PET-CT联合内质网应激标志物检测在非小细胞肺癌化疗效果和预后评估中的应用  

Application of PET-CT Combined with Endoplasmic Reticulum Stress Marker Detection in Evaluation of Chemotherapeutic Efficacy and Prognosis of Non-Small Cell Lung Cancer

作　　者：陈婧姼 邢影[1] 杨俊泉[1] CHEN Jing-shi;XING Ying;YANG Jun-quan(the 1st Department of Radiochemotherapy,Tangshan People’s Hospital(Tangshan Cancer Hospital),Tangshan 063000,China)

机构地区：[1]唐山市人民医院(唐山市肿瘤医院)放化一科,河北唐山063000

出　　处：《南昌大学学报（医学版）》2024年第1期65-70,76,共7页Journal of Nanchang University：Medical Sciences

基　　金：河北省医学科学研究课题计划(20192395)。

摘　　要：目的探讨正电子发射断层扫描(PET)/CT联合内质网应激(ERS)标志物在非小细胞肺癌(NSCLC)化疗效果和预后评估中的应用。方法选取2017年9月至2022年6月于唐山市人民医院放化一科病理诊断为NSCLC的84例患者的临床资料进行回顾性分析。通过PET/CT定量评估氟代氟脱氧葡萄糖(18F-FDG)最大摄取(SUV max),用酶联免疫吸附法测定血清Tribbles同源蛋白3(TRB3)、萄糖调节蛋白78(GRP78)和C/EBP同源蛋白(CHOP)水平。评估SUV max和各ERS标志物的相关性以及各指标和治疗反应的相关性。通过受试者工作特征曲线(ROC)获得SUV max和ERS标志物用于识别治疗反应者的最佳临界值。结果入选NSCLC患者的CHOP(r=-0.284,P=0.007)和TRB3(r=0.387,P=0.005)与SUV max显示出明显的相关性,而GRP78与SUV max没有明显的相关性(r=0.086,P=0.443)。84名NSCLC患者中CR、PR、SD和PD例数分别为2例(2.4%)、43例(51.2%)、34例(40.5%)和5例(6.0%)。多因素分析表示SUV max(OR:1.217,95%CI:1.090~1.525,P=0.002)、CHOP(OR:0.140,95%CI:0.062~0.454,P<0.001)和临床分期(OR:1.283,95%CI:1.112~1.718,P=0.009)是治疗反应的独立预测因素。在SUV_CHOP评分系统中得分为0分、1分和2分的患者客观缓解率分别为90%(18/20)、60.6%(20/33)、22.6%(7/31)(P<0.001),中位无进展生存期(PFS)分别为18.9、13.6和10.6个月(P<0.001),和中位总生存期(OS)分别为28.3、19.4和13.4个月(P<0.001)。结论接受一线化疗的Ⅲ-Ⅳ期NSCLC患者中,治疗前SUV max和CHOP是临床化疗反应和预后的独立预测因素,两者联合建立的SUV_CHOP评分系统对化疗反应和预后有较好的预测价值。Objective To explore the application of PET-CT combined with endoplasmic reticulum stress(ERS)marker detection in the evaluation of chemotherapeutic efficacy and prognosis of non-small cell lung cancer(NSCLC).Methods Clinical data of 84 patients who were pathologically diagnosed with NSCLC by Department of Radiotherapy,Tangshan People’s Hospital,from September 2017 to June 2022 were analyzed retrospectively.The maximum 18F-fluorodeoxyglucose(18F-FDG)uptake(SUV max)was quantitatively evaluated by PET/CT.Serum levels of tribbles homologous protein 3(TRB3),glucose regulatory protein 78(GRP78)and C/EBP homologous protein(CHOP)were determined by ELISA.The correlation between SUV max and ERS markers and the correlation between the markers and therapeutic response were evaluated.In addition,the optimal cutoff values of SUV max and ERS markers for identifying therapeutic response were obtained using the receiver operating characteristic(ROC)curve.Results The SUV max was obviously correlated with the levels of CHOP(r=-0.284,P=0.007)and TRB3(r=0.387,P=0.005),but was not related to the level of GRP78(r=0.086,P=0.443).Among the 84 NSCLC patients,CR,PR,SD and PD occurred in 2(2.4%),43(51.2%),34(40.5%)and 5(6.0%),respectively.Multivariate analysis showed that SUV max(OR:1.217;95%CI:1.090-1.525;P=0.002),CHOP(OR:0.140;95%CI:0.062-0.454;P<0.001)and clinical stage(OR:1.283;95%CI:1.112-1.718;P=0.009)were the independent predictors of treatment response.With the SUV_CHOP scoring system,the objective remission rates of patients with scores of 0,1 and 2 were 90%(18/20),60.6%(20/33)and 22.6%(7/31),the median progression-free survivals were 18.9,13.6 and 10.6,and the median overall survivals were 28.3,19.4 and 13.4 months,respectively(P<0.001).Conclusion In stageⅢ-ⅣNSCLC patients treated with first-line chemotherapy,SUV max and CHOP are independent predictors of therapeutic response and prognosis,and the SUV_CHOP scoring system established by their combination has a good predictive value for therapeutic response and prognosis.

关 键 词：PET/CT 内质网应激 非小细胞肺癌 临床肿瘤反应 预后 

分 类 号：R734.2[医药卫生—肿瘤]