18F-FDG PET/CT代谢参数对116例非小细胞肺癌患者预后评估价值

Prognostic value of 18F-FDG PET/CT metabolic parameters in patients with non-small cell lung cancer

目的18F-氟代脱氧葡萄糖(fluorodeoxyglucose F18,18F-FDG)正电子发射型计算机断层显像-计算机体层成像(positron emission computed tomography/computed tomography,PET-CT)可为非小细胞肺癌(non-small cell lung cancer,NSCLC)的预后评估及疗效监测提供重要信息。本研究旨在探讨18 F-FDG PET-CT代谢参数对NSCLC患者预后评估的价值。方法回顾性分析2014-1-1-2017-12-31海南西部中心医院术后病理确诊116例NSCLC患者病例资料,分析最大标准摄取值(maximum standardized uptake value,SUVmax)、肿瘤代谢体积(metabolic tumor volume,MTV)和病灶糖酵解总量(total lesion glycolysis,TLG)与临床可能预后因素的关系。采用Kaplan-Meier法、Log-rank检验及多因素Cox回归分析代谢SUVmax、MTV及TLG与总生存时间(overall survival,OS)和无进展生存时间(progression-free survival,PFS)的关系。结果116例NSCLC患者的SUVmax、MTV和TLG中位数分别为12.45(5.10~31.28)、27.50(6.40~131.60)和224.37(10.36~1580.26)cm3。116例NSCLC患者整体中位OS为24.60个月(17.5~35.8),中位PFS为15.20(11.4~22.5)个月,1、2和3年OS分别为79.31%(92/116)、57.76%(67/116)和36.21%(42/116)。单因素分析显示,病灶数目(χ^2=4.306,P=0.024;χ^2=4.752,P=0.013)、胸腔积液(χ^2=5.108,P=0.006;χ^2=7.428,P<0.001)、TNM分期(χ^2=7.228,P<0.001;χ^2=8.205,P<0.001)、病灶最大直径(χ^2=4.183,P=0.035;χ^2=4.375,P=0.021)、是否手术(χ^2=4.791,P=0.012;χ^2=4.619,P=0.018)、MTV(χ^2=11.228,P<0.001;χ^2=9.805,P<0.001)及TLG(χ^2=7.510,P<0.001;χ^2=5.103,P=0.008)是NSCLC患者PFS和OS的影响因素,而SUVmax仅是PFS的影响因素,χ^2=4.722,P<0.05。多因素分析显示,MTV(HR=8.152,95%CI为3.610~20.147,P<0.001)和TLG(HR=3.964,95%CI为1.863~9.252,P=0.005)是影响NSCLC患者PFS的独立危险因素,且MTV(HR=5.105,95%CI为2.137~14.580,P<0.001)是影响NSCLC患者OS的独立危险因素。结论MTV和TLG是影响NSCLC患者PFS的独立危险因素,且MTV还是影响NSCLC患者OS的独立危险因素,18F-FDG PET/CT代谢参数对NSCLC患者预后评估具有一定的价值。

OBJECTIVE Fluorodeoxyglucose F18(18 F-FDG)positron emission computed tomography(PET/CT)may provide important information for the prognostic evaluation and efficacy monitoring of non-small cell lung cancer(NSCLC).This study aimed to investigate the value of 18F-FDG PET/CT metabolic parameters in the prognostic evaluation of patients with NSCLC.METHODS Retrospective analysis of 116cases of NSCLC confirmed by pathology after operation in Hainan Western Central Hospital from January 1,2014to December 31,2017.The relationship between the maximum standard uptake(SUVmax),tumor metabolic volume(MTV)and total glycolysis(TLG)and clinical factors were analyzed.Kaplan-Meier method,Log-rank test and multivariate COX regression were used to analyze the relationship between metabolic SUVmax,MTV and TLG and total survival time(OS)and progression-free survival time(PFS).RESULTS The median SUVmax,MTV and TLG of 116NSCLC patients were 12.45(5.10-31.28),27.50(6.40-131.60)and 224.37(10.36-1580.26)cm3,respectively.The median OS was 24.60months(17.5-35.8)and the median PFS was 15.20months(11.4-22.5)in 116NSCLC patients.The overall survival rates of 1,2and 3years were 79.31%(92/116),57.76%(67/116)and 36.21%(42/116),respectively.Univariate analysis showed that the number of lesions,pleural effusion,TNM stage,maximum diameter of lesions,surgery,MTV and TLG were the influencing factors of PFS and OS in NSCLC patients(χ^2 values were 4.306,5.108,7.228,4.183,4.791,11.228,7.510,4.752,7.428,0.723,4.375,4.619,9.805and 5.103,all P<0.05),while SUVmax was only the influencing factor of PFS(χ^2=4.722,P<0.05).Multivariate analysis showed that MTV(HR=8.152,95%CI:3.610-20.147,P<0.001)and TLG(HR=3.964,95%CI:1.863-9.252,P=0.005)were independent risk factors for PFS in NSCLC patients,MTV(HR=5.105,95%CI=:2.137-14.580,P<0.001)were independent risk factors for OS in NSCLC patients(χ^2=5.248,P<0.05).CONCLUSION MTV and TLG were independent risk factors for PFS in patients with NSCLC,and MTV was also an independent risk factor for OS in patients with NSCLC.18F-FDG PET/CT metabolic parameters have certain value for prognostic evaluation of patients with NSCLC.