晚期非小细胞肺癌EGFR突变与^(18)F-FDG PET/CT代谢参数的相关性及其对预后评估的影响  

Correlation of EGFR mutation status with metabolic parameters on ^(18)F-FDG PET/CT in patients with advanced non-small cell lung cancer and its influence on prognosis

作　　者：廖恺 程刚[1] 黄颖[1] Kai Liao;Gang Cheng;Ying Huang(Department of Nuclear Medicine,The First Affiliated Hospital of Chongqing Medical University,Chongqing 40016,China)

机构地区：[1]重庆医科大学附属第一医院核医学科,重庆市400016

出　　处：《中国肿瘤临床》2021年第2期66-72,共7页Chinese Journal of Clinical Oncology

摘　　要：目的:探讨晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者^(18)F-FDG PET/CT代谢参数及临床资料与表皮生长因子受体(epidermal growth factor receptor,EGFR)基因突变状态的相关性。同时探究EGFR基因突变状态对PET/CT代谢参数评估晚期NSCLC患者预后的影响。方法:回顾性分析2017年1月至2018年12月在重庆医科大学附属第一医院接受18F-FDG PET/CT检查并有EGFR基因突变检测结果的109例晚期NSCLC患者。根据患者EGFR基因检测结果分为EGFR突变型组(n=48)与EGFR野生型组(n=61),比较两组间PET/CT代谢参数及临床信息的差异并分析其与EGFR突变状态的关系。随访患者的无进展生存(progression free survival,PFS)状态,分析EGFR突变状态对PET/CT代谢参数评估PFS的影响。结果:多因素Logistic分析发现,女性(OR=12.154,P<0.001)、腺癌(OR=4.822,P=0.019)、低最大标准摄取值(maximum standardized uptake value,SUVmax)(≤9.58,OR=4.347,P=0.005)是EGFR突变的独立预测因子。ROC生存曲线分析肿瘤代谢体积(metabolic tumor volume,MTV)(AUC=0.749,P=0.0002),糖酵解总量(total lesion glycolysis,TLG)(AUC=0.747,P=0.0003)对患者的PFS状态具有预测价值。Cox回归分析发现,在EGFR基因突变型组中,MTV>14.85的患者疾病进展风险更高(HR=2.724,P=0.004);EGFR野生型组中,MTV>12.48的患者疾病进展风险更高(HR=3.195,P=0.002)。结论:对于晚期NSCLC患者,EGFR突变与更低的FDG摄取相关,体积代谢参数具有重要的预后预测价值,但对于EGFR基因突变不同状态,可以考虑不同的标准。Objective:To assess the correlation between metabolic parameters on ^(18)F-fluorodeoxyglucose positron emission tomography/computed tomography(^(18)F-FDG PET/CT)and the mutation status of the epidermal growth factor receptor(EGFR)gene in patients with advanced non-small-cell lung cancer(NSCLC)and to investigate the effect of EGFR mutation status on assessment of the prognosis based on metabolic parameters.Methods:A total of 109 patients with advanced NSCLC who underwent both ^(18)F-FDG PET/CT and EGFR mutation status evaluation at The First Affiliated Hospital of Chongqing Medical University between January 2017 and December 2018 were retrospectively analyzed.The patients were assigned into the EGFR mutant and EGFR wild-type groups according to their EGFR mutation status.Metabolic parameters and clinical information were compared between the two groups,and their relationship with EGFR mutation status were analyzed.The progression-free survival(PFS)of these patients was record to analyze the influence of EGFRmutation status on prognosis,as predicted using ^(18)F-FDG PET/CT findings.Results:Multivariate Logistic analysis demonstrated that female sex(OR=12.154,P<0.001),adenocarcinoma(OR=4.822,P=0.019),and a maximum standardized uptake value(SUVmax)≤9.58(OR=4.347,P=0.005)were correlated with the presence of EGFR mutations.The receiver operating characteristic curves of PFS illustrated that metabolic tumor volume(MTV)(AUC=0.749,P=0.0002)and total lesion glycolysis(TLG)(AUC=0.747,P=0.0003)could be used to evaluate the prognosis of NSCLC patients.According to the results of Cox regression analysis,patients with an MTV>14.85(HR=2.724,P=0.004)in the EGFR mutant group and patients with an MTV>12.48(HR=3.195,P=0.002)in the EGFR wild-type group had a higher risk of disease progression.Conclusions:EGFR mutations in advanced NSCLC patients are associated with low ^(18)F-FDG uptake,and volumetric parameters are of great significance in the prediction of prognosis.However,different evaluation criteria using ^(18)F-FDG PET/CT p

关 键 词：正电子发射计算机断层显像 非小细胞肺癌 表皮生长因子受体 

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