术前^(18)F-FDG PET/CT纵隔淋巴结SUVmax在ⅢA(N2)期非小细胞肺癌手术患者预后评估中的价值

Prognostic evaluation value of SUVmax of mediastinal lymph nodes in preoperative ^(18)F-FDG PET/CT for patients with stage ⅢA(N2) non-small-cell lung cancer

目的通过分析ⅢA(N2)期非小细胞肺癌(NSCLC)术前^(18)F-FDG PET/CT纵隔淋巴结最大标准摄取值(SUVmax)与术后预后的关系,探讨用纵隔淋巴结SUVmax评估ⅢA(N2)期NSCLC术后预后的价值。方法收集行PET/CT检查后接受手术的104例ⅢA(N2)期NSCLC患者临床资料,以纵隔淋巴结SUVmax均数为分界点,分为<均数者与≥均数者。分析性别、年龄、吸烟指数、肺原发病灶部位、T分期、病理类型、术后是否行辅助治疗、肺原发病灶SUVmax、纵隔淋巴结SUVmax以及肺原发病灶与纵隔淋巴结SUVmax差值、纵隔淋巴结阳性站数等变量对患者生存的影响,单因素生存分析用Kaplan-Meier法及Log-rank检验,多因素分析用Cox回归分析。结果 104例ⅢA(N2)期NSCLC患者纵隔淋巴结SUVmax为4.73±2.08,纵隔淋巴结SUVmax<4.73者60例、≥4.73者44例。单因素生存分析表明,术后是否行辅助治疗(P=0.025)、T分期(P=0.043)、肺原发病灶SUVmax(P=0.006)、纵隔淋巴结SUVmax(P=0.020)以及肺原发病灶与纵隔淋巴结SUVmax差值(P=0.005)、纵隔淋巴结阳性站数(P=0.008)等影响患者预后;多因素分析表明,纵隔淋巴结SUVmax(HR=2.329,95%CI:0.778～2.940,P=0.012)、肺原发病灶SUVmax(HR=1.841,95%CI:0.836～3.672,P=0.037)、纵隔淋巴结阳性站数(HR=1.626,95%CI:0.273～1.926,P=0.019)、T分期(HR=0.831,95%CI:0.173～1.362,P=0.028)及术后是否行辅助治疗(HR=0.734,95%CI:0.262～1.349,P=0.048)均是影响ⅢA(N2)期NSCLC患者术后生存的独立预后因素。结论术前^(18)F-FDG PET/CT纵隔淋巴结SUVmax可预测ⅢA(N2)期NSCLC患者术后预后。

Objective By analyzing the relationship between maximum standardized uptake values (SUVmax) of the mediastinal lymph nodes in the preoperative ^18F-FDG PET/CT imaging of patients with stage ⅢA (N2) non-small-cell lung cancer (NSCLC) and postoperative prognosis, we evaluate the prognostic significance of the mediastinal lymph node SUVmax on stage ⅢA (N2) NSCLC. Methods The clinical data of 104 patients with stage ⅢA (N2) NSCLC undergoing PET/CT examination were collected and divided into the patients with < mean and patients with ≥ mean, with the mediastinal lymph node SUVmax mean as the cut-off point. Gender, age, smoking index, primary lesion site, T staging, pathological type, postoperative adjuvant therapy, SUVmax of primary tumor and mediastinal lymph nodes, SUVmax difference between primary tumor and mediastinal lymph nodes, and the number of positive mediastinal lymph nodes were compared to determine their association with patient survival. Kaplan-meier method and Log-rank test were used in the univariate analysis and Cox regression analysis was used in the multivariate analysis. Results The SUVmax of mediastinal lymph nodes was 4.73± 2.08 in 104 patients with stage ⅢA (N2) NSCLC, with 60 cases with mediastinal lymph node SUVmax < 4.73 , and 44 cases with mediastinal lymph node SUVmax ≥4.73. Univariate survival analysis showed that the postoperative adjuvant therapy ( P =0.025), T staging ( P =0.043), SUVmax of mediastinal lymph nodes ( P =0.020) and primary tumor ( P = 0.006 ), SUVmax difference between primary tumor and mediastinal lymph nodes ( P =0.005), and the number of positive mediastinal lymph nodes ( P =0.008) were significant predictors of survival. Multivariate analysis showed that SUVmax of mediastinal lymph nodes ( HR =2.329, 95% CI: 0.778-2.940, P =0.012) and primary tumor ( HR =1.841, 95% CI: 0.836 -3.672, P =0.037), T staging ( HR =0.831, 95% CI :0.173-1.362, P =0.028), the number of positive mediastinal lymph nodes (HR=1.626, 95% CI: 0.273-1.926, P =0.019), and postoperative adjuvant therapy (HR =0.734, 95% CI :0.262-1.349, P =0.048) were independent prognostic factors for patients with stage ⅢA (N2) NSCLC. Conclusions SUVmax of the mediastinal lymph nodes in preoperative ^18F-FDG PET/CT can predict the postoperative prognosis of patients with stage ⅢA (N2) NSCLC.