Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul National University, Seoul, Republic of Korea.
BMC Cancer. 2023 Apr 26;23(1):381. doi: 10.1186/s12885-023-10846-x.
Tc-MAA accumulation within the tumor representing pulmonary arterial perfusion, which is variable and may have a clinical significance. We evaluated the prognostic significance of Tc-MAA distribution within the tumor in non-small cell lung cancer (NSCLC) patients in terms of detecting occult nodal metastasis and lymphovascular invasion, as well as predicting the recurrence-free survival (RFS).
Two hundred thirty-nine NSCLC patients with clinical N0 status who underwent preoperative lung perfusion SPECT/CT were retrospectively evaluated and classified according to the visual grading of Tc-MAA accumulation in the tumor. Visual grade was compared with the quantitative parameter, standardized tumor to lung ratio (TLR). The predictive value of Tc-MAA accumulation with occult nodal metastasis, lymphovascular invasion, and RFS was assessed.
Eighty-nine (37.2%) patients showed Tc-MAA accumulation and 150 (62.8%) patients showed the defect on Tc-MAA SPECT/CT. Among the accumulation group, 45 (50.5%) were classified as grade 1, 40 (44.9%) were grade 2, and 4 (4.5%) were grade 3. TLR gradually and significantly increased from grade 0 (0.009 ± 0.005) to grade 1 (0.021 ± 0.005, P < 0.05) and to grade 2-3 (0.033 ± 0.013, P < 0.05). The following factors were significant predictors for occult nodal metastasis in univariate analysis: central location, histology different from adenocarcinoma, tumor size greater than 3 cm representing clinical T2 or higher, and the absence of Tc-MAA accumulation within the tumor. Defect in the lung perfusion SPECT/CT remained significant at the multivariate analysis (Odd ratio 3.25, 95%CI [1.24 to 8.48], p = 0.016). With a median follow-up of 31.5 months, the RFS was significantly shorter in the defect group (p = 0.008). Univariate analysis revealed that cell type of non-adenocarcinoma, clinical stage II-III, pathologic stage II-III, age greater than 65 years, and the Tc-MAA defect within tumor as significant predictors for shorter RFS. However, only the pathologic stage remained statistically significant, in multivariate analysis.
The absence of Tc-MAA accumulation within the tumor in preoperative lung perfusion SPECT/CT represents an independent risk factor for occult nodal metastasis and is relevant as a poor prognostic factor in clinically N0 NSCLC patients. Tc-MAA tumor distribution may serve as a new imaging biomarker reflecting tumor vasculatures and perfusion which can be associated with tumor biology and prognosis.
Tc-MAA 在肿瘤内的蓄积代表肺动脉灌注，其变化可能具有临床意义。我们评估了 Tc-MAA 在肿瘤内分布对非小细胞肺癌（NSCLC）患者隐匿性淋巴结转移和血管淋巴管侵犯的检测以及无复发生存率（RFS）预测的预后意义。
回顾性分析 239 例临床 N0 期 NSCLC 患者，行术前肺灌注 SPECT/CT 检查，根据 Tc-MAA 在肿瘤内蓄积的视觉分级进行分类。视觉分级与定量参数标准化肿瘤与肺比（TLR）进行比较。评估 Tc-MAA 蓄积对隐匿性淋巴结转移、血管淋巴管侵犯和 RFS 的预测价值。
89 例（37.2%）患者 Tc-MAA 蓄积，150 例（62.8%）患者 Tc-MAA SPECT/CT 缺损。在蓄积组中，45 例（50.5%）为 1 级，40 例（44.9%）为 2 级，4 例（4.5%）为 3 级。TLR 逐渐且显著升高，从 0 级（0.009±0.005）到 1 级（0.021±0.005，P<0.05），再到 2-3 级（0.033±0.013，P<0.05）。单因素分析中，以下因素是隐匿性淋巴结转移的显著预测因素：中央位置、组织学不同于腺癌、肿瘤大小大于 3cm 代表临床 T2 或更高，以及肿瘤内无 Tc-MAA 蓄积。在多因素分析中，肺灌注 SPECT/CT 缺损仍然具有显著意义（比值比 3.25，95%CI [1.24 至 8.48]，p=0.016）。中位随访 31.5 个月后，缺损组的 RFS 明显缩短（p=0.008）。单因素分析显示，非腺癌细胞类型、临床分期 II-III 期、病理分期 II-III 期、年龄大于 65 岁以及肿瘤内 Tc-MAA 缺损是 RFS 较短的显著预测因素。然而，只有病理分期在多因素分析中具有统计学意义。
术前肺灌注 SPECT/CT 肿瘤内无 Tc-MAA 蓄积代表隐匿性淋巴结转移的独立危险因素，与临床 N0 NSCLC 患者的不良预后相关。Tc-MAA 肿瘤分布可作为反映肿瘤血管生成和灌注的新影像学生物标志物，与肿瘤生物学和预后相关。
