18F-FDG PET/CT联合肿瘤标志物诊断术前非小细胞肺癌纵隔淋巴结转移的价值

Value of 18F-FDG PET/CT combined with tumor markers in diagnosis of mediastinal lymph node metastasis of non-small cell lung cancer before operation

目的:探讨18F-FDG PET/CT联合肿瘤标志物诊断术前非小细胞肺癌(NSCLC)纵隔淋巴结转移的价值。方法:回顾性分析81例根治后经病理证实为NSCLC患者的临床资料、病理结果及18F-FDG PET/CT代谢参数。应用多元Logistic回归分析筛选纵隔淋巴结转移的影响因素,建立预测纵隔淋巴结转移的多元Logistic回归模型。采用受试者工作特征曲线(ROC曲线)及ROC曲线下面积(AUC)比较各个诊断因素的诊断效能。结果:纵隔淋巴结转移组的淋巴结最大标准摄取值(SUV max)、纵隔淋巴结短径、糖类抗原153(CA153)与无转移组比较,差异有统计学意义(均P<0.05)。多因素分析示,SUV max≥3.46(OR=3.72,95%CI:0.95~14.55)、淋巴结短径≥7.55 mm(OR=13.49,95%CI:3.27~55.63)、CA153≥16.70 ng/mL(OR=5.09,95%CI:1.08~24.08)是NSCLC纵隔淋巴结转移的独立危险因素(P<0.05)。与淋巴结SUV max、淋巴结短径、CA153的AUC比较,Logistic模型AUC最高(AUC=0.84,95%CI:0.75~0.92),特异度、敏感度分别为79.1%和78.8%。结论:结合CA153、纵隔淋巴结短径及纵隔淋巴结SUV max建立的Logistic诊断模型,提高了对术前NSCLC纵隔淋巴结转移的诊断能力,具有较高的临床价值。

Objective:To assess the value of 18F-FDG PET/CT combined with tumor markers in the diagnosis of lymph node metastasis in patients with non-small cell lung cancer(NSCLC)before operation.Methods:The clinical data,pathological results and 18F-FDG PET/CT metabolic parameters of 81 patients with NSCLC were analyzed retrospectively.Multivariate Logistic regression analysis was used to screen the factors for the diagnosis of mediastinal lymph node metastasis,and a logistic regression model was established to diagnose mediastinal lymph node metastasis.Receiver operating characteristic(ROC)curve was used to compare the diagnostic effectiveness of each diagnostic factor according to the area under ROC curve(AUC).Results:There were significant difference in maximum standard uptake value(SUV max),short diameter of mediastinal lymph node,and carbohydrate antigen 153(CA153)between the mediastinal lymph node metastasis group and the non-metastasis group(P<0.05).Multivariate Logistic regression analysis showed that the SUV max≥3.46 of mediastinal lymph node(OR=3.72,95%CI:0.95-14.55),short diameter≥7.55 mm of mediastinal lymph node(OR=13.49,95%CI:3.27-55.63),and CA153≥16.70 ng/mL(OR=5.09,95%CI:1.08-24.08)were the risk factors for mediastinal lymph node metastasis(P<0.05).ROC curve showed that compared with the AUC value of SUV max,short diameter and CA153,the AUC value of Logistic model was the largest(AUC=0.84),and its specificity and sensitivity were 79.1%and 78.8%,respectively.Conclusion:The Logistic diagnosis model established by combining CA153 with short diameter and SUV max of mediastinal lymph node improves the diagnostic efficacy of preoperative NSCLC mediastinal lymph node metastasis and it has high clinical value.