术前^(18)F-FDG PET/CT代谢参数对肺腺癌纵隔淋巴结转移的预测价值  

Predictive value of pre-surgical 18F-FDG PET/CT metabolic parameters for mediastinal lymph node metastasis in patients with lung adenocarcinoma

作　　者：戴萌[1] 王娜[1] 赵新明[1] 王建方[1] 张敬勉[1] 张召奇[1] 刘玉暖 敬凤连 赵秀娟[1] Dai Meng;Wang Na;Zhao Xinming;Wang Jianfang;Zhang Jingmian;Zhang Zhaoqi;Liu Yunuan;Jing Fenglian;Zhao Xiujuan(Department of Nuclear Medicine and Molecular Imaging,the Fourth Hospital of Hebei Medical University Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance,Shijiazhuang 050011,China)

机构地区：[1]河北医科大学第四医院核医学与分子影像科、河北省肿瘤微环境与耐药重点实验室,石家庄050011

出　　处：《中华核医学与分子影像杂志》2023年第9期518-522,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：河北省卫健委重点科技研究计划项目(20210720);河北省医学适用技术跟踪项目(GL2011-52)。

摘　　要：目的探讨基于术前^(18)F-FDG PET/CT原发灶代谢参数模型对肺腺癌纵隔淋巴结转移(LNM)的预测价值。方法回顾性分析2016年1月至2021年2月于河北医科大学第四医院诊治的肺腺癌患者288例[男135例、女153例,年龄(61.6±8.5)岁]病例资料。患者术前1个月内行全身^(18)F-FDG PET/CT检查,并行肺原发灶切除和规范淋巴结清扫术。提取多个PET/CT参数[PET代谢参数:最小SUV(SUVmin)、SUVmax、SUVmean、SUV标准差(SUVstd)、肿瘤代谢体积(MTV)和病灶糖酵解总量(TLG);CT参数:最小CT值(HUmin)、最大CT值(HUmax)、平均CT值(HUmean)、CT值标准差(HUstd)]。采用多因素logistic回归筛选LNM的预测因素。采用ROC曲线评估模型预测效能。结果288例患者中,90例存在LNM,涉及361个转移淋巴结(N1期186个,N2期175个)。PET代谢参数中,SUVmin[比值比(OR)=1.859,95%CI:1.074~3.220,P=0.027]、SUVmax(OR=2.255,95%CI:1.306~3.893,P=0.004)和SUVmean(OR=0.277,95%CI:0.115~0.665,P=0.004)是肺腺癌纵隔LNM的预测因素。PET/CT模型ROC AUC为0.849(95%CI:0.804~0.893),预测灵敏度、特异性、准确性、阳性预测值和阴性预测值分别为87.8%(79/90)、72.2%(143/198)、77.1%(222/288)、59.0%(79/134)和92.9%(143/154)。结论术前^(18)F-FDG PET/CT代谢参数预测模型能够提高肺腺癌纵隔淋巴结(N)分期准确性。Objective To investigate predictive value of model based on pre-surgical 18F-FDG PET/CT metabolic parameters for mediastinal lymph node metastasis(LNM)in lung adenocarcinoma.Methods A total of 288 patients with lung adenocarcinoma(135 males,153 females,age(61.6±8.5)years)who diagnosed and treated in the Fourth Hospital of Hebei Medical University from January 2016 to February 2021 were enrolled retrospectively.All patients underwent 18F-FDG PET/CT examination within 1 month before operation,and underwent complete resection of primary lung tumor and standard lymph node dissection.PET/CT parameters were extracted(PET metabolic parameters:minimum SUV(SUVmin),SUVmax,SUVmean,SUV standard deviation(SUVstd),metabolic tumor volume(MTV)and total lesion glycolysis(TLG);CT parameters:minimum CT value(HUmin),maximum CT value(HUmax),mean CT value(HUmean),CT value standard deviation(HUstd)).Multivariate logistic regression analysis was used for screening parameters and establishing model to predict LNM.ROC curves analyses were used to evaluate the predictive performance of models.Results Among 288 patients,90 had LNM,and 361 metastatic lymph nodes(N1:186,N2:175)were reported by pathology.SUVmin(odds ratio(OR)=1.859,95%CI:1.074-3.220,P=0.027),SUVmax(OR=2.255,95%CI:1.306-3.893,P=0.004),SUVmean(OR=0.277,95%CI:0.115-0.665,P=0.004)were predictors of LNM.The AUC of PET/CT model was 0.849(95%CI:0.804-0.893),and the sensitivity,specificity,accuracy,and positive and negative predictive values were 87.8%(79/90),72.2%(143/198),77.1%(222/288),59.0%(79/134)and 92.9%(143/154),respectively.Conclusion The model based on 18F-FDG PET/CT metabolic parameters can improve the accuracy of pre-surgical N-staging in patients with lung adenocarcinoma.

关 键 词：肺肿瘤 腺癌 肿瘤转移 淋巴结 纵隔 正电子发射断层显像术 体层摄影术 X线计算机 

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