全身PET/CT动态显像评估局部晚期NSCLC患者化疗联合免疫治疗后关键脏器的FDG动力学变化  

Kinetic metrics changes of FDG in key organs after chemo-immunotherapy in patients with locally advanced non-small cell lung cancer identified by total-body PET/CT dynamic imaging

作　　者：莫奕文 刘慧[2] 魏园 李新玲 李汝平 张旭[1] 樊卫[1] Mo Yiwen;Liu Hui;Wei Yuan;Li Xinling;Li Ruping;Zhang Xu;Fan Wei(Department of Nuclear Medicine,Sun Yat-sen University Cancer Center,State Key Laboratory of Oncology in South China,Collaborative Innovation Center for Cancer Medicine,Guangzhou 510060,China;Department of Radiotherapy,Sun Yat-sen University Cancer Center,State Key Laboratory of Oncology in South China,Collaborative Innovation Center for Cancer Medicine,Guangzhou 510060,China)

机构地区：[1]中山大学肿瘤防治中心、中山大学肿瘤研究所、华南肿瘤学国家重点实验室、肿瘤医学协同创新中心核医学科,广州510060 [2]中山大学肿瘤防治中心、中山大学肿瘤研究所、华南肿瘤学国家重点实验室、肿瘤医学协同创新中心放疗科,广州510060

出　　处：《中华核医学与分子影像杂志》2022年第12期719-723,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的采用全身PET/CT动态显像系统评估局部晚期非小细胞肺癌(NSCLC)患者化疗联合免疫治疗后关键脏器的FDG动力学变化情况,探索其潜在的生物学意义。方法回顾性分析2020年8月至2021年3月在中山大学肿瘤防治中心行^(18)F-FDG全身PET/CT动态显像的16例局部晚期NSCLC患者(男13例、女3例,年龄43~67岁)。勾画基线及化疗联合免疫治疗后关键脏器ROI,获取时间-活度曲线(TACs),使用二组织房室模型拟合动力学参数,包括K_(1)、k_(2)、k_(3)及FDG代谢率(MRFDG)。采用配对样本t检验或Wilcoxon符号秩检验比较各个脏器治疗前后FDG动力学参数的差异。结果治疗前与化疗联合免疫治疗后,结肠的SUV_(max)(3.23±1.29和4.81±2.73),肺的MRFDG[(2.77±1.96)和3.56(1.07,9.89)μmol·100 g^(-1)·min^(-1)],脾的SUV_(max)(2.16±0.27和2.33±0.41)、k_(3)[(0.008±0.002)和(0.012±0.004)min^(-1)]、MRFDG[(2.65±0.81)和(3.76±1.59)μmol·100 g^(-1)·min^(-1)]以及骨髓的SUV_(max)(2.59±0.45和4.49±2.73)、k_(2)[(0.76±0.37)和(1.27±0.66)min^(-1)]、k_(3)[(0.032±0.007)和0.066±0.029)min^(-1)]、MRFDG[(5.14±1.44)和(8.39±2.67)μmol·100 g^(-1)·min^(-1)]差异均有统计学意义(t值:-5.40~3.47,z=-2.02,均P<0.05);其余各脏器的SUV_(max)、速率常数及MRFDG治疗前后差异均无统计学意义(t值:-2.00~2.35,z值:-1.45~-0.05,均P>0.05)。结论化疗联合免疫治疗后,脾、骨髓的FDG动力学速率常数升高,可能与免疫系统激活相关;肺和结肠可能是出现免疫相关不良反应的靶器官。Objective To evaluate the kinetic metrics changes of FDG in key organs after chemo-immunotherapy in patients with locally advanced non-small cell lung cancer(NSCLC)identified by total-body PET/CT dynamic imaging,and explore its potential biological significance.Methods From August 2020 to March 2021,16 patients(13 males,3 females;age:43-67 years)with locally advanced NSCLC who underwent total-body ^(18)F-FDG PET/CT dynamic imaging in Sun Yat-sen University Cancer Center were retrospectively analyzed.ROIs of key organs were drawn at baseline and after chemo-immunotherapy to obtain the time-activity curves(TACs).The kinetic metrics,including K_(1),k_(2),k_(3)and metabolic rate of FDG(MRFDG),were fitted by the two-tissue compartment model.Paired t test or Wilcoxon signed rank test was used to compare the differences of FDG kinetic parameters in each organ before and after treatment.Results Compared with baseline,SUV_(max) of colon(3.23±1.29 vs 4.81±2.73),MRFDG((2.77±1.96)vs 3.56(1.07,9.89)μmol·100 g^(-1)·min^(-1))of lungs,SUV_(max)(2.16±0.27 vs 2.33±0.41),k_(3)((0.008±0.002)vs(0.012±0.004)min^(-1))and MRFDG((2.65±0.81)vs(3.76±1.59)μmol·100 g^(-1)·min^(-1))of spleen,and SUV_(max)(2.59±0.45 vs 4.49±2.73),k_(2)((0.76±0.37)vs(1.27±0.66)min^(-1)),k_(3)((0.032±0.007)vs(0.066±0.029)min^(-1))and MRFDG((5.14±1.44)vs(8.39±2.67)μmol·100 g^(-1)·min^(-1))of bone marrow were increased after chemo-immunotherapy with significant differences(t values:from-5.40 to 3.47,z=-2.02,all P<0.05).There were no significant differences of SUV_(max),k values and MRFDG in other organs(t values:from-2.00 to 2.35,z values:from-1.45 to-0.05,all P>0.05).Conclusions After chemo-immunotherapy,the activation of immune system may be manifested as the increase of FDG kinetic rate constants in spleen and bone marrow.The lung and colon may be target organs for immune-related adverse effects.

关 键 词：癌 非小细胞肺 药物疗法 联合 免疫疗法 药代动力学 正电子发射断层显像术 体层摄影术 X线计算机 氟脱氧葡萄糖F18 

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