^(18)F-脱氧葡萄糖正电子发射计算机断层扫描显像在预测肺鳞癌表皮生长因子受体突变中的价值

Value of ^(18)F-FDG PET-CT imaging to predict epidermal growth factor receptor mutations in patients with lung squamous cell carcinoma

目的探讨^(18)F-脱氧葡萄糖(^(18)F-FDG)正电子发射计算机断层扫描(PET-CT)显像在预测肺鳞癌表皮生长因子受体(EGFR)突变中的价值。方法回顾性分析2013年6月至2018年10月就诊于南京医科大学第一附属医院、经病理诊断的206例肺鳞癌患者的^(18)F-FDG PET-CT显像资料和临床资料,206例患者均行EGFR检测。采用受试者工作特征(ROC)曲线获得最大标准摄取值(SUV_(max))、代谢体积(MTV)和糖酵解总量(TLG)预测EGFR突变的最佳临界值,采用logistic回归模型进行多因素分析。结果206例肺鳞癌患者的^(18)F-FDG PET-CT显像均表现为^(18)F-FDG高摄取,SUV_(max)、MTV和TLG中位数分别为19.14、37.69 cm^(3)和291.73。206例肺鳞癌患者中,EGFR突变14例,其中第21外显子(L858R)突变7例,第19外显子突变6例,第20外显子突变1例。ROC曲线分析显示,SUV_(max)的ROC曲线下面积(AUC)为0.624(95%CI为0.454~0.794,P=0.122),MTV的AUC为0.892(95%CI为0.811~0.973,P<0.001),TLG的AUC为0.860(95%CI为0.768~0.952,P<0.001)。由于SUV_(max)的AUC较小,ROC曲线无法获得最佳临界值,以其中位数19.14作为临界值;MTV的临界值为20.09 cm^(3);TLG的临界值为211.07。单因素分析结果显示,性别、吸烟史、M分期、MTV、TLG均与肺鳞癌EGFR突变有关(均P<0.05)。logistic多因素分析结果显示,性别、吸烟史和TLG为预测肺鳞癌EGFR突变的独立影响因素(均P<0.05)。结论18F-FDG PET-CT测得的TLG是预测肺鳞癌EGFR突变的独立影响因素,且在预测EGFR突变中具有一定的参考价值。

Objective To investigate the value of ^(18)F-fluorodeoxy glucose(^(18)F-FDG)positron emission tomography/computed tomography(PET-CT)in predicting the epidermal growth factor receptor(EGFR)mutations in patients with lung squamous cell carcinoma.Methods We retrospectively analyzed the clinical data and ^(18)F-FDG PET-CT imaging data of 206 patients with lung squamous cell carcinoma confirmed by pathology and underwent EGFR mutation test in the First Affiliated Hospital of Nanjing Medical University from June 2013 to October 2018.Receiver operating characteristic(ROC)curve analysis was performed to quantify the predictive value of maximum standard uptake value(SUV_(max)),metabolic tumor volume(MTV),total lesion glycolysis(TLG).The Chi-squared test was used to assess the difference in PET parameters.A multivariate Logistic regression analysis was performed to yield the parameters with statistic difference.Results All of 206 patients with lung squamous cell carcinoma showed a high ^(18)F-FDG uptake.The median of SUV_(max),MTV and TLG were 19.14,37.69 cm^(3) and 291.73,respectively.Among the 206 patients,EGFR mutations were identified in 14 cases,including 7 with exon 21(L858R)mutation,6 with exon 19 mutation and 1 with exon 20 mutation.ROC curve showed that the AUC of SUV_(max),MTV and TLG were 0.624(95%CI=0.454-0.794,P=0.122),0.892(95%CI=0.811-0.973,P<0.001)and 0.860(95%CI=0.768-0.952,P<0.001),respectively.The median SUVmax(19.14)was used as the cutoff points due to the small value of AUC.The cutoff point of MTV was 20.09 cm^(3),the cutoff point of TLG was 211.07.Univariate analysis showed that the sex,smoking history,M stage,MTV and TLG were associated with EGFR mutations(all P<0.05).Logistic multivariate analysis showed that the sex,smoking history and TLG were the independent predictors of EGFR mutation(all P<0.05).Conclusion TLG detected by ^(18)F-FDG PET/CT is an independent factor for predicting EGFR mutation in patients with lung squamous cell carcinoma,and has certain reference value for predicting EGFR mutation.