18F-氟脱氧葡萄糖PET-CT显像预测Ⅲ期非小细胞肺癌的预后

Prognostic value of 18F-fluorodeoxyglucose uptake in patients with non-small cell lung cancer treated by concurrent chemoradiotherapy

目的 探讨18F-氟脱氧葡萄糖（FDG）PET-CT显像在Ⅲ期非小细胞肺癌（NSCLC）疗效评价及预后判断中的价值.方法 46例NSCLC患者分别在放疗前1周及放疗剂量达到40～50 Gy时进行18F-FDG PET-CT显像检查,以最大标准摄取值（SUVmax）的变化百分率为50%为分割点,将46例患者分为治疗有反应组（A组）和无反应组（B组）,对比分析两组治疗前和治疗中的SUVmax值及其变化率与疗效和预后的关系.结果 A组25例,B组21例.A组和B组治疗前的SUVmax值分别为7.59±3.14和14.72±4.67,治疗中的SUVmax值分别为2.89±1.39和9.82±3.31,两组差异均有统计学意义（均P＜0.05）.A组和B组SUVmax值变化百分率分别为61.9%±8.7%和33.6%±9.0%,差异有统计学意义（P=0.007）.A组和B组患者的1年生存率分别为68.0%和38.1%,2年生存率分别为64.0%和33.3%,两组差异均有统计学意义（均P＜0.05）.Logistic回归分析显示,治疗前和治疗中的SUVmax以及两者的变化百分率与NSCLC患者的预后有关.结论 治疗前和治疗中的SUVmax以及两者的变化百分率可作为Ⅲ期NSCLC患者早期疗效评价和预后判断的重要参考指标.

Objective To evaluate the value of 18F-FDG PET-CT for assessment of therapeutic response and prediction of patient outcome after concurrent chemoradiotherapy （CCRT） of non-small cell lung cancer （NSCLC）. Methods Forty six patients with histologically proven stage Ⅲ NSCLC had two repeated 18 F-FDG PET-CT scans either one week before therapy and at the dose of 40 ～ 50 Gy. The SUVmax and changes of the two groups were compared with （ 1 ） the therapeutic response and （2） treatment results and long-term survival. Results Of the 46 eligible cases, the pretreatment SUVmax of the responding and non-responding groups was 7.59 ± 3.14 and 14.72 ± 4.67, respectively. The midtreatment SUVmax of the two groups was 2.89 ± 1.39 and 9.82 ± 3.31, respectively. Significiant difference （ t = 4.74, P = 0.001 ;t =7.23, P =0. 001 ）in SUVmax was observed both before and during treatment. Furthermore, the percentage change of pretreatment and midtreatment SUVmax was △SUVmax= 61.9% ±8.7% and △SUVmax =33.6% ±9.0%, also with a significiant difference between the two groups （t = 2.83, P = 0.007 ）. In addition, the 1-year survival rate of the the responding and non-responding groups was 68.0% and 38.1%, respectively.The 2-year survival rate of the two groups was 64.0% and 33.3%, respectively,with a significiant difference between the two groups （ P = 0. 043, P = 0. 038 ）. Conclusion 18 F-FDG PET-CT is highly effective in detecting therapeutic response in stage Ⅲ NSCLC patients. The analysis of percentage change of SUVmax provides incremental value in early prediction of therapeutic response and patient outcome.