18F-FDGPET/CT全身肿瘤代谢容积评价非小细胞肺癌患者预后的应用价值研究

18F-FDG PET/CT Whole-Body Metabolic Tumor Burden Evaluate the Prognostic Value in Non-Small Cell Lung Cancer

目的探讨全身肿瘤代谢容积（MTVwb）评价非小细胞肺癌患者预后的应用价值。方法回顾性分析147例行^18F-FDG PET/CT扫描的非小细胞肺癌患者于治疗前的临床资料及PET/CT图像资料,并通过半自动方法测量全身肿瘤代谢负荷信息——MTVwb,采用Kaplan-Meier生存分析及Cox比例风险回归分析,比较MTVwb及临床TNM分期对非小细胞肺癌患者的预后价值。结果共搜集147例患者,17例失访,最终纳入130例。以MTVwb的中位数和四分位数为界,MTVwb中位数以下（〈4.16 cm-3）的患者半数存活时间约为13.13（95%CI：8.5-21.5）个月,MTVwb中位数以上（≥4.16 cm-3）的患者半数存活时间约为4.67（95%CI：3.97-8.6）个月;通过Cox回归模型进行单因素分析时,除性别和年龄时间没有统计学差异外,临床TNM分期、In（MTVwb）、In（MTVwb中位数）及In（MTVwb四分位数）均有统计学差异（P〈0.05）,In（MTVwb）的C值（0.634）高于临床TNM分期（0.609）,多因素分析比较In（MTVwb）和临床TNM分期时,In（MTVwb）的P值=0.003〈0.05,临床TNM分期的Ⅲ期和Ⅳ期P值均〉0.05。结论 MTVwb较临床TNM分期系统能够更好地评价非小细胞肺癌患者的预后,可能会更合理地预测非小细胞肺癌患者的总生存期。

Objective To evaluate the prognostic value of whole-body metabolic tumor volume（ MTVwb） for non-small cell lung cancer. Methods 147 patients with non-small cell lung cancer who received^18 F-FDG PET/CT scan before treatment were post-processed and followed up by telephone retrospectively. MTVwbwas measured semi-automatically at the post-processed station. Kaplan-Meier survival analysis and Cox proportional hazard regression analysis were applied to compare the prognostic value between MTVwband clinical TNM stage for non-small cell lung cancer. Results A total of 147 cases were collected in the study,17 cases were lost to follow up,and 130 cases were included for statistical analysis. All the 130 cases were allocated to two and four groups based on the median and quartiles of MTVwb. The half survival time of patients with MTVwbbelow the median（ 4. 16 cm-3） about 13. 13（ 95% CI： 8. 5 - 21. 5） months,and that of patients with MTVwbmedian greater than or equal to the median（ ≥4. 16 cm-3） about 4. 67（ 95% CI： 3. 97 - 8. 6） months. By the Cox proportional hazard regression and C-statistic were univariate analysis,except for gender and age have no statistical difference. The clinical TNM stage,In（ MTVwb）,In（ MTVwb） mediancut and In（ MTVwb） quartile all have significant statistical difference（ P〈0. 05）,and C-statistic of In（ MTVwb）（ 0. 634） is greater clinical TNM stage（ 0. 609）. Through multivariate analysis compare In（ MTVwb） with clinical TNM stage,In（ MTVwb） P value 0. 05,whlie P value 0. 05,clinical TNM stage include stage Ⅲ and Ⅳ. Conclusion Compared with clinical TNM stage,MTVwbis better for evaluating the prognosis of non-small cell lung cancer,which may reasonably predict overall survival time for patients with non-small cell lung cancer.