Prognostic value of metabolic tumor burden on 18F-FDG PET in nonsurgical patients with non-small cell lung cancer
Prognostic value of metabolic tumor burden on 18F-FDG PET in nonsurgical patients with non-small cell lung cancer
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DOI：
10.1007/s00259-011-1934-6
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发表时间：
2012-01-01
影响因子：
9.1
通讯作者：
Pu, Yonglin
中科院分区：
文献类型：
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作者：
Liao, Shengri;Penney, Bill C.;Pu, Yonglin
目的本研究旨在评估2-脱氧-2-[F-18]氟-D-葡萄糖代谢肿瘤负荷的预后价值（F-18-FDG）正电子发射断层扫描（PET）/CT，用代谢肿瘤体积（MTV）和总病变糖酵解（TLG）测量，独立于国际抗癌联合会（UICC）/美国癌症联合委员会（AJCC）肿瘤、淋巴结和转移（TNM）分期，方法回顾性分析169例（男78例，女91例，中位年龄68岁）非手术治疗的非小细胞肺癌（NSCLC）患者，术前均行F18-FDG PET/CT扫描，并与标准化摄取值（SUV）进行比较。F-18-FDG PET/CT扫描根据美国国家癌症研究所指南进行。全身肿瘤MTV（MTVWB）、原发肿瘤MTV（MTVT）、淋巴结转移MTV（MTVN）和远处转移MTV（MTVM）;全身肿瘤TLG（WB）、原发肿瘤TLG（T）、淋巴结转移TLG（N）和远处转移TLG（M）;全身肿瘤SUVmax图10示出了原发性肿瘤（SUV最大WB）、淋巴结转移（SUV最大T）和远处转移（SUV最大M）的SUV平均值以及全身肿瘤的SUV平均值。在MIMvista工作站上用PETedge工具测量原发性肿瘤（SUVmeanWB）、淋巴结转移（SUVmeanN）和远处转移（SUVmeanM）的平均值（SUVmeanT）。从PET/CT开始，幸存者的中位随访时间为35个月（范围2-82个月）。统计学方法包括Kaplan-Meier曲线、考克斯回归和C-统计。中位总生存期（OS）为10.9个月[95%置信区间（CI）9.0-13.2个月]。MTV与OS在统计学上相关。调整分期前后ln（MTVWB）、ae（MTVT）、ae（MTVN）和ae（MTVM）增加1个单位的风险比（HR）为：分别为1.47/1.43（p < 0.001/< 0.001）、1.06/1.05（p < 0.001/< 0.001）、1.11/1.10（p < 0.001/< 0.001）和1.04/1.03（p = 0.007/0.043）。TLG与OS具有统计学显著相关性，调整分期前后ln（TLG（WB））、ae（TLG（T））、ae（TLG（N））和ae（TLG（M））增加1个单位的HR为1.36/1.33（p < 0.001/< 0.001）、1.02/1.02（p = 0.001/0.002）、1.05/1.04（p < 0.001/< 0.001）和1.02/1.02（p = 0.003/0.024）。ln（SUV最大WB）和ae（SUV最大N）与OS具有统计学相关性，调整分期前后增加1个单位的相应HR分别为1.46/1.43（p = 0.013/0.024）和1.22/1.16（p = 0.002/0.040）。校正分期前后的ae（SUV平均N）与OS具有统计学相关性，HR分别增加1个单位1.32（p < 0.001）和1.24（p = 0.015）。在校正分期前，ae（SUV平均M）和ae（SUV最大M）与OS具有统计学相关性，HR分别增加1个单位1.26（p = 0.017）和1.18（p = 0.007），但在校正分期后则不相关（p = 0.127和0.056）。OS与ae（SUVmaxT）、ln（SUVmeanWB）或ae（SUVmeanT）之间无统计学显著相关性。三位放射科医师之间的观察者间变异性较低，SUVmaxWB、ln（MTVWB）和ln（TLG（WB））的组内相关系数（ICC）大于0.94。SUVmeanWB的观察者间变异性较高，ICC为0.806。结论FDG PET上的MTV和TLG测量的全身肿瘤、原发肿瘤、淋巴结转移和远处转移的基线代谢肿瘤负荷是独立于临床分期的预后指标，观察者间变异性较低，可用于进一步对非手术治疗的NSCLC患者进行分层。这项研究还表明MTV和TLG是比SUVmax和SUVmean更好的预后指标。这些结果将需要在前瞻性研究中在更大的队列中进行验证。
Purpose The objective of this study was to assess the prognostic value of metabolic tumor burden on 2-deoxy-2-[F-18]fluoro-D-glucose (F-18-FDG) positron emission tomography (PET)/CT measured with metabolic tumor volume (MTV) and total lesion glycolysis (TLG), independent of Union Internationale Contra la Cancrum (UICC)/American Joint Committee on Cancer (AJCC) tumor, node, and metastasis (TNM) stage, in comparison with that of standardized uptake value (SUV) in nonsurgical patients with non-small cell lung cancer (NSCLC).Methods This study retrospectively reviewed 169 consecutive nonsurgical patients (78 men, 91 women, median age of 68 years) with newly diagnosed NSCLC who had pretreatment F-18-FDG PET/CT scans. The F-18-FDG PET/CT scans were performed in accordance with National Cancer Institute guidelines. The MTV of whole-body tumor (MTVWB), of primary tumor (MTVT), of