^18F-FDG PET-CT在广泛期小细胞肺癌预后判断中的价值

Prognostic value of lSF-fluorodeoxyglucose （FDG） positron emission tomography-computed tomography （PET-CT） in extensive-stage small cell lung cancer

目的 探讨18F-FDG正电子发射计算机体层摄影（PET-CT）在广泛期小细胞肺癌（ES-SCLC）预后判断中的价值.方法 回顾性分析55例ES-SCLC患者的临床资料和18F-FDG PET-CT检查情况,以及原发灶最大标准摄取值（SUVmax）、原发灶肿瘤代谢体积（MTVp）、原发灶糖酵解总量（TLGp）、所有病灶中最大SUVmax、所有病灶肿瘤代谢体积之和（MTVsum）及所有病灶糖酵解总量之和（TLGsum）与临床病理特征的关系.结果 55例ES-SCLC患者的原发灶SUVmax、中位MTVp、中位TLGp、最大SUVmax、中位MTVsum和中位TLGsum分别为11.34±7.02、29.61 cm^3、207.72、13.61±7.10、123.57 cm^3和988.48.原发灶SUVmax、MTVp和TLGp与肿瘤类型和最大径均有关（均P〈0.05）, MTVp和TLGp与胸腔积液有关（均P〈0.05）.MTVsum和TLGsum与病灶数目、胸腔积液、乳酸脱氢酶（LDH）、血红蛋白和美国东部肿瘤协作组（ECOG）评分均有关（均P〈0.05）,TLGsum与肿瘤最大径有关（P=0.039）.全组复发、进展51例,中位无进展生存时间（PFS）为6.9个月.全组死亡50例,中位总生存时间（OS）为11.7个月.单因素分析显示,MTVsum、TLGsum、病灶数目、ECOG评分、肝转移、骨转移、化疗疗程和放疗与患者的PFS和OS有关（均P〈0.05）,LDH和血红蛋白与患者的PFS有关（均P〈0.05）.多因素分析显示,LDH、ECOG评分、肝转移、化疗疗程、MTVsum和TLGsum为影响ES-SCLC患者PFS的独立因素（均P〈0.05）,ECOG评分和TLGsum为影响ES-SCLC患者OS的独立因素（均P〈0.05）.结论 18 F-FDG PET-CT显像在ES-SCLC患者预后判断中具有一定的参考价值, MTVsum和TLGsum是影响ES-SCLC患者PFS的独立影响因素,TLGsum还是影响ES-SCLC患者OS的独立因素.

Objective To investigated the prognostic value of 18F-fluorodeoxyglucose（FDG） positron emission tomography-computed tomography（PET-CT）in extensive-stage small cell lung cancer（ES-SCLC）. Methods Fifty-five patients with ES-SCLC who underwent pretreatment 18F-FDG PET-CT were retrospectively recruited in this study. The correlations of maximum standardized uptake value（SUVmax）of primary lesion,metabolic tumor volume（MTV）of primary lesion（MTVp）, total lesion glycolysis（TLG） of primary lesion（TLGp）,the highest SUVmax of all lesions, the sum of metabolic volume（MTV sum）, the sum of total lesions glycolysis（TLGsum）and clinical factors were analyzed. Results The SUVmax, MTVp,TLGp,the highest SUVmax, MTVsum and TLGsum of 55 patients were 11.34±7.02, 29.61 cm^3, 207.72,13.61 ± 7.10, 123.57 cm^3and 988.48, respectively. The SUVmax of primary lesion, MTVp and TLGp were correlated with tumor type and the maximal tumor length,respectively（all P〈0.05）. The correlations were also found between MTVp,TLGp and hydrothorax, respectively（both P〈0.05）. MTVsum and TLGsum were correlated with number of lesions, hydrothorax, LDH, hemoglobin and ECOG, respectively（all P〈0.05）. The association was also found between TLGsum and the maximal tumor length （P=0.039）. 51 patients were progressive or recurrent with the median 6.9 months of progression free survival（PFS）;and 50 patients were died with the median 11.7 months of overall survival（OS）.Univariate analysis showed that MTVsum,TLGsum, number of lesions, ECOG, live metastasis, bone metastasis, the cycle of chemotherapy and thoracic radiation therapy were all associated with PFS and OS（all P〈0.05）;LDH and hemoglobin were only associated with PFS（both P〈0.05）. Multivariate analysis demonstrated that LDH, ECOG, live metastasis, the cycle of chemotherapy, MTVsum, TLGsum were the independent predictors of PFS（all P〈0.05）; and ECOG and TLG sum were the independent predictors of OS（all P〈0.05）. Conclusions 18 F-FDG PET-CT has certain prognostic value of patients with ES-SCLC. MTVsum and TLGsum are the independent predictors of PFS,and TLGsum is also an independent predictor of OS.