探讨PET/CT原发灶SUVmax在肺鳞癌患者术后预后中的意义及与临床病理特征的关系

Analysis of the Role of PET/CT SUVmax in Prognosis and Its Correlation with Clinicopathological Characteristics in Resectable Lung Squamous Cell Carcinoma

背景与目的肺癌居于全球男性及女性癌症相关死亡原因的首位,大多数患者在确诊时已属晚期,5年生存率仅为18%。肺癌可分为非小细胞肺癌(non-small cell lung carcinoma,NSCLC)和小细胞癌(small cell lung carcinoma,SCLC),其中NSCLC占肺癌的80%-85%,NSCLC根据组织学可主要分为腺癌(约占40%),鳞状细胞癌(20%-30%)和大细胞癌(10%),针对驱动基因的靶向治疗在肺腺癌中取得一定成绩,但在肺鳞癌的治疗中收效甚微,肺鳞癌的诊治更需得到关注,18F-脱氧葡萄糖(fluorodeoxyglucose,FDG)正电子发射断层扫描/计算机体层摄影(positron emission tomography/computed tomography,PET/CT)越来越多地应用于肺癌的诊断与分期中,本研究旨在探讨18F-FDG PET/CT原发灶最大标准摄取值(maximum standardized uptake value,SUVmax)在肺鳞癌患者术后预后中的意义及与临床病理特征的关系。方法回顾分析2005年5月-2014年10月收治的182例初治、接受PET/CT检查、行根治术的原发肺鳞癌患者的临床影像病理及随访资料。采用Kaplan-Meier法及Cox模型分析患者生存情况,并分析原发灶SUVmax与各临床病理因素的关系。结果 182例肺鳞癌患者原发灶SUVmax以13.0为界分为两组,SUVmax>13.0组与≤13.0组患者的中位总生存期分别为56个月和87个月,差异具有统计学意义(P=0.022)。原发灶SUVmax与性别、肿瘤最大径、肿瘤-淋巴结-转移(tumor-node-metastasis,TNM)分期、中性粒细胞、中性粒细胞/淋巴细胞比例(neutrophil-lymphocyte ratio,NLR)存在正相关性,与血红蛋白呈负相关(P<0.05)。Cox多因素分析显示SUVmax(HR=1.714,95%CI:1.021-2.876,P=0.042)、TNM分期(HR=1.677,95%CI:1.231-2.284,P=0.001)均为患者生存的独立预后影响因子,提示SUVmax有独立于病理TNM分期之外的预后价值。而且,SUVmax在I期肺鳞癌患者的预后中有意义(P=0.045)。结论 PET/CT SUVmax对肺鳞癌患者术后生存的预测有重要的价值,是独立于TNM分期之外的一个重要预后因素,并且原发灶SUVmax与多个临床病理因素间存在相关性。

Background and objective Lung cancer is the leading cause of cancer death in men and women in the world, more than one-half of cases are diagnosed at a advanced stage, and the overall 5-year survival rate for lung cancer is 18%. Lung cancer is divided into non-small cell lung carcinoma （NSCLC） and small cell lung carcinoma （SCLC）. Approximately 80%-85%of cases are NSCLC which includes three main types：adenocarcinoma （40%）, squamous cell carcinoma （SCC） （20%-30%）, and large cell carcinoma （10%）. Although therapies that target driver mutations in adenocarcinomas are showing some promise, they are proving ineffective in smoking-related SCC. We need pay more attention to the diagnosis and treatment of SCC. 18F-FDG positron emission tomography （PET）/computed tomography （CT） has emerged as an accurate staging mo-dality in lung cancer diagnosis. hTe aim of this study is to investigate the role of maximum standardized uptake value （SUVmax） on PET-CT in prognosis and its correlation with clinicopathological characteristics in resectable SCC. Methods One hun-dred and eighty-two resectable SCC patients who underwent PET/CT imaging between May 2005 and October 2014 were enrolled into this retrospectively study. All the enrolled patients had underwent pulmonary resection with mediastinal lymph node dissection without preoperative chemotherapy or radiotherapy. Survival outcomes were analyzed using the Kaplan-Meier method and multivariate Cox proportional hazards model. Correlation between SUVmax and clinicopathological factors was analysed using Pearson correlation analysis and Spearman rank correlation analysis. Results hTe patients were divided into two groups on the basis of SUVmax 13.0 as cutoff value, and patients with SUVmax more than 13.0 had shorter median overall survival than patients less than 13.0 in univariate analysis （56 months vs 87 months;P=0.022）. hTere was remarkable correla-tion between SUVmax and gender, tumor size, tumor-node-metastasis （TNM） stage, neutrophil, NLR, hemoglobin （P〈0.05）. Multivariate Cox analysis demonstrated that SUVmax （HR=1.714, 95%CI：1.021-2.876, P=0.042）, TNM stage （HR=1.677, 95%CI：1.231-2.284, P=0.001） were independent predictors for survival. Furthermore, univariate survival analysis showed signiifcant difference by SUVmax in patients of stage I （P=0.045）. Conclusion SUVmax may be of importance prognostic factor independent of TNM stage, which was considerable for risk stratiifcation in patients with TNM stage. Besides, there was correlation between SUVmax of primary tumor and clinicopathological characteristics.