18F-FDG PET/CT在评价肺癌分期和评估新辅助化疗疗效中的价值研究

Value of 18F-FDG PET/CT in Evaluating the Staging of Lung Cancer and the Curative Effect of Neoadjuvant Chemotherapy

目的探究18氟-2脱氧-D-葡萄糖(18F-FDG)正电子发射断层显像/X线计算机体层成像仪(PET/CT)在评价肺癌分期和评估新辅助化疗疗效中的价值。方法将2013年1月-2017年7月间在我院接受治疗的80例非小细胞癌患者纳入研究范围,均有明确化疗前病理组织学结果、18F-FDGPET/CT及CT影像学资料,先参照化疗前病理组织学分期结果,对比18F-FDGPET/CT及CT用于肺癌分期的符合率;并分别于第一个新辅助化疗周期结束后行18F-FDGPET/CT、第一、二个化疗周期结束后均行CT检查,评估化疗疗效,对比两种检查方式疗效评估差异。结果以病理组织结果为金标准,CT用于肺癌分期的符合率为83.75%,18F-FDGPET/CT为92.50%(χ^2=2.926,P=0.087);第一个化疗周期结束后,经18F-FDGPET/CT评价,代谢缓解率为57.50%,42.50%代谢无缓解,客观有效率为57.50%;CT评价PR32.50%、SD67.50%,客观有效率32.50%,差异有统计学意义(χ^2=15.625,P﹤0.001);第二个新辅助化疗周期结束后,CT评价PR34(42.50%)例,SD38(47.50%)例,PD8(10.00%)例,客观有效率42.50%,与第一周期化疗结束后PET/CT评估所得客观有效率比较差异无统计学意义(χ^2=3.60,P﹥0.05)。以第二周期化疗结束后CT疗效评估结果为参照,18F-FDGPET/CT预测肺癌新辅助化疗疗效的灵敏度82.35%、特异度为60.86%、准确率70.00%、阳性预测值60.87%、阴性预测值为82.35%。结论较CT而言,18FFDGPET/CT不仅可用于肺癌早期临床分期,还可更早对新辅助化疗疗效进行评估,但在疗效评估时SUVmax下降临界值仍有待进一步深入探究。

Objective To explore the value of 18F-2-deoxy-2-D-glucose (18F-FDG) positron emission tomography/X-ray computed tomography (PET/CT) in evaluating the staging of lung cancer and the curative effect of neoadjuvant chemotherapy.Methods Eighty patients with non-small cell carcinoma treated in the hospital between January 2013 and July 2017 were enrolled in the study.All patients had clear histopathological findings,18F-FDG PET/CT and CT imaging data before chemotherapy.Referring to the results of histopathological staging before chemotherapy,the coincidence rate was compared between 18F-FDG PET/CT and CT for staging of lung cancer.The 18F-FDG PET/CT was performed at the end of the first cycle of neoadjuvant chemotherapy,and CT was performed at the end of the first and second cycle of neoadjuvant chemotherapy to assess the curative effect of chemotherapy.The differences between the two examination methods for evaluating the curative effect were compared.Results With the pathological results as the golden standard,the coincidence rate of CT in staging of lung cancer was slightly higher than that of 18F-FDG PET/CT (83.75% vs 92.50%)(χ^2=2.926,P=0.087). After the first cycle of chemotherapy,the remission and non-remission rates of metabolism and the objective response rate evaluated by 18F-FDG PET/CT were 57.50%,42.50% and 57.50%,respectively.The PR,SD and the objective response rate evaluated by CT were 32.50%,67.50% and 32.50%,respectively (χ^2=15.625,P<0.001).After the second cycle of neoadjuvant chemotherapy,the PR,SD and PD evaluated by CT were 34 cases (42.50%),38 cases (47.50%) and 8 cases (10.00%),respectively.The objective response rate was 42.50%.There was no significant difference in the objective response rate evaluated by PET/CT after the first cycle of chemotherapy (χ^2=3.60,P>0.05).According to the results of CT in assessment of the curative effect after the second cycle of chemotherapy, the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of 18F-FDG PET/CT in predicting the curative effect of neoadjuvant chemotherapy for lung cancer were 82.35%,60.86%,70.00%,60.87% and 82.35%,respectively.Conclusion Compared with CT,18F-FDG PET/CT not only can be used for early clinical staging of lung cancer,but also assessment of the curative effect of early neoadjuvant chemotherapy. However,the threshold value of SUVmax decline in assessment of the curative effect needs further study.