nodal metastases (MTVN), and of distant metastases (MTVM); the TLG of whole-body tumor (TLG(WB)), of primary tumor (TLG(T)), of nodal metastases (TLG(N)), and of distant metastases (TLG(M)); the SUVmax of whole-body tumor (SUVmaxWB), of primary tumor (SUVmaxT), of nodal metastases (SUVmaxN), and of distant metastases (SUVmaxM) as well as the SUVmean of whole-body tumor (SUVmeanWB), of primary tumor (SUVmeanT), of nodal metastases (SUVmeanN), and of distant metastases (SUVmeanM) were measured with the PETedge tool on a MIMvista workstation with manual adjustment. The median follow-up among survivors was 35 months from the PET/CT (range 2-82 months). Statistical methods included Kaplan-Meier curves, Cox regression, and C-statistics.Results There were a total of 139 deaths during follow-up. Median overall survival (OS) was 10.9 months [95% confidence interval (CI) 9.0-13.2 months]. The MTV was statistically associated with OS. The hazard ratios (HR) for 1 unit increase of ln(MTVWB), ae(MTVT), ae(MTVN), and ae(MTVM) before/after adjusting for stage were: 1.47/1.43 (p < 0.001/< 0.001), 1.06/1.05 (p < 0.001/< 0.001), 1.11/1.10 (p < 0.001/< 0.001), and 1.04/1.03 (p = 0.007/0.043), respectively. TLG had statistically significant associations with OS with the HRs for 1 unit increase in ln(TLG(WB)), ae(TLG(T)), ae(TLG(N)), and ae(TLG(M)) before/after adjusting for stage being 1.36/1.33 (p < 0.001/< 0.001), 1.02/1.02 (p = 0.001/0.002), 1.05/1.04 (p < 0.001/< 0.001), and 1.02/1.02 (p = 0.003/0.024), respectively. The ln(SUVmaxWB) and ae(SUVmaxN) were statistically associated with OS with the corresponding HRs for a 1 unit increase before/after adjusting for stage being 1.46/1.43 (p = 0.013/0.024) and 1.22/1.16 (p = 0.002/0.040). The ae(SUVmeanN) was statistically associated with OS before and after adjusting for stage with HRs for a 1 unit increase of 1.32 (p < 0.001) and 1.24 (p = 0.015), respectively. The ae(SUVmeanM) and ae(SUVmaxM) were statistically associated with OS before adjusting for stage with HRs for a 1 unit increase of 1.26 (p = 0.017) and 1.18 (p = 0.007), respectively, but not after adjusting for stage (p = 0.127 and 0.056). There was no statistically significant association between OS and ae(SUVmaxT), ln(SUVmeanWB), or ae(SUVmeanT). There was low interobserver variability among three radiologists with intraclass correlation coefficients (ICC) greater than 0.94 for SUVmaxWB, ln(MTVWB), and ln(TLG(WB)). Interobserver variability was higher for SUVmeanWB with an ICC of 0.806.Conclusion Baseline metabolic tumor burdens at the level of whole-body tumor, primary tumor, nodal metastasis, and distant metastasis as measured with MTV and TLG on FDG PET are prognostic measures independent of clinical stage with low inter-observer variability and may be used to further stratify nonsurgical patients with NSCLC. This study also suggests MTV and TLG are better prognostic measures than SUVmax and SUVmean. These results will need to be validated in larger cohorts in a prospective study.