全身PET/CT在非小细胞肺癌预后判断中的价值

The value of integrated positron emission tomography/computer tomography

目的 PET/CT(integrated positron emission tomography/computerized tomography)对肺癌的诊断及分期价值已得到广泛的认同,但其对肺癌预后及疗效评估的价值还存在争议。文中探讨全身PET/CT对非小细胞肺癌(non-small cell aungcancer,NSCLC)预后判断的临床应用价值。方法从2005年1月17日至2007年1月17日期间收治的86例NSCLC患者,均经病理诊断为NSCLC,其中腺癌41例,鳞癌37例,混合型腺癌5例,大细胞癌3例。收集所有患者的PET/CT资料,并随访至2008年3月31日止。用Kaplan-Meier法和Cox回归分析法分析本组生存资料,探讨标准摄取值(standarized uptake value,SUV值)和PET/CT分期对NSCLC患者生存判断的价值。同时比较PET/CT与常用预后评价因子(ECOG PS评分、体重变化、性别、病理类型及化疗次数)对该组患者的预后判断的意义及差异。结果至研究终止日死亡59例,存活27例。SUV与生存时间呈负相关,SUV值切分点设为3、3.5、5、7、10时生存分析显示,SUV在3.5以上时,小于或等于切分点和大于切分点的2组之间生存天数均存在显著性差异,P分别为0.044、0.047、0.034、0.34。PET/CT分期、ECOG PS评分、体重下降及化疗次数与生存期也显著相关。COX多因素回归分析显示,PET/CT分期是有意义的生存预测因子,P=0.020,优于ECOG PS(P=0.058)和化疗次数(P=0.078)。结论 PET/CT的SUV值是判断NSCLC患者预后的良好的生存预测因子,SUV值越高,生存风险越大。PET/CT的TNM分期也是良好的独立生存预测因子,分期越高,生存风险越大。

Objective There is general agreement on the effectiveness of PET/CT（integrated positron emission tomography / computerized tomography）for the diagnosing and the staging of lung cancer.However,there is still a controversy whether PET/CT is effective in the prognosis and treatment evaluation for lung cancer.Therefore,this paper aims at exploring the clinical value of applying the whole body PET/CT to the prognosis of NSCLC.Methods The PET/CT data of 86 patients diagnosed as NSCLC by pathology during the period of Jan 17,2005 to Jan 17,2007 were collected and followed up until Mar 31,2008.Kaplan-Meier Survival Analysis and COX Regression Analysis were carried out so as to analyze the survival data and probe into the significance of SUV（Standardized Uptake Value） and staging with PET/CT in the prognosis of NSCLC.In the meanwhile,PET/CT data and regularly-used evaluation factors like the value in ECOG PS,weight loss,gender,pathological type and chemotherapeutic cycles were compared respectively,with the purpose of judging whether these data were of great significance and of marked difference in the prognosis of these NSCLC patients.Results The enrolled subjects were 86 NSCLC patients,67 male（63±14）,19 female（57±13）,sex ratio 3.5∶ 1,41 adenocarcinoma,37 squamous cell carcinoma,5 adenocarcinoma with mixed subtypes and 3 large cell carcinoma.59 patients died and 27 maintained life by Mar 31,2008.There was a negative correlation between the SUV and survival time of the patients.When the cutting point of SUV was set to 3,3.5,5,7 and 10,the survival analysis indicated that survival difference within each group was remarkable as the SUV was above 3.5.P=0.044,0.047,0.034.Moreover,there was a close correlation between the value in ECOG PS,weight loss,gender and chemotherapeutic cycles and the survival time of patients.Finally,COX regression analysis indicated that PET/CT was a good survival predictor（P=0.020）,which was superior to ECOG PS（P=0.058） and chemotherapeutic cycles（P=0.078）.Conclusion The SUV in PET/CT is a good survival predictor to NSCLC patients.The greater the SUV is,the bigger survival risk the patients will run.In addition,TNM staging with PET/CT is a good independent survival predictor as well.The more advanced stage the patients are on,the bigger survival risk the patients will have to face.