局部晚期NSCLC同步放化疗效果及预后相关因素  

PREDICTIVE FACTORS FOR TREATMENT EFFICACY OF CONCURRENT CHEMORADIOTHERAPY IN PATIENTS WITH LOCALLY ADVANCED NON-SMALL CELL LUNG CANCER AND THEIR PROGNOSIS

作　　者：张朋菲 周洪建 宋轶鹏[1] ZHANG Pengfei;ZHOU Hongjian;SONG Yipeng(Department of Radiotherapy,Yantai Yuhuangding Hospital of Qingdao University,Yantai 264000,China)

机构地区：[1]青岛大学附属烟台毓璜顶医院放疗科,山东烟台264000 [2]招远市人民医院肿瘤科

出　　处：《青岛大学学报（医学版）》2023年第5期714-719,共6页Journal of Qingdao University(Medical Sciences)

基　　金：烟台市重点研发计划项目(2018SFGY110)。

摘　　要：目的探究临床因素及18 F-脱氧葡萄糖(18 F-FDG)正电子发射计算机断层扫描(PET-CT)代谢参数预测局部晚期非小细胞肺癌(NSCLC)病人同步放化疗效果及预后的价值。方法回顾分析142例接受PET-CT检查的局部晚期NSCLC病人的临床特征、肿瘤检测指标、病理类型及原发灶最大标准摄取值(SUVmax)和平均标准摄取值(SUVmean)等资料;通过受试者工作特征(ROC)曲线确定连续性变量最佳分界值,并将其进行二分类。应用单因素及多因素Logistic回归分析病人客观缓解率(ORR)的影响因素,Kaplan-Meier方法、log-rank检验及COX风险模型进行生存分析。结果原发灶SUVmax和SUVmean预测ORR的ROC曲线下面积(AUC)分别为0.740、0.665(△AUC=0.075,P=0.016);肿瘤病理类型(OR=3.827,95%CI=1.308~11.199,P=0.014)、癌胚抗原(CEA)(OR=8.479,95%CI=3.015~23.848,P<0.001)、神经元特异性烯醇化酶(NSE)(OR=3.875,95%CI=1.154~9.664,P=0.004)及SUVmax(OR=4.198,95%CI=1.627~10.831,P=0.003)对治疗效果有预测价值;原发灶SUVmax为总体生存时间(OS)的独立预测因素(P=0.033)。结论病理类型、CEA水平、NSE水平以及原发灶SUVmax可预测局部晚期NSCLC病人同步放化疗效果,SUVmax是OS的独立预后因素。Objective To investigate the value of clinical factors and metabolic parameters of 18 F-FDG PET-CT in predicting the efficacy of concurrent chemoradiotherapy in patients with locally advanced non-small cell lung cancer(NSCLC)and their prognosis.Methods A retrospective analysis was performed on the clinical characteristics,tumor markers,pathological types,maximum standardized uptake values(SUVmax),and mean standardized uptake values(SUVmean)of primary tumors of 142 locally advanced NSCLC patients who underwent a PET-CT scan.The cut-off values were calculated by plotting receiver operating characteristic(ROC)curves and the continuous variables were classified into two categories.Univariate and multivariate Logistic regression was used to analyze the influencing factors for objective response rate(ORR).The Kaplan-Meier method,log-rank test,and Cox regression model were used for survival analysis.Results The areas under the ROC curve(AUCs)of primary tumor SUVmax and SUVmean for predicting ORR were 0.740 and 0.665(△AUC=0.075,P=0.016),respectively.Univariate and mul-tivariate Logistic regression results showed that tumor pathological type(OR=3.827,95%CI=1.308-11.199,P=0.014),carcinoembryonic antigen(CEA)(OR=8.479,95%CI=3.015-23.848,P<0.001),neuron-specific enolase(NSE)(OR=3.875,95%CI=1.154-9.664,P=0.004),and SUVmax(OR=4.198,95%CI=1.627-10.831,P=0.003)had predictive value for efficacy.The Kaplan-Meier survival analysis and Cox regression model showed that primary tumor SUVmax(P=0.033)was an indepen-dent predictor of overall survival(OS).Conclusion Pathological type,CEA level,NSE level,and primary tumor SUVmax can predict the efficacy of concurrent chemoradiotherapy in locally advanced NSCLC patients,and SUVmax is an independent prognostic factor for OS.

关 键 词：癌 非小细胞肺 氟脱氧葡萄糖F18 正电子发射断层显像计算机体层摄影术 治疗应用 预后 

分 类 号：R734.2[医药卫生—肿瘤]