晚期NSCLC患者基线18F-FDG PET/CT代谢参数预测一线化疗联合免疫治疗的疗效与预后的价值

Baseline18F-FDG PET/CT for advanced non-small cell lung cancer first-line chemotherapy combined with immunotherapy efficacy and prognosis evaluation

    摘要
  • 摘要:
    目的  探究治疗前原发灶与转移灶基线18F-FDG PET/CT代谢参数对接受一线化疗联合免疫治疗的晚期非小细胞肺癌（NSCLC）患者的疗效与预后的预测价值。
    方法  回顾性分析2018年12月至2023年9月于青岛大学附属医院行一线化疗联合免疫治疗的86例晚期NSCLC患者的临床及影像资料，其中男性73例、女性13例，年龄（65.1±7.4）岁。4个周期后评估患者疗效，结果分为临床获益组和非临床获益组。以42%SUVmax为临界值获得肿瘤原发灶的最大标准摄取值（SUVmax）、肿瘤代谢体积（MTV）、病灶糖酵解总量（TLG）（分别记为SUVmax-p、MTV-p、TLG-p）和全身病灶的MTV、TLG （分别记为MTV-wb、TLG-wb），转移灶与原发灶SUVmax、MTV、TLG比值（分别记为R-SUVmax、R-MTV、R-TLG）。组间比较采用Mann-Whitney U检验或卡方检验，采用二元Logistic回归进行多因素分析并基于有统计学意义的参数构建综合模型，绘制ROC曲线获取最佳截断值及模型的预测效能，Kaplan-Meier法绘制PFS曲线，Log-rank检验比较组间生存情况，采用多因素Cox比例风险模型预测患者无进展生存期（PFS）的预后因素。
    结果  中位随访时间为26.5个月。64例（74.42%）患者疾病进展，中位PFS为8（1~55）个月。临床获益组57例（66.28%，57/86），非临床获益组29例（33.72%，29/86）。临床获益组与非临床获益组患者间的临床分期、MTV-p、TLG-p、R-SUVmax、R-MTV、R-TLG差异有统计学意义（χ2=5.57，Z=−2.909~−2.002；均P<0.05）。多因素分析结果显示临床分期（OR=0.277，95%CI：0.085~0.909）、R-MTV（OR=0.230，95%CI：0.068~0.779）、R-TLG（OR=1.812，95%CI：1.068~3.076）可以预测晚期NSCLC患者免疫治疗疗效。绘制ROC曲线，综合模型的AUC为0.696（95%CI：0.574~0.817），灵敏度为0.554，特异度为0.852。Cox比例风险回归模型分析结果显示，R-MTV（HR=1.452，95%CI：1.111~1.897；P=0.006）、R-TLG（HR=0.860，95%CI：0.768-0.962；P=0.008）越大，患者生存期越短。
    结论  基线18F-FDG PET/CT转移灶与原发灶的MTV及TLG的比值及临床分期可以预测患者免疫治疗的疗效，R-SUVmax、R-MTV是NSCLC患者PFS的独立危险因素。

     

    Abstract:
    Objective  To explore the prognostic value of metabolic parameters of primary and metastatic lesions in patients with advanced non-small cell lung cancer (NSCLC) who received first-line chemotherapy combined with immunotherapy before treatment.
    Methods The clinical and baseline 18F-FDG PET/CT data of 86 patients with advanced lung cancer who received first-line chemotherapy combined with immunotherapy in the Affiliated Hospital of Qingdao University from December 2018 to September 2023 were retrospectively analyzed. The patients were evaluated after 4 cycles. The results were divided into clinical benefit group (including CR, PR and SD) and non-clinical benefit group (PD). The metabolic parameters of primary tumor (SUVmax-p, MTVp, TLG-p) and metastases (SUVmax-m, MTV-m, TLG-m) and their ratio (R-SUVmax, R-MTV, R-TLG) were obtained with 42%SUVmax as threshold. Multivariate logistic regression was used for multivariate analysis. Survival curves were constructed using the Kaplan-Meier method, and the log-rank test was used to compare the differences between subgroups. Univariate analysis P<0.05 was included in the Cox proportional hazard model to predict the prognostic factors of progression-free survival (PFS).
    Results The median follow-up time was 26.5 months. 64 (74.42%) cases had disease progression, with a median PFS of 8 months (1-55 months). Among the 86 patients, 57(66.28%) cases in the clinical benefit group and 29 (33.72%) cases in the non-clinical benefit group. There were significant differences between clinical benefit group and non-clinical benefit group in clinical staging (0.018), MTV-p (0.004), TLG-p (0.006), R-SUVmax (0.045), R-MTV (0.022) and R-TLG (0.011). Cox analysis showed that the larger the R-MTV (HR=1.452, 95%CI: 1.111−1.897; P=0.006) and R-TLG (HR=0.860, 95%CI: 0.768−0.962; P=0.008), the shorter the survival time.
    Conclusion Clinical stage and the ratio of MTV and TLG of baseline 18F-FDG PET/CT metastasis to primary lesions are independent risk factors for PFS in NSCLC patients, which can predict the efficacy of immunotherapy.

     

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