^18F-FDG PET/CT代谢参数预测局部晚期NSCLC近期治疗反应研究

Study of ^(18)F-FDG PET/CT quantitative metabolic parameters in prediction of early treatment response in Locally advanced non-small cell lung cancer

目的局控失败是非小细胞肺癌(non-small cell lung cancer,NSCLC)患者治疗失败的主要原因之一,早期预测肿瘤的治疗反应,及时修改治疗方案,有助于改善患者预后。研究治疗前氟代脱氧葡萄糖正电子发射计算机断层显像(^(18)F-fluorodeoxyglucose positron emission tomography/computed tomography,^(18)F-FDG PET/CT)代谢参数预测不同病理类型NSCLC患者对联合放化疗近期治疗反应的可行性。方法选取山东省肿瘤医院2014-10-01—2016-06-30不能手术接受联合放化疗的Ⅲ期NSCLC患者61例。其中腺癌31例,鳞癌30例。首先在PET/CT图像上勾画大体肿瘤靶区(gross tumor volume,GTV),提取多个肿瘤代谢参数,包括标准摄取值(standard uptake value,SUV)体积直方图,最大标准摄取值(maximum SUV,SUVmax)、平均标准摄取值(mean SUV,SUVmean)、肿瘤代谢活性体积(metabolic tumor volume,MTV)、病变总糖酵解(total lesion glycolysis,TLG)以及累积SUV体积直方图曲线下面积(area under the curve of the cumulative SUV volume histogram,AUC-CSH)。分析各代谢参数与不同病理类型NSCLC患者近期治疗反应的相关性及预测指标最佳阈值、敏感性和特异性。结果腺癌组AUC-CSH、SUVmax、SUVmean、MTV和TLG与近期治疗反应相关;鳞癌组除MTV外均与近期治疗反应相关。SUVmax、AUC-CSH分别为腺癌组和鳞癌组预测治疗反应的独立预测因子,标准化回归系数分别为-0.708、0.733,P<0.05。受试者工作特征曲线(receiver-operating characteristic curve,ROC)分析,腺癌组SUVmax的截断值为8.6,敏感性和特异性分别为76.5%和100.0%;鳞癌组AUC-CSH的截断值为0.471 5,敏感性和特异性分别为83.3%和100.0%。结论在放疗前PET/CT图像上,肿瘤异质性代谢参数与局部晚期NSCLC患者近期治疗反应存在相关性,可以作为NSCLC患者近期治疗反应的预测因子,不同病理类型宜采用差异性的预测参数。

OBJECTIVE This study was to investigate the correlation of pretreatment ^（18）F-FDG PET/CT metabolic parameters and the early treatment response to chemoradiotherapy in patients with non-small cell lung cancer（NSCLC）.METHODS PET/CT images of 61 patients with locally advanced NSCLC（31 patients with adenocarcinoma and 30 with squamous cell carcinoma）were collected at Shandong Cancer Hospital.All patients accepted chemoradiotherapy.The gross tumor volume（GTV）was delineated on PET/CT images with standard uptake values（SUVs）≥2.5.SUV volume histograms,maximum SUV（SUVmax）,mean SUV（SUVmean）,metabolic tumor volume（MTV）,total lesion glycolysis（TLG）and area under the curve of the cumulative SUV volume histogram（AUC-CSH）were extracted.The correlations between the metabolic parameters and early treatment response were analyzed.RESULTS AUC-CSH,SUVmax,SUVmean,MTV and TLG were correlated with the early treatment response in lung adenocarcinoma patients.For squamous cell carcinoma,all parameters were associated with the early treatment response except for MTV.Multivariate analysis demonstrated that SUVmax was an independent prognostic factor for the early treatment response in adenocarcinoma cases（standardized coefficient=-0.708,P〈0.05）.AUC-CSH was an independent prognostic factor for squamous cell carcinoma（standardized coefficient=0.733,P〈0.05）.Receiver-operating characteristic curve（ROC）analysis showed that the cut-off threshold of SUVmaxfor adenocarcinoma was 8.6,with 76.5% sensitivity and 100.0% specificity,and the cut-off threshold of AUC-CSH for squamous cell carcinoma was 0.471 5,with 83.3% sensitivity and 100.0% specificity.CONCLUSIONQuantitative metabolic parameters are valuable for predicting the early treatment response in NSCLC,and special parameters should be applied for different pathological types of NSCLC.