CI：2.977 - 20.489）、胃泌素释放肽前体（proGRP）（≥45.65 ng/L，P = 4.070，95%CI：1.442 - 11.487）、组织多肽抗原（TPA）（≥68.20 U/L，P = 6.996，95%CI：1.458 - 33.574）、碱性磷酸酶（ALP）（≥82.50 IU/L，P = 4.160，95%CI：1.416 - 12.219）和活化部分凝血活酶时间比值（aPTTR）（≥1.16；P = 4.58，95%CI：1.913 - 10.946）与PFS独立相关。EGFR突变（P = 0.343）和ALK重排（P = 0.608）在生存分析中也无显著意义。
高SUV衍生参数（SUVmax、SUVmean、MTV和TLG）可能在一定程度上提供预后价值。特别是，TLG以及其他临床特征[TNM分期、proGRP、TPA、ALP和aPTTR]可能与肺腺癌患者的PFS独立且显著相关。然而，EGFR/ALK基因状态与肺腺癌患者的PFS无有效相关性。
