^(18)F-FDG PET/CT多参数对非小细胞肺癌预后评估的价值  

Value of ^(18)F-FDG PET/CT multiparameters in evaluating prognosis of non-small cell lung cancer

作　　者：朱碧莲 郑勇 董科[1] ZHU Bilian;ZHENG Yong;DONG Ke(Department of Nuclear Medicine,Jinhua Municipal Centeral Hospital,Jinhua 321000,China)

机构地区：[1]金华市中心医院核医学科,321000

出　　处：《浙江医学》2025年第2期163-167,183,I0005,共7页Zhejiang Medical Journal

基　　金：金华市科技局重点项目(2021-3-069)。

摘　　要：目的探讨18氟代脱氧葡萄糖(^(18)F-FDG)正电子发射断层扫描(PET)/CT多参数对非小细胞肺癌(NSCLC)生存预后的评估价值。方法回顾性选取2020年1月至2023年6月金华市中心医院确诊的165例NSCLC患者为研究对象,根据肿瘤-淋巴结-远处转移(TNM)分期分为Ⅰ期38例,Ⅱ期73例和Ⅲ期54例。随访6个月肿瘤进展48例(进展组),无进展117例(无进展组)。比较两组人口学信息(性别、年龄、高血压和糖尿病)、肿瘤病理学(病理分型和组织学分级)、影像学[肿瘤位置、肿瘤直径、TNM分期、最大标准摄取值(SUVmax)和平均标准摄取值(SUV_(mean))、肿瘤代谢体积(MTV)和病灶糖酵解总量(TLG)]。采用最小绝对收缩和选择算子(LASSO)回归筛选NSCLC患者肿瘤进展的非共线性指标。采用多因素Cox回归分析影响NSCLC患者肿瘤进展的危险因素。采用ROC曲线评估模型对肿瘤进展的预测效能。校准曲线和决策曲线评估模型的一致性和获益性。结果进展组患者年龄、肿瘤直径、SUV_(max)、SUV_(mean)、MTV和TLG值均大于无进展组,组织学低分化比例、TNM分期Ⅲ期比例均高于无进展组,差异均有统计学意义(均P<0.05)。LASSO回归筛选出NSCLC患者肿瘤进展的非共线性指标有TNM分期、SUV_(max)、MTV和TLG。多因素Cox回归分析显示,TNM分期Ⅲ期(HR=5.264,95%CI:4.421~7.648,P<0.001)、SUV_(max)(HR=3.621,95%CI:2.754~5.022,P<0.001)、MTV(HR=3.009,95%CI:2.323~4.457,P<0.001)和TLG(HR=2.659,95%CI:1.859~3.523,P<0.001)升高均是NSCLC患者肿瘤进展的独立危险因素。建立量化模型Y=-0.231+1.958×(TNM分期)+1.323×(SUV_(max))+1.085×(MTV)+0.859×(TLG)。ROC曲线分析显示,模型预测肿瘤进展的AUC为0.859,95%CI:0.801~0.956,P<0.001。校准曲线和决策曲线显示模型的一致性和获益性较好。结论^(18)F-FDG PET/CT是评估NSCLC肿瘤进展的重要影像学工具,SUVmax、MTV和TLG与肿瘤进展风险密切相关,联合TNM分期建立量化模型预测肿瘤进Objective To study the value of ^(18)F-fluorodeoxyglucose positron emission tomography/computed tomography(^(18)F-FDG PET/CT)multiparameters for evaluating the survival prognosis of patients with non-small cell lung cancer(NSCLC).Methods A total of 165 patients with NSCLC confirmed in Jinhua Municipal Centeral Hospital from January 2020 to June 2023 were retrospectively analyzed,and they were divided into stageⅠ(n=38),stageⅡ(n=73),and stageⅢ(n=54)according to the tumor-node-metastasis(TNM)staging.After 6 months of follow-up,48 patients experienced tumor progression(progression group)and 117 patients did not(non-progression group).The demographic information(sex,age,hypertension and diabetes),tumor pathology(pathological classification and histological grade),imaging[tumor location,diameter,TNM staging,maximal standard uptake value(SUVmax)and mean standard uptake value(SUVmean),metabolic tumor volume(MTV)and total lesion glycolysis(TLG)]were compared between the progression and non-progression groups.Least absolute shrinkage and selection operator(LASSO)regression was used to screen non-collinear indicators of tumor progression in NSCLC patients.Multivariate Cox regression analysis was used to analyze the risk factors for tumor progression in NSCLC patients.Receiver operating curve(ROC)was used to evaluate the predictive power of the model for tumor progression.Calibration curve and decision curve were used to evaluate the consistency and benefit of the model.Results Compared with non-progression group,age,tumor diameter,SUV_(max),SUV_(mean),MTV and TLG,and ratio of lowhistological differentiation,ratio of TNM stagingⅢin tumor progression group significantly increased(all P<0.05).Noncollinearity indicators screened based on LASSO regression included TNM staging,SUVmax,MTV and TLG.Multivariate Cox regression analysis showed that TNM stagingⅢ(HR=5.264,95%CI:4.421-7.648,P<0.001),SUV_(max)(HR=3.621,95%CI:2.754-5.022,P<0.001),MTV(HR=3.009,95%CI:2.323-4.457,P<0.001)and TLG(HR=2.659,95%CI:1.859-3.523,P<0.001)in

关 键 词：非小细胞肺癌 18氟代脱氧葡萄糖 肿瘤-淋巴结-远处转移分期 标准摄取值 肿瘤代谢体积 病灶糖酵解总量 

分 类 号：R73[医药卫生—肿瘤]