18F-FDG PET/CT代谢参数对小细胞肺癌预后的预测价值

The predictive value of volumetric metabolic parameters of 18F-FDG PET/CT on the prognosis of small cell lung cancer

    摘要
  • 摘要:
    目的 探讨18F-氟脱氧葡萄糖（FDG）PET/CT代谢参数对初诊小细胞肺癌（SCLC）患者不同分期广泛期（ES）和局限期（LS）预后的预测价值。
    方法  回顾性分析2019年1月至2020年12月于郑州大学第一附属医院初诊的118例SCLC患者（LS-SCLC 42例，ES-SCLC 76例）的临床资料及影像资料，其中男性97例、女性21例，年龄（62.9±10.3）岁。收集患者的基本临床资料（年龄、性别、吸烟史、体重减轻情况）、血清肿瘤标志物癌胚抗原（CEA）、神经元特异性烯醇化酶（NSE）、PET/CT代谢参数以40%SUVmax和SUV=2.5为临界值计算的全身肿瘤代谢体积（wbMTV40%、wbMTV2.5）和全身病灶糖酵解总量（wbTLG40%、wbTLG2.5）、TNM分期、美国退伍军人医院肺癌研究组（VALG）分期及免疫组织化学检查结果。以总生存期（OS）为观察指标。组间比较采用独立样本t检验或Mann-Whitney U检验。采用 Kaplan-Meier法计算生存率并行Log-rank检验和单因素分析，采用 Cox比例风险回归模型进行多因素分析。
    结果 76例ES-SCLC患者死亡62例（62/76，81.5%），存活14例（14/76，18.5%），中位生存时间15.0（95%CI：13.1~16.9）个月；42例LS-SCLC患者死亡30例（30/42，71.4%），存活12例（12/42，28.6%），中位生存时间22.0（95%CI：15.8~28.2）个月，两组间患者中位生存时间差异有统计学意义（Z=−2.22，P=0.026）。单因素分析结果显示，wbMTV2.5（χ2=6.01，P=0.014）、wbTLG2.5（χ2=7.45，P=0.006）、血清CEA升高（χ2=8.01，P=0.005）、年龄（χ2=4.328，P=0.037）是ES-SCLC患者OS的影响因素；SUVmax（χ2=3.90，P=0.048）、wbMTV2.5（χ2=3.86，P=0.049）、血清CEA升高（χ2=7.93，P=0.005）是LS-SCLC患者OS的影响因素。多因素分析结果显示，血清CEA（HR=2.68，95%CI：1.49~4.81，P=0.001）、wbTLG2.5（HR=2.32，95%CI:1.38~3.90，P=0.002）、wbMTV2.5（HR=2.17，95%CI：1.29~3.66，P=0.003）是ES-SCLC患者OS的独立预后因素。
    结论 18F-FDG PET/CT代谢参数对SCLC患者预后具有预测价值，其中wbMTV2.5和wbTLG2.5是ES-SCLC患者OS的独立预后因素，可为SCLC的临床治疗提供参考。

     

    Abstract:
    Objective  To investigate the value of volume metabolic parameters in 18F-FDG PET/CT imaging in predicting the prognosis of newly diagnosed extensive (ES) and limited (LS) small cell lung cancer (SCLC) .
    Methods  118 patients with SCLC (76 ES-SCLC patients、42 LS-SCLC patients) who were newly diagnosed in the first affiliated Hospital of Zhengzhou University from January 2019 to December 2020 were analyzed retrospectively.The clinical data, volume metabolic parameters of 18F-FDG PET/CT imaging and immunohistochemical results of puncture pathology were collected.Including sex, age, smoking history, weight loss, serum CEA, serum NSE, primary focus SUVmax, sum of whole body MTV (wbMTV) and sum of whole body TLG (wbTLG) , TTF-1, Ki-67, etc.The overall survival (OS) was followed up, and Kaplan-Meier method was used to analyze the prognostic factors of OS.
    Results  The median survival time of 76 patients with ES-SCLC was 15.0 (95%CI: 13.1~16.9) months, and that of 42 patients with LS-SCLC was 20.0 (95%CI:11.5~28.5) months. There was significant difference in median survival time between the two groups (Z=−2.224, P=0.026) .Univariate analysis showed that wbMTV2.5 (=6.01, P=0.014) , wbTLG2.5 (=7.45, P=0.006) , serum CEA (=8.01, P=0.005) , and age (=4.328, P=0.037) were the influencing factors of OS in ES-SCLC patients.SUVmax (=3.90, P=0.048) , wbMTV2.5 (=3.86, P=0.049) , serum CEA (=7.93, P=0.005) were the influencing factors of OS in LS-SCLC patients.
    Conclusion  18F-FDG PET/CT metabolic parameters have certain predictive reference value for the prognosis of SCLC patients. wbMTV2.5 and wbTLG2.5 serve as independent prognostic factors for OS in ES-SCLC patients and can provide a basis for personalized treatment of SCLC..

     

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