18F-脱氧葡萄糖正电子发射计算机断层扫描最大标准化摄取值与非小细胞肺癌临床病理特征的关系

Primary tumor SUVmax measured on 18F-FDG PET-CT correlates with histologic grade and pathologic stage in non-small cell lung cancer

目的 探讨18F-脱氧葡萄糖（18F-FDG）正电子发射计算机断层扫描（PET-CT）最大标准化摄取值（SUVmax）与非小细胞肺癌（NSCLC）组织学类型、分化程度及病理分期等的关系.方法 回顾性分析540例行18 F-FDG PET-CT检查后接受手术治疗的初治NSCLC患者的临床资料,根据患者不同的临床及病理参数进行分组,采用t检验或单因素方差分析比较不同组别间SUVmax的差异,采用Pearson相关或Spearman秩相关分析SUVmax与肿瘤大小、组织学类型、分化程度及病理分期的相关性.结果 细支气管肺泡癌组、腺癌组、腺鳞癌组、鳞癌组和其他类型组的SUVmax分别为1.3±1.1、5.1±3.4、8.5±2.8、9.9±4.6和10.9±5.1.组织学分级I级组、Ⅱ级组和Ⅲ级组的SUVmax分别为2.4±2.2、5.9±3.9和8.4±4.4,差异均有统计学意义（均P＜0.05）.SUVmax与肿瘤大小、组织学分级及TNM分期均呈中等度相关（均P＜0.05）,与T分期和N分期均呈低度相关（均P＜0.05）.结论 SUVmax在不同组织学类型非小细胞肺癌间存在明显差异.SUVmax与肿瘤大小、组织学分级及病理分期呈正相关关系.

Objective To assess the relationship between preoperative maximum standardized uptake value （SUVmax） measured on 18F-FDG PET-CT and clinicopathologic parameters in patients with surgically reseeted non-small cell lung cancer （NSCLC）. Methods A total of 540 patients （348 men and 192 women, mean age 60 ± 10 years） with histologically proven non-small cell lung cancer, who had undergone both preoperative ISF-FDG PET-CT imaging and curative surgery in our institution from October 2006 to January 2013, were analyzed retrospectively in this study. Primary tumor 18F-FDG uptake, measured as SUVmax corrected for lean body mass, was compared among different variables and correlated with tumor size, histologic grade and postoperative pathologic TNM stage. Histologic grade was categorized into three degrees, where grade I represents highly, grade Ⅱ moderately and grade Ⅲ poorly differentiated. Large cell carcinomas were all assessed as poorly differentiated （ grade Ⅲ ）. Pathologic stage was assigned according to the seventh AJCC TNM staging system. Results There were 344 adenocarcinomas （AC, non- BAC type）, 146 squamous cell carcinomas （SCC）, 28 bronchioloalveolar carcinomas （BAC）, 10 adenosquamous carcinomas （ASC） and 12 other type carcinomas （OTC, including 6 large cell carcinomas, 5 sarcomatoid carcinomas and 1 lymphoepitheloid carcinoma） ; the SUVmax in ascending order was BAC （ 1.3 ± 1.1 ）, AC （5.1±3.4）, ASC （8.5 ±2.8）, SCC （9.9 ±4.6） and OTC （10.9 ±5.1）, respectively. There were 76 grade I, 251 grade Ⅱ and 213 grade Ⅲ; the SUVmax in ascending order was grade I （2.4 ± 2.2） , grade Ⅱ （5.9 ± 3.9）, grade Ⅲ（8.4 ± 4.4）, respectively, and significant difference was identified among grade I , grade Ⅱ and grade Ⅲ （ all P 〈 0.01 ）. The SUVmax was positively correlated with tumor size （r = 0.564, P〈0.01）, histologic grade （r=0.492, P〈0.01）, T stage （r=0.306, P〈0.01）, N stage （r= 0.368, P 〈 0.01 ）, and TNM stage （ r = 0.437, P 〈 0.01 ）. Conclusions The preoperative SUVmax of the primary tumor differed significantly among histologic types in NSCLC. There were positive correlations between SUVmax and tumor size, histologic grade and pathologic stage. Our findings may suggest that a high SUVmax could be used to identify a high-rlsk population who would benefit most from adjuvant therapies.