Are Pretreatment 18F-FDG PET Tumor Textural Features in Non-Small Cell Lung Cancer Associated with Response and Survival After Chemoradiotherapy?
Are Pretreatment 18F-FDG PET Tumor Textural Features in Non-Small Cell Lung Cancer Associated with Response and Survival After Chemoradiotherapy?
复制标题
DOI：
10.2967/jnumed.112.107375
复制
发表时间：
2013-01-01
影响因子：
9.3
通讯作者：
Landau, David
中科院分区：
文献类型：
--
作者：
Cook, Gary J. R.;Yip, Connie;Landau, David
有证据表明，在某些实体瘤中，F-18-FDG PET图像中肿瘤摄取的纹理特征与对放化疗的反应和生存率相关。我们已经研究了在非小细胞肺癌（NSCLC）中是否存在类似的关系。研究方法：53例接受放化疗的NSCLC患者（平均年龄65.8岁; 31例男性，22例女性）接受了治疗前F-18-FDG PET/CT扫描。在12周时通过实体瘤中的CT反应评价标准（RECIST）评估反应。记录总生存期（OS）、无进展生存期（PFS）和局部PFS（LPFS）。原发性肿瘤纹理通过参数粗糙度、对比度、繁忙度和复杂度来测量。以下参数也来自PET数据：原发性肿瘤标准化摄取值（SUV）（平均SUV、最大SUV和峰值SUV）、代谢肿瘤体积和总病变糖酵解。结果如下：与无应答者相比，RECIST应答者显示较低的粗糙度（平均值，0.012 vs. 0.027; P = 0.004）和较高的对比度（平均值，0.11 vs. 0.044; P = 0.002）和忙碌（平均值，0.76 vs. 0.37; P = 0.027）。复杂性和任何SUV参数均不能预测RECIST反应。通过Kaplan-Meier分析，原发性肿瘤粗糙度较高的患者的OS、PFS和LPFS较低（中位数分别为21.1个月vs.未达到，P = 0.003; 12.6 vs. 25.8个月，P = 0.002; 12.9 vs. 20.5个月，P = 0.016）。多变量分析显示，肿瘤粗糙度是OS的独立预测因子。对比度和忙碌度与OS无显著相关性（分别为P = 0.075和0.059），但PFS和LPFS在各自水平较高的患者中较长（对比：中位数为20.5个月vs. 12.6个月，P = 0.015，中位数未达到vs. 24个月，P = 0.02;忙碌：中位数为20.5个月vs. 12.6个月，P = 0.01，中位数未达到vs. 24个月，P = 0.006）。复杂性和任何SUV参数均未显示与生存参数显著相关。结论：在NSCLC中，基线F-18-FDG PET扫描摄取显示异常纹理（通过粗糙度、对比度和繁忙度测量）与RECIST放化疗无应答和预后较差相关。用这些参数测量肿瘤代谢异质性可能提供可用于肺癌放化疗临床试验中患者分层的指标。
There is evidence in some solid tumors that textural features of tumoral uptake in F-18-FDG PET images are associated with response to chemoradiotherapy and survival. We have investigated whether a similar relationship exists in non-small cell lung cancer (NSCLC). Methods: Fifty-three patients (mean age, 65.8 y; 31 men, 22 women) with NSCLC treated with chemoradiotherapy underwent pretreatment F-18-FDG PET/CT scans. Response was assessed by CT Response Evaluation Criteria in Solid Tumors (RECIST) at 12 wk. Overall survival (OS), progression-free survival (PFS), and local PFS (LPFS) were recorded. Primary tumor texture was measured by the parameters coarseness, contrast, busyness, and complexity. The following parameters were also derived from the PET data: primary tumor standardized uptake values (SUVs) (mean SUV, maximum SUV, and peak SUV), metabolic tumor volume, and total lesion glycolysis. Results: Compared with nonresponders, RECIST responders showed lower coarseness (mean, 0.012 vs. 0.027; P = 0.004) and higher contrast (mean, 0.11 vs. 0.044; P = 0.002) and busyness (mean, 0.76 vs. 0.37; P = 0.027). Neither complexity nor any of the SUV parameters predicted RECIST response. By Kaplan-Meier analysis, OS, PFS, and LPFS were lower in patients with high primary tumor coarseness (median, 21.1 mo vs. not reached, P = 0.003; 12.6 vs. 25.8 mo, P = 0.002; and 12.9 vs. 20.5 mo, P = 0.016, respectively). Tumor coarseness was an independent predictor of OS on multivariable analysis. Contrast and busyness did not show significant associations with OS (P = 0.075 and 0.059, respectively), but PFS and LPFS were longer in patients with high levels of each (for contrast: median of 20.5 vs. 12.6 mo, P = 0.015, and median not reached vs. 24 mo, P = 0.02; and for busyness: median of 20.5 vs. 12.6 mo, P = 0.01, and median not reached vs. 24 mo, P = 0.006). Neither complexity nor any of the SUV parameters showed significant associations with the survival parameters. Conclusion: In NSCLC, baseline F-18-FDG PET scan uptake showing abnormal texture as measured by coarseness, contrast, and busyness is associated with non-response to chemoradiotherapy by RECIST and with poorer prognosis. Measurement of tumor metabolic heterogeneity with these parameters may provide indices that can be used to stratify patients in clinical trials for lung cancer chemoradiotherapy.