18F-FDGPET／CT显像评价非小细胞肺癌放化疗疗效及复发预测

^(18)F-FDG PET/CT for Response Evaluation and Recurrence Prediction before and after Chemoradiotherapy for NSCLC

目的:探讨非小细胞肺癌(NSCLC)患者放化疗前后^(18)F-FDG摄取及其变化率与无进展生存期(PFS)的相关性,进行疗效反应分组,并与其他预后因子比较预测复发能力。方法:回顾性分析38例在放化疗前后于我科进行PET/CT检查的NSCLC患者,每例患者收集3组数据:治疗前SUV(SUV1)、治疗后SUV(SUV2)及治疗前后SUV变化率(△SUV%),分析三者与PFS的相关性,对相关性最强的因素进一步分析以确定划分治疗有无反应的临界值。结果:SUV1与PFS没有相关性(Pearson r=0.078,P=0.641);腺癌和非腺癌患者的SUV1具有显著性差异(P=0.025);不同临床分期的NSCLC患者的SUV1不具有显著性差异(P=0.839)。SUV2与PFS呈显著负相关(Pearson r=-0.354,P=0.029);腺癌患者SUV2小于非腺癌患者(P=0.017);Ⅰ～Ⅲa期患者SUV2小于Ⅲb～Ⅳ期患者(P=0.016)。△SUV%与PFS呈显著正相关(Pearsonr=0.503,P=0.001);Ⅰ～Ⅲa期患者△SUV%大于Ⅲb～Ⅳ期患者(P=0.003);不同病理类型患者的△SUV%没有显著性差异(P=0.348)。△SUV%>30%为有反应组,PFS显著长于无反应组;有/无反应组(χ~2=7.556,P=0.006)及腺癌/非腺癌组(χ~2=5.551,P=0.018)生存曲线差异有统计学意义,前者χ~2值略大于后者,但差异无统计学意义(χ~2=0.205,P>0.05)。结论:△SUV%与PFS相关性最佳,大于30%视为治疗有反应;根据△SUV%的疗效评估可比临床分期稍准确预测复发,但无显著差异。分期相同的患者根据SUV值可进一步划分为不同危险组来决定随访密度或治疗方案。

Purpose： To evaluate the correlation between FDG uptake and progression - free survival （PFS） before and after chemoradiotherapy in patients with NSCLC. Methods： Thirty - eight patients with NSCLC who underwent 18F - FDG PET examinations before and after treatment in our department were retrospectively studied. Three groups of data from every patient were evaluated： SUV1, SUV2 and SUV%. The correlation between them and PFS were analyzed, and the most significant one was deter- mined to obtain a cut - off value, which can divide the responding and non - responding groups. Results： SUV1 had no significant correlation with PFS（Pearson r = 0. 078, P = 0. 641） . There was a significant difference in SUV1 between adenocarcinoma and other histological types（P = 0. 025）; no significant dif- ference in SUV1 between different clinical stages of NSCLC（P = 0. 0839） . SUV2 had significant negative correlation with PFS（Pearson r = - 0. 354, P = 0. 029） ; SUV2 in alveolarcarcinoma group was significantlysmaller than that in non - alveolarcarcinoma group（P = 0. 017） ; SUV2 in stage Ⅰ - Ⅲa groups was sig- nificantly smaller than that in stageⅢ b- Ⅳgroups（P = 0. 016） . SUV% had significant correlation with PFS（Pearson r = 0. 503, P = 0. 001） ; SUV % in stage Ⅰ - Ⅲa groups was significantly smaller than that in stage Ⅱb - Ⅳ groups（P = 0. 003） . There was no significant difference in ASUV% between different histological types （P = 0.348） . The SUV% of responding groups was less than 30% and the PFS was longer than that of non- responding groups. There were significant differences of survival curves be- tween responding and non- responding groups（x2 = 7.556, P = 0. 006）, and between alveolarcarcinoma and non - alveolarcarcinoma patients（x2 = 5. 551, P = 0. 018）. Conclusion： SUV % has the most significant cor- relation with PFS, it can be identified as responding groups when ASUV % is more than 30% ; The treat- ment response assessed by SUV % might be superior than clinical stages in predicting recurrence, but there is no significant difference between them. And it may contribute to subdivide patients with the same TNM stage for appropriate follow - up or treatment strategies.