PET/CT标准摄取值与Ⅲ期非小细胞肺癌西妥昔单抗联合同期放化疗预后相关性的研究  

Prognostic value of SUVmax for locally advanced non-small cell lung cancer patients treated with synchronous cetuximab plus concurrent chemoradiotherapy

作　　者：刘笛[1] 陈佳艳[1,2] 沈钰新[1] 赵伟新[1] 傅小龙[1] 蒋国樑[1] 樊旼[1] 

机构地区：[1]复旦大学附属肿瘤医院放疗科,复旦大学上海医学院肿瘤学系,上海200032 [2]南京医科大学附属南京第一医院放疗科,江苏南京210006

出　　处：《中国癌症杂志》2014年第3期225-230,共6页China Oncology

基　　金：卫生部临床学科重点项目(No:卫规财函[2010]439号)

摘　　要：背景与目的:PET/CT在非小细胞肺癌(non-small cell lung cancer,NSCLC)的预后判断中有重要价值,但单独针对Ⅲ期且接受靶向治疗患者的研究较少。本研究旨在探讨在这些患者中18F氟代脱氧葡萄糖(18F-fluorodeoxyghcose,18F-FDG)PET/CT基线标准摄取值(standard uptake value,SUV)与预后的相关性。方法:前瞻性分析复旦大学附属肿瘤医院放疗科2009年9月—2012年7月入组的17例接受西妥昔单抗(cetuximab,C225)联合顺铂+长春瑞宾(NP方案)诱导化疗及同期放化疗的患者,入组前两周内完成PET/CT检查。采用Cox回归风险比例模型对SUV-T、SUV-N、SUV-TOTAL、性别、年龄、组织学类型、TNM分期、功能状态评分(performance status,PS)、吸烟状态与患者生存时间进行单因素生存分析,差异有统计学意义者进行多因素生存分析。Log-rank检验及Kaplan-Meier法分别评估以SUV-T、SUV-N、SUV-TOTAL界值分组患者间生存期的差异并绘制生存曲线。结果:单因素预后分析提示,上述SUVmax、PS评分、吸烟状态与预后相关,其中SUV-T及SUV-N的界值是11、SUV-TOTAL为20。多因素分析结果显示,SUV-TOTAL(P=0.012)、SUV-T(P=0.025)、SUVN(P=0.033)是影响本组患者生存的独立预后因素,其中SUV-TOTAL>20组患者的相对危险度(hazard ratio,HR)为14.7。结论:对于C225联合同步放化疗的患者,PET/CT局部区域、原发灶及纵隔淋巴结SUV值与预后有一定相关性,值得进一步大样本研究。将3者结合起来,可指导该治疗的合理应用。Background and purpose： We investigated whether fluorine-18 fluorodeoxyglucose （l8F-FDG） maximal standard uptake value （SUVm~） of the primary tumor （SUV-T）, SUVmax of the regional lymph nodes （SUV-N） or the overall loco-regional lesion SUVmax （SUV-TOTAL） was related to survival of patients with stage Ⅲ non- small cell lung cancer （NSCLC） who received Cetuximab and combined definitive chemoradiotherpay. Methods： From September 2009 to July 2012, seventeen patients with unresectable stage W NSCLC receiving cetuximab with cisplatin/vinorelbine （NP） followed by concomitant NP and intensity-modulated radiotherapy （IMRT） at the Fudan University Shanghai Cancer Center were enrolled onto a prospectively study. All patients received positron emission tomography/computerized tomography （PET/CT） scans within 2 weeks before enrolment. Univariate analysis were used to assess the correlation between SUV-T, SUV-N, SUV-TOTAL, gender, age, histology, tumonr-node-metastasis（TNM） stage, performance status （PS） as well as smoking status and survival. The factors which showed statistical significance entered into multivariate Cox-regression model. Survival functions of different populations were estimated by Kaplan-Meier method and compared by Log-rank test. Results： In the univariate analysis, SUV-T, SUV-N, SUV- TOTAL, PS and smoking status were prognostic factors. The best cut-off values for SUV-T, SUV-N and SUV-TOTAL were 11, 11 and 20, respectively. Multivariate analysis revealed that SUV-TOTAL （P=0.012）, SUV-T （P=0.025）, and SUV-N （P=0.033） were independent predictors of survival with hazard ratio （HR） of 14.7, 11.2, and 6.2, respectively. Conclusion： Local, regional and locoregional maximal SUVs defined by 18F-FDG PET-CT scanning may have a strong correlation with survival in this patients setting, which merits further study.

关 键 词：非小细胞肺癌 PET CT 标准摄取值 预后 

分 类 号：R734.2[医药卫生—肿瘤]