^(18)F-FDG PET/CT体积代谢参数在局限期小细胞肺癌预后的预测价值  

Value of ^(18)F-FDG PET/CT with Volume Metabolic Parameters for Prognosis Evaluation in Limited-Disease Small Cell Lung Cancer

作　　者：林晓平[1] 樊卫[1] 梁培炎[1] 胡莹莹[1] 张旭[1] LIN Xiao-ping FAN Wei LIANG Pei-yan HU Ying-ying ZHANG Xu(Nuclear Medicine Department, State Key Laboratory of Oncology in South China//Sun Yat-sen University Cancer Center, Guangzhou, 510060, China)

机构地区：[1]华南肿瘤学国家重点实验室//中山大学肿瘤防治中心核医学科,广东广州510060

出　　处：《中山大学学报（医学科学版）》2017年第5期765-773,共9页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省食管癌研究所科技计划青年项目(Q201603)

摘　　要：【目的】探讨治疗前^(18)F-FDG PET/CT不同代谢参数对局限期小细胞肺癌(SCLC)预后的预测价值。【方法】回顾性分析2005年6月至2016年12月在我院经病理或细胞学、全面影像学检查确诊的局限期SCLC,在治疗前4周进行^(18)FFDG PET/CT全身显像的54例患者纳入本研究。记录患者一般特征信息,治疗前KPS评分,吸烟史,发病时是否体重减轻,治疗前同期LDH、NSE、OS和PFS。采用固定阈值法系统自动勾画病灶(原发灶+转移灶),所有病灶(原发灶+转移灶)勾画在1个VOI内,自动测量及记录该VOI内的SUV_(max)、SUV_(mean)及SUV_(peak),自动测量并记录病灶固定阈值为SUV_(max)的40%及50%的TLG及MTV,分别命名为TLG40%、TLG50%、MTV40%、MTV50%。采用Kaplan-Meier法进行生存分析比较,Cox模型分析预后因素。【结果】本组^(18)F-FDG代谢参数结果:pSUV_(max)中位数为11.4(1.7~24.6),SUV_(max)中位数为13.92(2.61~43.28),SUV_(mean)中位数为8.31(1.71~26.85),SUV_(peak)中位数为10.51(1.49~27.48)。TLG40%中位数340.22(16.58~2 827.26)、TLG50%中位数为215.645(1.70~2 270.36)、MTV40%中位数36.71(1.15~259.47)cm3、MTV50%中位数为19.65(0.93~1 900.00)cm3。局限期SCLC患者预后单因素及多因素分析结果显示:TLG50%是OS的独立预后因素(P=0.013),但不是PFS预后影响因素(P>0.05)。pSUV_(max)、SUV_(max)、SUV_(mean)、SUV_(peak)均不是OS及PFS预后影响因素(P>0.05)。【结论】体积代谢参数TLG50%是LD期SCLC总生存时间的独立预后因素。^(18)F-FDG PET/CT体积代谢参数(TLG及MTV)与局限期SCLC预后有关,可为临床医生个体化治疗提供依据。【Objective】To investigate the prognostic value of ^18F-FDG PET/CT with different metabolic parameters in newly diagnosed limited-disease（LD）small cell lung cancer（SCLC）.【Methods】Retrospective analysis was carried out in the patients between June 2005 to December 2016 in our hospital confirmed of LD SCLC by pathology or cytology and comprehensive imaging.Fifty-four patients were recruited. Record the general characteristics of patients,pre-treatment KPS score,smoking status,weight loss,serum LDH,NSE,OS,PFS. All lesions（primary lesions ＋ metastases）were sketched out within one VOI,and the SUVmax,SUVmean and SUVpeak in the VOI were automatically measured and recorded. The automatic measurement was performed by the fixed threshold method. The thresholds of tumor of MTV and TLG were 40% and 50% of SUVmax. The TLG and MTV were identified as TLG40%,TLG50%,MTV40% and MTV50% respectively. Kaplan-Meier method was used for survival analysis. All the prognostic factors were analyzed by Cox model.【Result】The median SUVmax was 13.92（2.61 ~ 43.28）,the median of SUVmean was 8.31（1.71 ~ 26.85）and the median of SUVpeak was 10.51（1.49 ~ 27.48）. The median of TLG40% was 340.22（16.58 ~ 2 827.26）,the median of TLG50%was 215.645（1.70 ~ 2 270.36）,the median of MTV40% was 36.71（1.15 ~ 259.47 cm^3）,the median of MTV50% was 19.65（0.93 ~1900.00）cm^3. Univariate and multivariate analysis of metabolic index and prognosis showed that TLG50% was the prognostic factor of OS（P = 0.013）,but not of PFS（P〈0.05）. The SUVmax,SUVmean and SUVpeak were not the prognostic factors of OS and PFS（P〈0.05）.【Conclusion】The volume metabolic parameters TLG50% was the independent prognostic factor of the overall survival time of the LD SCLC. The volume metabolic parameters（TLG and MTV）of ^18F-FDG PET/CT were related to the prognosis of SCLC,which could provide the basis for individual chemotherapy.

关 键 词：小细胞肺癌 局限期 ^18F-FDG PET/CT 预后 SUV TLG MTV 

分 类 号：R814[医药卫生—影像医学与核医学]