^(18)F-FDG PET/CT原发灶代谢参数对肺腺癌临床分期的预测价值

Value of^(18)F-FDG PET/CT metabolic parameters of the primary tumor for predicting clinical stage in lung adenocarcinoma

目的:探讨基于^(18)F-脱氧葡萄糖(FDG)PET/CT代谢参数对肺腺癌临床分期的预测价值。方法:回顾性分析经病理确诊的86例肺腺癌患者的临床和影像资料。86例中早期组54例,进展期组32例。测量原发灶最大径、最大标准化摄取值(SUV_(max))、平均标准摄取值(SUV_(mean)),以相对阈值法(40%为阈值)测量肿瘤代谢体积(MTV)及糖酵解总量(TLG)。采用单因素及多因素logistic回归分析对进展期肺腺癌的危险因素进行分析,并生成相应的预测模型。通过ROC曲线分析各参数及模型预测进展期肺腺癌的价值。结果:进展期组中央型肺癌、有肺癌相关症状、血清癌胚抗原(CEA)≥5.00μg/L的构成比,以及原发灶最大径、SUV_(max)、MTV、TLG均大于早期组,差异均有统计学意义(均P<0.01)。多因素分析显示,有肺癌相关症状、血清CEA≥5.00μg/L、SUV_(max)均为进展期肺腺癌的独立危险因素(均P<0.01)。ROC曲线分析显示,各代谢参数对进展期肺腺癌均有良好的预测效能,其中以TLG的AUC最大,达0.782,最佳界值为14.27 g,敏感度为90.6%,特异度为61.1%。logistic回归模型诊断进展期肺腺癌的AUC为0.854(95%CI 0.773~0.934),敏感度、特异度和准确率分别为78.1%、79.6%和79.0%。结论:^(18)F-FDG PET/CT原发灶代谢参数对进展期肺腺癌具有良好的预测效能,联合临床特征能提高对肺腺癌临床分期的诊断效能,为临床提供指导。

Objective:To investigate the value of^(18)F-FDG PET/CT metabolic parameters of the primary tumor for predicting clinical stage in lung adenocarcinoma.Methods:The clinical and imaging data of 86 patients with lung adenocarcinoma were retrospectively analyzed.86 cases were divided into the early-stage group(54 cases)and the advanced-stage group(32 cases).The maximum diameter,SUV_(max),SUV_(mean)of the primary tumor were measured.Metabolic tumor volume(MTV)and total lesion glycolysis(TLG)were calculated by the relative threshold method(40%).The risk factors of advanced-stage lung cancer were determined through univariate and multivariate logistic regression analysis,and the prediction models were built.The ROC curve was used for the value of each parameter in predicting advanced-stage lung cancer.Results:The proportion of patients who had central primary lesions and symptoms,the proportion of CEA≥5.00 ng/mL,the maximum diameter,SUV_(max),MTV,TLG of the primary tumor in the advanced-stage group were significantly higher than those in early-stage group(all P<0.01).The multivariate analysis showed that symptoms,CEA≥5.00 ng/mL and SUV_(max)were the independent risk factors in advanced-stage adenocarcinoma(all P<0.01).ROC curve showed that all parameters had important values for the evaluation of advanced-stage adenocarcinoma.The best diagnostic efficiency was TLG with the AUC of 0.782,the optimal cut-off value of 14.27 g,the sensitivity of 90.6%and the specificity of 61.1%.The AUC of the logistic regression model in diagnosis of advanced-stage adenocarcinoma was 0.854(95%CI 0.773~0.934),with the sensitivity,specificity and accuracy of 78.1%,79.6%and 79.0%,respectively.Conclusions:^(18)F-FDG PET/CT metabolic parameters of the primary tumor have an important value in the prediction for advanced-stage adenocarcinoma.^(18)F-FDG PET/CT combined with clinical features can improve the diagnostic efficiency of clinical staging of lung cancer and provide more accurate guidance for clinic.