~1H磁共振波谱在非小细胞肺癌脑转移放疗疗效评价中的预测价值

Predictive Value of Proton Magnetic Resonance Spectroscopy in the Evaluation of Radiotherapy for Patients with Brain Metastases from Non-small Cell Lung Cancer

目的探讨~1H磁共振波谱(~1H-MRS)在非小细胞肺癌(NSCLC)脑转移放疗疗效评价中的预测价值。方法接受立体定向放疗(SRT)联合全脑照射(WBRT)的56例NSCLC脑转移患者在治疗前应用~1H-MRS进行检查,测量Cho/Cr的比值,比较治疗前Cho/Cr比值高组与Cho/Cr比值低组间疗效的差异,分析~1H-MRS在NSCLC脑转移放疗疗效评价中的预测价值。结果治疗前Cho/Cr比值中位值为1.989。治疗前Cho/Cr比值高组(>1.989)1、3、5年生存率分别为29.3%(95%CI:11.3%~47.3%)、0%、0%,平均生存时间为9.77个月(95%CI:7.50~12.04个月)。Cho/Cr比值低组(<1.989)1、3、5年生存率分别为70.5%(95%CI:53.3%~87.7%)、22.3%(95%CI:6.6%~38.0%)、1.8%(95%CI:0~8.1%),平均生存时间为24.67个月(95%CI:17.69~31.66个月)。治疗前Cho/Cr比值高组与Cho/Cr比值低组比较平均生存时间有统计学差异(P<0.05)。结论 ~1H-MRS对NSCLC脑转移放疗的疗效评价具有预测价值,治疗前Cho/Cr比值高组预后差。

Objective To investigate the predictive value of proton magnetic resonance （MR） spectroscopy （1H-MRS） in evaluating the therapeutic efficacy of radiotherapy for patients with brain metastases from non-small cell lung cancer （NSCLC）. Methods Fifty-six patients with brain metastases from NSCLC underwent IH-MRS examination before treatment with stereotactic radiotherapy （SRT） in addition to whole brain radiotherapy （WBRT）. The patients were divided into two groups according to their pretreatment choline-to-creatinine （Cho/ Cr） ratio. The therapeutic efficacy of radiotherapy was compared between the two groups, and the prognostic value of 1H-MRS examination was analyzed. Results The median pretreatment Cho/Cr was 1.989. The overall survival rates at 1,3, and 5 years were 29.3%, 0%, and 0% in patients with higher pretreatment Cho/Cr, and 70.5%, 22.3%, and 1.8% in those with lower pretreatment Cho/Cr. The mean survival time was significantly lower in patients with higher pretreatment Cho/Cr than in those with lower pretreatment Cho/Cr （9.77 vs. 24.67 months,P 〈 0.05）. Conclusion Pretreatment Cho/Cr has a predictive value in the evaluation of radiotherapy for the treatment of NSCLC brain metastasis. Patients with higher pretreatment Cho/Cr have worse prognosis overall.