Division of Nuclear Medicine, Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Division of Nuclear Medicine, Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Korea.
Eur Radiol. 2023 Oct;33(10):7274-7283. doi: 10.1007/s00330-023-09641-w. Epub 2023 Apr 15.
To evaluate the prognostic value of TLR from PET/CT in patients with resection margin-negative stage IB and IIA non-small cell lung cancer (NSCLC) and compare high-risk factors necessitating adjuvant treatment (AT).
Consecutive FDG PET/CT scans performed for the initial staging of NSCLC stage IB and IIA were retrospectively reviewed. The maximum standardized uptake value (SUVmax) of the primary tumor and mean SUV of the liver were acquired. The tumor-to-liver SUV ratio (TLR) was also calculated. Charts were reviewed for basic patient characteristics and high-risk factors for considering AT (poor differentiation, visceral pleura invasion, vascular invasion, tumors > 4 cm, and wedge resection). Statistical analysis was performed using Cox regression analysis and the Kaplan-Meier method.
Of the 112 patients included, 15 (13.4%) died, with a median overall survival (OS) of 43.8 months. Twenty-two patients (19.6%) exhibited recurrence, with median disease-free survival (DFS) of 36.0 months. In univariable analysis, pathology, poor differentiation, and TLR were associated with shorter DFS and OS. In multivariable analysis, TLR (hazard ratio [HR] = 1.263, p = 0.008) and differentiation (HR = 3.087, p = 0.012) were associated with shorter DFS. Also, TLR (HR = 1.422, p < 0.001) was associated with shorter OS.
TLR from FDG PET/CT was an independent prognostic factor for recurrence and survival. PET parameters constitute risk factors for consideration in the decision-making for AT in margin-negative stage IB and IIA NSCLC.
In this study, TLR from FDG PET/CT was an independent prognostic factor in stage IB-IIA non-small cell cancer patients. Although additional validation studies are warranted, TLR has the potential to be used to determine the need for adjuvant therapy.
• High TLR is an independent poor prognostic factor in stage IB-IIA NSCLC. • Adjuvant treatment should be considered in patients with high TLR following complete tumor resection.
评估正电子发射断层扫描/计算机断层扫描（PET/CT）中 TLR 对切缘阴性ⅠB 期和ⅡA 期非小细胞肺癌（NSCLC）患者的预后价值，并比较需要辅助治疗（AT）的高危因素。
回顾性分析连续行 FDG PET/CT 进行初始分期的 NSCLC ⅠB 期和ⅡA 期患者。获取原发肿瘤的最大标准化摄取值（SUVmax）和肝脏的平均 SUV。还计算了肿瘤与肝脏 SUV 比值（TLR）。查阅图表以获取基本患者特征和考虑 AT 的高危因素（低分化、内脏胸膜侵犯、血管侵犯、肿瘤>4cm 和楔形切除）。使用 Cox 回归分析和 Kaplan-Meier 方法进行统计分析。
在 112 例患者中，15 例（13.4%）死亡，中位总生存期（OS）为 43.8 个月。22 例（19.6%）出现复发，无病生存期（DFS）的中位时间为 36.0 个月。单变量分析显示，病理、低分化和 TLR 与较短的 DFS 和 OS 相关。多变量分析显示，TLR（风险比[HR] = 1.263，p = 0.008）和分化（HR = 3.087，p = 0.012）与较短的 DFS 相关。此外，TLR（HR = 1.422，p < 0.001）与较短的 OS 相关。
FDG PET/CT 的 TLR 是复发和生存的独立预后因素。PET 参数构成切缘阴性ⅠB 和ⅡA NSCLC 患者 AT 决策的危险因素。
在这项研究中，FDG PET/CT 的 TLR 是ⅠB-ⅡA 期非小细胞癌患者的独立预后因素。尽管需要进一步的验证研究，但 TLR 有可能用于确定辅助治疗的需求。
• TLR 高是 IB-IIA 期 NSCLC 的独立不良预后因素。• 在完全肿瘤切除后，TLR 较高的患者应考虑辅助治疗。
