Prognostic value of preoperative positron emission tomography in resected stage I non-small cell lung cancer
Prognostic value of preoperative positron emission tomography in resected stage I non-small cell lung cancer
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DOI：
10.1097/jto.0b013e318160c122
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发表时间：
2008-02-01
影响因子：
20.4
通讯作者：
Govindan, Ramaswamy
中科院分区：
文献类型：
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作者：
Goodgame, Boone;Pillot, Giancarlo A.;Govindan, Ramaswamy
目的：手术切除的I期非小细胞肺癌（NSCLC）患者中约有20%至40%会复发。正电子发射断层扫描（PET）与2-[F-18]氟-2-脱氧-d -葡萄糖（FDG）常用于分期NSCLC。我们进行了这项研究，以确定术前最大肿瘤标准化摄取值（SUVmax）是否与切除的I期NSCLC患者的复发相关。患者和方法：我们确定了1999年至2003年间连续接受手术治疗的I期非小细胞肺癌患者，这些患者术前进行了FDG-PET成像。患者根据SUVmax高于或低于该组中位数分为两组。通过Kaplan-Meier法估计复发率，并分析总生存率作为次要终点。结果：在136例符合纳入标准的患者中，77例（57%）为T1肿瘤，59例（43%）为T2肿瘤。中位随访时间为46个月，32例复发。中位SUVmax为5.5。低SUVmax和高SUVmax患者的5年估计复发率分别为14%和37% (p = 0.002)， 5年总生存率分别为74%和53% （p = 0.006）。在基于SUVmax、t分类、年龄和组织学的多变量分析中，高SUVmax与复发（p = 0.002）和死亡率（p = 0.041）独立相关。结论：术前FDG-PET高SUVmax（>= 5.5）是切除的I期NSCLC复发和死亡的独立预测因子。应考虑对I期NSCLC和高SUVmax患者进行辅助化疗的前瞻性试验。
Purpose: Approximately 20 to 40% of patients with surgically resected stage I non-small cell lung cancer (NSCLC) will develop recurrent disease. Positron emission tomography (PET) with 2-[F-18] fluoro-2-deoxy-D-glucose (FDG) is used often in staging NSCLC. We conducted this study to determine whether the preoperative maximum tumor standardized uptake value (SUVmax) was associated with recurrence in patients with resected stage I NSCLC.Patients and Methods: We identified consecutive patients who underwent curative surgical resection for stage I NSCLC between 1999 and 2003 who had preoperative FDG-PET imaging. Patients were divided into two cohorts based on SUVmax above or below the median for the group. Recurrence rates were estimated by the Kaplan-Meier method and overall survival was analyzed as a secondary end point.Results: Of 136 patients who met inclusion criteria, 77 (57%) had T1 and 59 (43%) had T2 tumors. The median follow-up time was 46 months and 32 patients had a disease recurrence. The median SUVmax was 5.5. The 5-year estimates of recurrence rates for patients with low and high SUVmax were 14% and 37%, respectively (p = 0.002), with 5-year overall survivals of 74% and 53%, respectively (p = 0.006). In multivariate analyses based on SUVmax, T-classification, age, and histology, high SUVmax, was independently associated with recurrence (p = 0.002) and mortality (p = 0.041).Conclusion: High SUVmax (>= 5.5) on preoperative FDG-PET is an independent predictor of relapse and death in resected stage I NSCLC. Prospective trials of adjuvant chemotherapy in patients with stage I NSCLC and high SUVmax should be considered.