18F-FDG PET/CT对血清乳酸脱氢酶正常的小细胞肺癌预后的预测价值  

Value of 18 F-FDG PET/CT for prognosis evaluation in small cell lung cancer with normal serum lac-tate dehydrogenase

作　　者：林晓平[1] 胡莹莹[1] 张旭[1] 梁培炎[1] 樊卫[1] Lin Xiaoping Hu Yingying Zhang Xu Liang Peiyan Fan Wei(Department of Nuclear Medicine, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China)

机构地区：[1]中山大学肿瘤防治中心核医学科,广州510060

出　　处：《中华核医学与分子影像杂志》2017年第10期601-606,共6页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的 探讨18 F-FDG PET/CT显像预测初诊血清LDH正常的SCLC患者预后的价值.方法 回顾性分析2005年6月至2016年12月经病理确诊并进行18 F-FDG PET/CT全身显像的68例SCLC患者（男59例、女9例,中位年龄58.5岁）.记录患者一般特征信息,治疗前同期LDH、NSE、OS、PFS及原发灶SUVmax等.组间SUVmax差异用Mann-Whitney u检验分析.利用寿命表法和Kaplan-Meier法估计生存率和中位生存时间,并绘制生存曲线,用log-rank法分析各组因素反映在生存时间上的差异是否具有统计学意义,利用Cox回归模型筛选预后影响因素.结果 （1）68例患者分期如下：按VALG分期,局限期38例,广泛期30例;按TNM分期,Ⅰ期3例,Ⅱ期7例,Ⅲ期29例,Ⅳ期29例.68例治疗前原发灶SUVmax为11.35（9.90,13.90）,其中局限期组为11.05（9.72,13.60）,广泛期组为12.25（10.05,14.12）,两者差异无统计学意义（z=-0.797,P=0.426）.68例同期血清LDH为195.15（171.00,220.80）U/L.（2）中位随访时间为18（范围：2~101）个月,疾病进展46例,死亡35例.中位OS为23（95%CI：13.3~32.7）个月,中位PFS为17（95%CI：11.4~22.6）个月.（3）根据ROC曲线,原发灶SUVmax最佳阈值为10.85,低者25例,高者43例,2组中位OS分别为40.0（95%CI：2.5~77.5）个月和18.0（95%CI：13.3~22.7）个月（χ2=8.956,P=0.003）.（4）体质量减轻、VALG分期及原发灶SUVmax是否大于10.85均为OS独立预后因素（均P〈0.05）.VALG分期为PFS独立预后因素（P〈0.001）.结论 18 F-FDG PET/CT有助于区分血清LDH正常的初诊SCLC患者的不同预后,可为个体化治疗方案的选择提供更多依据.Objective To evaluate the value of 18 F-FDG PET/CT imaging in predicting the progno-sis of newly diagnosed SCLC with normal serum LDH （ SCLC-nsLDH） . Methods A total of 68 SCLC pa-tients （59 males, 9 females, median age：58.5 years） proved by pathology between June 2005 and Decem-ber 2016 were retrospectively analyzed. All patients underwent 18 F-FDG PET/CT. The general information of patients, including LDH, NSE, OS, PFS and SUVmax , were recorded. SUVmax differences were analyzed with Mann-Whitney u test. Life-table method and Kaplan-Meier analysis were used to estimate the survival rate and median survival time. The survival function curve was drawn. Log-rank test was used to analyze whether there existed statistical differences in survival period among different groups. Cox regression analysis was used for screening the influencing factors of prognosis. Results （ 1） In 68 SCLC patients, there were 38 cases with limited disease （ LD） and 30 cases with extensive disease （ ED） . There were 3 cases in stageⅠ, 7 cases in stage Ⅱ, 29 cases in stage Ⅲ, 29 cases in stage Ⅳ. The median SUVmax of the primary tumor was 11.35 （9.90, 13.90）. There was no significant difference between the median SUVmax of LD group and that of ED group：11.05（9.72, 13.60） vs 12.25（10. 05, 14.12）months;z=-0.797, P=0.426. The median serum LDH was 195.15（171.00, 220.80） U/L. （2） The median follow-up time was 18（range：2-101） months. The disease developed in 46 patients and 35 patients died. The median OS was 23 （95%CI：13.3-32.7） months and median PFS was 17 （95% CI： 11.4-22.6） months. （3） ROC curve showed the optimal SUVmax cutoff value was 10.85. The OS of patients with SUVmax≤10.85 （ n=25） and with SUVmax〉10.85 （n=43） were 40.0（95% CI：2.5-77.5） months and 18.0（95% CI：13.3-22.7） months（χ2=8.956, P=0.003）, respectively. （4）Weight loss, VALG stage and primary tumor SUVmax were independent prog-nostic factors for OS （all P〈0.05）. Only V

关 键 词：小细胞肺癌 预后 乳酸脱氢酶类 正电子发射断层显像术 体层摄影术 X线计算机 脱氧葡萄糖 

分 类 号：R730.44[医药卫生—肿瘤] R734.2[医药卫生—临床医学]