基线^(18)F-FDG PET/CT图像参数对非小细胞肺癌患者治疗后远处转移的预测价值研究

Predictive Value of Pre-treatment^(18)F-FDG PET/CT for Post-treatment Distant Metastasis in Patients with Non-Small Cell Lung Cancer

目的:本研究旨在探讨非小细胞肺癌(non-small cell lung cancer,NSCLC)患者治疗前^(18)F-FDG PET/CT原发灶图像参数及临床资料对治疗后新发远处转移的预测价值,为NSCLC患者的临床治疗和随访模式提供参考。方法:回顾性分析2015年4月至2021年7月在四川省肿瘤医院行^(18)F-FDG PET/CT检查并经病理证实为NSCLC的患者118例,初诊时均未发现确切的远处转移。采用单因素及多因素COX回归分析PET代谢参数、CT影像特征、临床资料并确定预测远处转移的因素并计算最佳截断值。结果:118例患者中,21例患者在治疗后两年内出现了不同部位的远处转移,包括8例脑、7例骨、4例肾上腺、4例肺及肝脏、心包及远处淋巴结各1例。单因素分析显示临床资料中治疗方案、TNM分期及有无淋巴结转移与远处转移相关(P<0.05),^(18)F-FDG PET/CT原发灶代谢参数[最大标准化摄取值(maximum standardized uptake value,SUV_(max))、肿瘤代谢体积及病变糖酵解总量]及CT影像特征肿瘤最大径(D_(max))与远处转移相关(P<0.001),但多因素COX回归分析示仅有SUV_(max)是NSCLC患者治疗后短期内新发远处转移的独立预后因素(P=0.018),最佳截断值为10.249(AUC=0.811,P<0.001)。结论:基线^(18)F-FDG PET/CT代谢参数SUV_(max)是预测NSCLC患者治疗后两年内新发远处转移的独立预后因素,对指导临床治疗和随访有一定的参考价值。

Objective:This study aimed to investigate the predictive value of pre-treatment^(18)F-FDG PET/CT for new distant me-tastases in patients with non-small cell lung cancer(NSCLC),and to provide a reference for the clinical treatment and follow-up pattern of NSCLC patients.Methods:The data from 118 patients with pathologically confirmed NSCLC who underwent^(18)F-FDG PET/CT at Sichuan Cancer Hospital from April 2015 to July 2021 were retrospectively analyzed,and none of these patients were found to have definite signs of distant metastasis at the time of initial diagnosis.PET metabolic parameters,CT imaging characteristics,and clinical data were analyzed using unifactorial and multifactorial COX regression to determine the factors predicting distant metastasis and calculate the optimal cut-off value.Results:During the two years of follow-up,a variety of distant metastases developed in 21 of 118 patients,including 8 brain metastases,7 bone metastases,4 adrenal metastases,4 lung metastases,1 liver metastases,1 pericardium metastases and 1 distant lymph node metastases.On univariate analysis,^(18)F-FDG PET/CT parameters(SUV_(max),MTV,TLG)and tumor maximum diameter(D_(max))showed significance in predicting distant metastasis(P<0.001),along with treatment,TNM stage,and presence of lymph node metastasis(P<0.05).However,multifactorial COX regression analysis showed that only maximum standardized uptake value(SUV_(max))was an independent prognostic factor for new distant metastasis within two years after treatment in NSCLC patients(P=0.018).The optimal cut-off value was 10.249(AUC=0.811,P<0.001).Conclusion:Pre-treatment measurement of SUV_(max) using^(18)F-FDG PET/CT is an independent prognostic factor for predicting new distant metastases within a short time in NSCLC patients,which may provide valuable guidance for clinical treatment decisions and follow-up strategies.