Ⅲ~Ⅳ期肺腺癌患者EGFR-TKI单药治疗前基线^(18)F-FDG PET/CT代谢参数的价值  

Value of baseline ^(18)F-FDG PET/CT metabolism parameters in patients with stageⅢ-Ⅳlung adenocarcinoma before EGFR-TKI monotherapy

作　　者：崔燕 李旭[1] 陈聪霞[1] 郭悦[1] 姚稚明[1] Cui Yan;Li Xu;Chen Congxia;Guo Yue;Yao Zhiming(Department of Nuclear Medicine,Beijing Hospital,National Center of Gerontology Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院核医学科、国家老年医学中心、中国医学科学院老年医学研究院,北京100730

出　　处：《中华核医学与分子影像杂志》2024年第7期390-395,共6页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的探讨表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKI)单药治疗前基线^(18)F-FDG PET/CT代谢参数预测Ⅲ~Ⅳ期肺腺癌患者的疗效及预后价值。方法回顾性收集2012年1月至2020年6月于北京医院EGFR-TKI单药治疗且治疗前1个月内完成基线^(18)F-FDG PET/CT显像的61例Ⅲ~Ⅳ期肺腺癌患者(男19例、女42例,中位年龄64岁)的资料。分析临床资料及^(18)F-FDG摄取最高病灶的代谢参数,包括SUVmax、瘦体质量SUVmax(SULmax)、瘦体质量SUV峰值(SULpeak)、肿瘤代谢体积(MTV)、病灶糖酵解总量(TLG)。随访患者治疗后疗效、无进展生存(PFS)和总生存(OS)。采用ROC曲线分析获得各代谢参数预测疾病缓解、疾病进展的最佳界值,采用Kaplan-Meier法、log-rank检验及Cox比例风险回归模型分析影响患者PFS和OS的预后因素。结果疗效评估为疾病缓解者42.9%(24/56),SULpeak、SUVmax、SULmax、MTV、TLG预测疾病缓解的最佳界值分别为5.9、13.1、11.1、10.6 ml、99.6 g,SUVmax>13.1组、MTV>10.6 ml组、TLG>99.6 g组的疾病缓解率明显高于SUVmax≤13.1组[51.2%(21/41)和3/15;χ^(2)=4.37,P=0.037]、MTV≤10.6 ml组[9/12和36.6%(15/41);χ^(2)=5.53,P=0.019]、TLG≤99.6 g组[10/13和35.0%(14/40);χ^(2)=6.96,P=0.008]。随访0.05~6.80年,10.3%(6/58)无疾病进展,44.3%(27/61)患者死亡。SULpeak、SUVmax、SULmax、MTV、TLG预测PFS的最佳界值分别为11.2、17.0、13.7、2.7 ml、14.8 g;预测OS的最佳界值分别为5.6、14.3、8.8、2.8 ml、37.3 g。从未吸烟、SUVmax≤17.0、SULpeak≤11.2患者的PFS期明显延长(χ^(2)值:3.87~7.37,均P<0.05),其中从未吸烟[风险比(HR)=2.29,95%CI:1.08~4.87,P=0.031]、SULpeak≤11.2(HR=2.67,95%CI:1.35~5.27,P=0.005)是PFS期延长的独立预测因子。Ⅲ+ⅣA期、SUVmax≤14.3、SULpeak≤5.6、SULmax≤8.8、TLG≤37.3 g患者的OS期明显延长(χ^(2)值:5.78~8.83,均P<0.05),其中Ⅲ+ⅣA期(HR=2.81,95%CI:1.08~7.32,P=0.034)、SULmax≤8.8(HR=9.66,95%CI:1.25~74.91,P=0.030)是OS延长的独立预Objective To investigate the efficacy and prognostic value of baseline ^(18)F-FDG PET/CT metabolism parameters in patients with stageⅢ-Ⅳlung adenocarcinoma before epidermal growth factor receptor tyrosine kinase inhibitor(EGFR-TKI)monotherapy.Methods From January 2012 to June 2020,61 patients(19 males,42 females;median age:64 years)with stageⅢ-Ⅳlung adenocarcinoma who underwent baseline ^(18)F-FDG PET/CT imaging before EGFR-TKI monotherapy in 1 month in Beijing Hospital were retrospectively analyzed.The clinical data and metabolic parameters including SUVmax,SUVmax of lean body mass(SULmax),peak of SUV of lean body mass(SULpeak),metabolic tumor volume(MTV),and total lesion glycolysis(TLG)of the hottest lesions on PET were analyzed.Patients were followed up to obtain the efficacy evaluation,progression-free survival(PFS)and overall survival(OS).ROC curve analysis was performed to obtain the optimal cut-off value of metabolic parameters to predict disease remission and prognosis.Kaplan-Meier method,log-rank test and Cox proportional risk regression model were used to analyze the prognostic factors.Results After EGFR-TKI monotherapy,42.9%(24/56)patients were in disease remission.The optimal cut-off values for predicting disease remission of SULpeak,SUVmax,SULmax,MTV,and TLG were 5.9,13.1,11.1,10.6 ml and 99.6 g,respectively.The remission rates of patients with SUVmax>13.1,MTV>10.6 ml and TLG>99.6 g were significantly higher than those of patients with SUVmax≤13.1(51.2%(21/41)vs 3/15;χ^(2)=4.37,P=0.037),MTV≤10.6 ml(9/12 vs 36.6%(15/41);χ^(2)=5.53,P=0.019)and TLG≤99.6 g(10/13 vs 35.0%(14/40);χ^(2)=6.96,P=0.008).The follow-up period for survival was 0.05-6.80 years,and 10.3%(6/58)patients had no disease progression,and 44.3%(27/61)patients died.The optimal cut-off values of SULpeak,SUVmax,SULmax,MTV,and TLG for PFS were 11.2,17.0,13.7,2.7 ml and 14.8 g,and those for OS were 5.6,14.3,8.8,2.8 ml and 37.3 g,respectively.Patients with never-smoking,SUVmax≤17.0 and SULpeak≤11.2 had longer PFS(χ^(2) val

关 键 词：肺肿瘤 腺癌 基因 erbB-1 蛋白激酶抑制剂 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]