术前^18F-FDG PET/CT显像对非小细胞肺癌患者中远期预后的预测价值

Mid-long-term prognostic value of preoperative ^18F-FDG PET/CT imaging on patients with resectable non-small cell lung cancer

目的 探讨非小细胞肺癌(NSCLC)根治性切除术术前^18F-脱氧葡萄糖(FDG) PET/CT显像对患者中远期预后的预测价值.方法 回顾性分析2010年4月至2016年8月间北京医院收治的70例行根治性手术且术前1个月内行^18F-FDG PET/CT显像的初诊NSCLC患者资料,其中男35例,女35例,中位年龄64岁.分析患者肺癌原发灶及纵隔或肺门淋巴结的PET/CT影像学征象[原发灶大小及最大标准摄取值(SUVmax)、纵隔或肺门高代谢淋巴结(HML) SUVmax及分布类型]并随访.研究终点为总生存(OS)期和无进展生存(PFS)期.采用Kaplan-Meier法、log-rank检验和Cox比例风险回归模型分析探讨患者生存的预后因素.结果 随访0.9~8.2年.70例患者中,31.4% (22/70)进展,24.3%(17/70)死亡.对于OS期,术前NSCLC原发灶SUVmax≥10与<10者(4.6和7.6年)、原发灶大小>3 cm与≤3 cm者(4.8和7.4年)、纵隔或肺门HML分布于肺癌同侧与位于双侧或无HML者(4.4和7.4年)、纵隔或肺门HML SUVmax≥5.0与<5.0者(3.8和7.3年)的差异均有统计学意义(x^2值:10.135~ 15.238,均P<0.01);上述组别患者PFS期(3.9和6.7年、3.8和6.6年、3.8和6.4年、3.3和6.3年)的差异亦有统计学意义(x^2值:8.410~ 14.600,均P<0.01).Cox多因素分析显示,原发灶大小和SUVmax是预测NSCLC术后OS期及PFS期的独立危险因素(均P<0.01),纵隔或肺门HML分布类型对预测NSCLC的OS期有边际意义(P=0.051).结论 NSCLC根治术术前^18F-FDG PET/CT显像中的原发灶大小和SUVmax对NSCLC术后生存期有重要的预测价值;纵隔或肺门HML分布类型对术后NSCLC的预后可能有预测价值.

Objective To investigate the role of preoperative ^18F-fluorodeoxyglucose(FDG)PET/CT imaging in mid-long-term prognosis of patients with resectable non-small cell lung cancer(NSCLC).Methods Seventy resectable NSCLC patients(35 males,35 females,median age 64 years)in Beijing Hospital between April 2010 and August 2016 were enrolled into this retrospectively study.All patients underwent ^18F-FDG PET/CT imaging followed by pulmonary resection with mediastinal or hilar lymph nodes dissection within 1 month.The findings of PET/CT imaging including characteristics of primary lesions and mediastinal or hilar lymph nodes(size and maximum standardized uptake value(SUVmax)of primary lesion,SUVmax and distribution of high metabolic lymph nodes(HML))were analyzed,and patients were followed up.Survival outcome indicators were defined as overall survival(OS)and progression-free survival(PFS).Survival analysis was conducted by Kaplan-Meier method,log-rank method and Cox proportional hazard models to assess the predictive factors.Results Patients were followed up for 0.9-8.2 years.Among 70 patients,31.4%(22/70)had disease progression and 24.3%(17/70)died.As for OS,there were significantly differences between patients with SUVmax of primary lesion≥10 and<10(4.6 vs 7.6 years),with size of primary lesion>3 cm and≤3 cm(4.8 vs 7.4 years),with unilateral mediastinal or hilar HML and bilateral sides or without HML(4.4 vs 7.4 years),with SUVmax of mediastinal or hilar lymph nodes≥5.0 and<5.0(3.8 vs 7.3 years)(χ^2 values:10.135-15.238,all P<0.01),as well as PFS(3.9 vs 6.7,3.8 vs 6.6,3.8 vs 6.4,3.3 vs 6.3 years;χ^2 values:8.410-14.600,all P<0.01).Cox multivariate analysis demonstrated that the size and SUVmax of primary lesion were independent predictive factors of OS and PFS(all P<0.01).Moreover,the distribution of mediastinal or hilar HML had marginal significance in predicting OS(P=0.051).Conclusions Size and SUVmax of primary lesion in preoperative ^18F-FDG PET/CT imaging are predictive factors for the survival of postoperative NSCLC.The distribution of the mediastinal or hilar HML may have significance for the survival prediction of postoperative NSCLC.