18F-脱氧葡萄糖正电子发射计算机断层扫描代谢参数与肺腺癌实性型和微乳头型组织学亚型的关系

The correlation between metabolic parameters in 18F-FDG PET-CT and solid and micropapillary histological subtypes in lung adenocarcinoma

目的探讨18F-脱氧葡萄糖(18F-FDG)正电子发射计算机断层扫描(PET-CT)代谢参数[原发病灶最大标准摄取值(SUVmax)、肿瘤代谢体积(MTV)、糖酵解总量(TLG)]与肺腺癌实性型和微乳头型组织学亚型的关系及预测效能。方法回顾性分析145例手术切除前行18F-FDG PET-CT检查肺腺癌患者的临床数据及影像资料。实性型和微乳头型亚型组与其他亚型组间各参数的比较采用Mann-WhitneyU检验, 采用受试者工作特征(ROC)曲线和曲线下面积(AUC)评估PET-CT各参数对实性型和微乳头型亚型成分的预测效能, 多因素分析采用logistic回归分析。结果全组145例患者中, 实性型和微乳头型亚型肺腺癌22例, 其他亚型123例。实性型和微乳头型亚型组患者的中位SUVmax和中位TLG分别为15.07和34.98, 高于其他亚型组(分别为6.03和10.16, 均P<0.05)。ROC曲线显示, SUVmax和TLG对预测实性型和微乳头型亚型效能较好[AUC分别为0.811(95%CI:0.715~0.907)和0.725(95%CI:0.610~0.840), 均P<0.05]。含有实性或微乳头型成分组患者的中位SUVmax和中位TLG分别为11.58和22.81, 高于不含实性和微乳头型成分组患者(分别为4.27和6.33, 均P<0.05)。ROC曲线分析结果显示, SUVmax和TLG对预测肺腺癌病灶存在实性型或微乳头型成分效能较好[AUC分别为0.757(95%CI:0.679~0.834)和0.681(95%CI:0.595~0.768), 均P<0.05]。多因素logistic回归分析显示, 临床分期(Ⅲ~Ⅳ期)、SUVmax≥10.27、TLG≥7.12是肺腺癌微乳头型或实性型成分存在的独立危险因素(均P<0.05)。结论肺腺癌原发灶的SUVmax和TLG对微乳头型和实性型组织学成分具有较好的预测效能, 尤其是在预测实性型和微乳头型为主型肺腺癌方面, 并且SUVmax和TLG是预测微乳头型或实性型成分存在的独立影响因素。

Objective Solid and micropapillary pattern are highly invasive histologic subtypes in lung adenocarcinoma and are associated with poor prognosis while the biopsy sample is not enough for the accurate histological diagnosis.This study aims to assess the correlation and predictive efficacy between metabolic parameters in 18F-fluorodeoxy glucose positron emission tomography/computed tomography(18F-FDG PET-CT),including the maximum SUV(SUVmax),metabolic tumor volume(MTV),total lesion glycolysis(TLG)and solid and micropapillary histological subtypes in lung adenocarcinoma.Methods A total of 145 resected lung adenocarcinomas were included.The clinical data and preoperative 18F-FDG PET-CT data were retrospectively analyzed.Mann-Whitney U test was used for the comparison of the metabolic parameters between solid and micropapillary subtype group and other subtypes group.Receiver operating characteristic(ROC)curve and areas under curve(AUC)were used for evaluating the prediction efficacy of metabolic parameters for solid or micropapillary patterns.Univariate and multivariate analyses were conducted to determine the prediction factors of the presence of solid or micropapillary subtypes.Results Median SUVmax and TLG in solid and papillary predominant subtypes group(15.07 and 34.98,respectively)were significantly higher than those in other subtypes predominant group(6.03 and 10.16,respectively,P<0.05).ROC curve revealed that SUVmax and TLG had good efficacy for prediction of solid and micropapillary predominant subtypes[AUC=0.811(95%CI:0.715~0.907)and 0.725(95%CI:0.610~0.840),P<0.05].Median SUVmax and TLG in lung adenocarcinoma with the solid or micropapillary patterns(11.58 and 22.81,respectively)were significantly higher than those in tumors without solid and micropapillary patterns(4.27 and 6.33,respectively,P<0.05).ROC curve revealed that SUVmax and TLG had good efficacy for predicting the presence of solid or micropapillary patterns[AUC=0.757(95%CI:0.679~0.834)and 0.681(95%CI:0.595~0.768),P<0.005].Multivariate logistic analysis showed that the clinical stage(StageⅢ-Ⅳ),SUVmax≥10.27 and TLG≥7.12 were the independent predictive factors of the presence of solid or micropapillary patterns(P<0.05).Conclusions Preoperative SUVmax and TLG of lung adenocarcinoma have good prediction efficacy for the presence of solid or micropapillary patterns,especially for the solid and micropapillary predominant subtypes and are independent factors of the presence of solid or micropapillary patterns.