^(18)F-FDG PET/CT显像联合血清鳞状细胞癌抗原对非小细胞肺癌患者预后的评估价值

The evaluation value of^(18)F-FDG PET/CT imaging combined with serum SCCA in the prognosis of patients with non-small cell lung cancer

目的分析^(18)F-脱氧葡萄糖(^(18)F-FDG)PET/CT显像联合血清鳞状细胞癌抗原(SCCA)对非小细胞肺癌(NSCLC)患者预后的评估价值。方法选取2014年1月至2019年3月内蒙古自治区人民医院收治的NSCLC患者126例。所有患者术前均进行全身PET/CT显像检查,并测定^(18)F-FDG PET/CT显像的最大标准化摄取值(SUV_(max)),采用酶联免疫吸附法检测血清SCCA水平,分析SUV_(max)、SCCA与NSCLC患者临床病理特征的关系;采用Kaplan-Meier法评估NSCLC患者生存情况,采用多因素Cox回归分析影响NSCLC患者预后的相关因素。结果126例NSCLC患者原发灶SUV_(max)为8.45~42.05,中位数为12.60,以中位数为截点将126例患者分为高值组(SUV_(max)>12.60,n=63)与低值组(SUV_(max)≤12.60,n=63)。经受试者工作特征(ROC)曲线确定血清SCCA最佳截断值为1.85 ng/ml,据此将126例患者分为高SCCA组(SCCA>1.85μg/L,n=48)与低SCCA组(SCCA≤1.85μg/L,n=78)。NSCLC患者SUV_(max)值、SCCA水平与TNM分期、分化程度、肿瘤最大直径相关(P<0.05)。126例NSCLC患者3年无病生存率为61.90%(78/126),高SCCA组、SUV_(max)高值组的3年无病生存率分别低于低SCCA组及低值组(37.50%vs.76.92%,42.86%vs.80.95%,均P<0.05),41例SUV_(max)联合血清SCCA均异常(SUV_(max)>12.60且SCCA>1.85μg/L)患者3年无病生存率为36.58%(15/41)。NSCLC患者3年无病生存率与TNM分期、血清SCCA、SUV_(max)、SUV_(max)联合血清SCCA密切相关(P<0.05)。多因素Cox回归分析得出,TNMⅢ期、SCCA>1.85μg/L、SUV_(max)>12.60、SUV_(max)联合血清SCCA均异常是影响NSCLC患者预后的独立危险因素(P<0.05)。结论^(18)F-FDG PET/CT显像SUV_(max)、血清SCCA与NSCLC患者预后密切相关,二者均是影响患者预后的独立危险因素,SUV_(max)联合血清SCCA评估NSCLC患者预后的临床价值更高,可考虑将二者联合作为评估NSCLC患者预后的参考指标。

Objective To investigate the evaluation value of^(18)F-FDG PET/CT imaging combined with serum SCCA in the prognosis of patients with non-small cell lung cancer.Methods A total of 126 patients with NSCLC who were confirmed by surgical and pathological examinations in People's Hospital of Inner Mongolia Autonomous Region from January 2014 to March 2019 were selected.All patients underwent whole body PET/CT imaging examination before operation,and the_(max)imum standardized uptake value(SUV_(max))of^(18)F-FDG PET/CT imaging was determined.Serum SCCA levels were detected by enzyme-linked immunosorbent assay.The relationship between SUV_(max),SCCA and clinicopathological characteristics of NSCLC was analyzed.Kaplan-Meier method was used to estimate the survival of NSCLC patients,and univariate and multivariate Cox regression analysis was used to explore the related factors affecting the prognosis of NSCLC.Results The SUV_(max)of 126 NSCLC patients with primary tumor ranged from 8.45 to 42.05,with a median of 12.60,and 126 NSCLC patients were divided into the high-value group(SUV_(max)>12.60,n=63)and the low-value group(SUV_(max)≤12.60,n=63).The optimal cut-off value of serum SCCA was determined by operating characteristic curve(ROC)to be 1.85μg/L.According to the cut-off value,the 126 NSCLC patients were divided into high SCCA group(SCCA>1.85μg/L,n=48)and low SCCA group(SCCA≤1.85μg/L,n=78).The SUV_(max)value and SCCA level of NSCLC patients were correlated with TNM stage,degree of differentiation,and_(max)imum tumor diameter(P<0.05).The 3-year disease-free survival rate of 126 NSCLC patients was 61.90%(78/126),and the 3-year disease-free survival rates of the high SCCA group(SCCA>1.85μg/L)and the high SUV_(max)group(SUV_(max)>12.60)were lower than those of the low SCCA group(SCCA≤1.85μg/L)and low SUV_(max)group(SUV_(max)≤12.60)(37.50%vs.76.92%,42.86%vs.80.95%,all P<0.05),and the 3-year disease-free survival rate of 41 patients with SUV_(max)combined with serum SCCA were abnormal(SUV_(max)>12.60 and SCCA>1.85μg/L)was 36.58%(15/41).Univariate analysis showed that the 3-year disease-free survival rate of NSCLC patients was closely related to TNM stage,serum SCCA,SUV_(max),SUV_(max)combined with serum SCCA(P<0.05).Multivariate Cox regression analysis showed that TNM stageⅢ,SCCA>1.85μg/L,SUV_(max)>12.60,and SUV_(max)combined with abnormal serum SCCA(SUV_(max)>12.60 and SCCA>1.85μg/L)were all independent risk factors affecting the prognosis of NSCLC patients(P<0.05).Conclusions^(18)F-FDG PET/CT imaging SUV_(max)and serum SCCA are closely related to the prognosis of NSCLC patients,both of which are independent risk factors affecting the prognosis of patients.SUV_(max)combined with serum SCCA has higher clinical value in evaluating the prognosis of NSCLC patients,so the combination of the two can be considered as a reference index for evaluating the prognosis of NSCLC patients.