18F-FDG PET/CT全身肿瘤代谢体积——非小细胞肺癌患者的独立预后因素

摘要

目的 探讨18F-FDG PET/CT全身肿瘤代谢体积(MTVwb)在非小细胞肺癌(NSCLC)患者预后评估中的临床价值.方法 回顾性分析治疗前首次行18F-FDG PET/CT检查的130例NSCLC患者.应用Kaplan-Meier生存分析及Cox比例风险模型,分析临床分期、性别、年龄、病理学类型、化疗、放疗、手术治疗及PET/CT显像中的MTVwb、全身最大标准摄取值(SUVmax)与患者预后的关系,同时运用C值对比MTVwb及临床分期对预后的预测能力.结果 在单因素分析中,化疗(HR=0.569,95％ CI:[0.366,0.886],P=0.013)、临床分期Ⅳ期(HR=3.012,95％ CI:[1.575,5.762],P=0.001)、MTVwb (HR=1.925,95％ CI:[1.261,2.940],P=0.002) 是影响患者预后的因素(P ＜ 0.05).Cox 比例风险模型多因素分析显示,化疗(HR = 0.266,95％ CI:[0.144,0.493],P ＜ 0.001)、临床分期Ⅳ期(HR = 2.940,95％ CI:[1.315,6.574],P=0.009) 和MTVwb (HR= 1.538,95％ CI:[1.180,2.004],P= 0.001) 是NSCLC患者生存预后的独立影响因素(P ＜ 0.05);且MTVwb的C值(0.634)＞临床分期的C值(0.609).结论 18F-FDG PET/CT 显像中的MTVwb对NSCLC患者预后评估有较高的临床价值,且与SUVmax及临床分期、年龄、性别、治疗方法、病理类型等多种因素比较,具有更好的预后预测价值.%Objective To evaluate the prognostic value of whole-body metabolic tumor volume (MTVwb) measured by 18F-FDG PET/CT in patients with non-small cell lung cancer (NSCLC). Methods 130 patients with histologically proven NSCLC were identified for this retrospective analysis. All patients underwent 18F-FDGPET/ CT scan before treatment. The prognostic significance of MTVwb and whole-body maximum standard uptake value (SUVmax) measured by 18F-FDG PET/CT, stage, gender, age, histology, radiotherapy, chemotherapy, surgery were assessed by the Kaplan-Meier survival curve and Cox proportional hazard regression analysis. C-statistic index was utilized to compare the power of stage with MTVwb in predicting patient's prognosis. Results In a univariate analysis, chemotherapy (HR = 0.569, 95％ CI: [0.366, 0.886, P = 0.013), stage Ⅳ of clinical staging (HR = 3.012, 95％ CI: [1.575, 5.762], P= 0.001), MTVwb (HR= 1.925, 95％ CI: [1.261, 2.940], P=0.002) were risk factors of survival (P ＜ 0.05). In a multivariate Cox regression, chemotherapy (HR= 0.266, 95％ CI: [0.144, 0.493], P ＜ 0.001), stage Ⅳof clinical staging (HR=2.940, 95％ CI: [1.315, 6.574], P = 0.009), MTVwb (HR = 1.538, 95％ CI: [1.180, 2.004], P = 0.001) were independent risk factors of surviva1 (P ＜ 0.05). And C- statistic index of MTVwb (0.634) was greater than that of stage (0.609). Conclusion MTVwb measured by 18F-FDG PET/CT imaging in NSCLC patients has a great clinical significance in predicting prognosis. Compared with stage, SUVmax, age, gender, treatment methods and histology, MTVwb is better for evaluating the prognosis of NSCLC.