18F-FDG PET/CT在局限期小细胞肺癌预后评估中的价值

Prognostic value of 18 F-FDG PET/CT in patients with limited-stage small cell lung cancer

目的 探讨18 F-FDG PET/CT在局限期小细胞肺癌（LS-SCLC）预后评估中的价值.方法 回顾性分析2009年4月至2015年12月间66例（男58例、女8例,中位年龄65岁）治疗前行18 F-FDG PET/CT显像的LS-SCLC患者的临床资料.分析SUVmax、所有病灶MTV之和（MTVsum）、TLG之和（TLGsum）与临床因素的关系;通过ROC曲线获得SUVmax、MTVsum及TLGsum预测PFS的最佳阈值;采用Kaplan-Meier法及log rank检验进行单因素生存分析,多因素生存分析采用Cox比例风险模型.结果 66例患者的SUVmax、MTVsum、TLGsum分别为10.57±3.27、38.71（2.89,221.68）cm3、267.04（1167,1684.13）.SUVmax、MTVsum、TLGsum均与胸腔积液、病灶最大径、临床分期及LDH有关,而MTVsum、TLGsum除与上述临床因素有关外,还与肿瘤类型、NSE有关.经过中位时间为33个月的随访（4例失访）,有43例患者复发、进展,中位PFS期为12.30个月;38例患者死亡,中位OS期为15.75个月.SUVmax、MTVsum及TLGsum预测PFS的最佳界值分别为10.08、16.18 cm3、209.14.单因素生存分析显示,胸腔积液、病灶最大径、临床分期、NSE、LDH、手术、MTVsum及TLGsum均与患者PFS和OS有关;SUVmax与患者PFS有关,而与OS无关.多因素分析结果显示,NSE、LDH、MTVsum、TLGsum是影响LS-SCLC患者PFS的独立预后因素（HR值：3.83、4.46、9.26、3.87,均P〈0.05）;而SUVmax不是患者PFS独立预后因素（HR=1.47,P〉0.05）,LDH、MTVsum是患者OS的独立预后因素（HR值：2.77、6.83,均P〈005）.结论 18 F-FDG PET/CT显像能够预测LS-SCLC患者的预后,SUVmax是PFS的影响因素.MTVsum和TLGsum是患者PFS的独立影响因素,MTVsum还是患者OS的独立影响因素.

Objective To investigated the prognostic value of 18 F-FDG PET/CT in patients with limited-stage small cell lung cancer （LS-SCLC）. Methods Sixty-six patients （58 males, 8 females;median age 65 years） with LS-SCLC who underwent pretreatment 18 F-FDG PET/CT from April 2009 to December 2015 were included in this retrospective study. The relations between the SUVmax , the sum of MTV （ MTVsum ） , the sum of TLG （ TLGsum ） and clinical factors were analyzed. ROC curve was plotted to estimate the most discrimination threshold （ cutoff point） for each parameter to maximize the sensitivity and specifici-ty in predicting the progression or recurrence. Kaplan-Meier method and log-rank test were used to perform univariate survival analysis and Cox proportional hazards model for multivariate analysis. Results The SUVmax, MTVsum and TLGsum of 66 patients were 10.57±3.27, 38.71（2.89, 221.68） cm3 and 267.04 （1167, 1684.13）, respectively. SUVmax, MTVsum and TLGsum were all associated with hydrothorax, the maximum diameter of tumor, clinical stage and LDH. MTVsum and TLGsum were also associated with tumor type and NSE. During the median 33 months of follow-up, 4 patients were lost to follow-up, 43 patients were progressive or recurrent with the median PFS of 12.30 months, and 38 patients died with the median OS of 15.75 months. The optimal cutoff point of SUVmax, MTVsum and TLGsum were 10.08, 16.18 cm3, 209.14, re-spectively. Univariate analysis showed that hydrothorax, the maximum diameter of tumor, clinical stage, NSE, LDH, surgery, MTVsum and TLGsum were all associated with PFS and OS. SUVmax was associated with PFS, but not with OS. Multivariate analysis demonstrated that NSE, LDH, MTVsum and TLGsum were the in-dependent predictors of PFS （ HR：3.83, 4.46, 9.26, 3.87, all P〈0.05） , and LDH, MTVsum were also the independent predictors of OS （ HR：2.77, 6.83, both P〈0.05） . However, SUVmax was not the independent predictor of PFS（HR=1.47, P〉0.05）. Conclusions 18F-FDG PET/CT can predict the prognosis of pa-tients with LS-SCLC. SUVmax is correlated with PFS, MTVsum and TLGsum are independent predictors of PFS, and MTVsum is also an independent predictor of OS.