^(18)F-FDGPET/CT半定量参数预测肺腺癌患者EGFR突变的价值

Value of ^(18)F-FDG PET/CT semi-quantitative parameters for predicting EGFR mutations in pulmonary adenocarcinoma

目的评价氟代脱氧葡萄糖(^(18)F-FDG)正电子发射型计算机断层显像(PET)/CT半定量参数预测肺腺癌患者表皮生长因子受体(EGFR)突变的价值。方法选取2016年12月至2020年12月在中国科学院大学附属肿瘤医院接受EGFR突变检测并行PET/CT检查的肺腺癌患者218例,采用EGFR基因检测试剂盒行EGFR突变检测。分析EGFR突变与患者临床特征、^(18)F-FDG PET/CT半定量参数[原发肿瘤最大标准化摄取值(SUV_(max))、代谢肿瘤体积(MTV)及糖酵解总量(TLG)]的关系。ROC曲线分析18F-FDG PET/CT半定量参数预测EGFR突变的诊断价值。结果218例患者中,EGFR突变型121例(55.5%),EGFR野生型97例(44.5%)。EGFR突变型患者女性比例、无吸烟史比例、Ⅳ期所占比例、远处转移发生率均高于EGFR野生型患者,而肿瘤直径、SUV_(max)、MTV和TLG均低于EGFR野生型患者,差异均有统计学意义(均P<0.05)。二元logistic回归分析显示有远处转移、SUV_(max)<12.6均是影响EGFR突变的独立预测因素(均P<0.05)。ROC曲线分析显示SUV_(max)、MTV和TLG的AUC分别为0.632、0.607和0.642。结论原发灶有远处转移、SUV_(max)<12.6与肺腺癌患者EGFR突变有关。PET代谢显像可能成为评估肺腺癌患者分子特征的有力辅助工具。

Objective To assess the value of ^(18)F-FDG PET/CT semi-quantitative parameters for predicting EGFR mutation status in pulmonary adenocarcinoma.Methods Two hundred and eighteen patients with pulmonary adenocarcinoma admitted in Cancer Hospital of the University of Chinese Academy of Sciences from December 2016 to December 2020 were enrolled in the study.Patients underwent pre-therapy diagnostic ^(18)F-FDG PET/CT scans and were tested for EGFR mutation on biopsy or surgical specimens by EGFR gene detection kit.The ^(18)F-FDG PET/CT parameters,including the maximum standardized uptake value(SUV_(max))of the primary tumor,metabolic tumor volume(MTV)and total lesion glycolysis(TLG)were analyzed in different subgroups of patients.The ROC curve analysis and a multivariate analysis were performed to identify the value of ^(18)F-FDG PET/CT for predicting EGFR mutation.Results Among 218 patients,EGFR mutation was identified in 121 patients(55.5%)and EGFR wild type was identified in 97 patients(44.5%).The proportion of women,no smoking history,stage Ⅳ and distant metastasis in patients with EGFR mutation were higher than those in patients with EGFR wild type,while the tumor diameter,SUV_(max),MTV and TLG were lower than those in patients with EGFR wild type(all P<0.05).Logistic regression analysis demonstrated that distant metastasis and SUV_(max)<12.6 were predictors of EGFR mutations(both P<0.05).The AUC values of low SUV_(max),MTV and TLG for predicting EGFR mutations were 0.632,0.607 and 0.642,respectively.Conclusion Distant metastasis and SUV_(max)<12.6 are associated with mutant EGFR status.PET metabolic imaging may be a useful complementary tool for assessing the molecular profile in patients with pulmonary adenocarcinoma.