Prognostic Value of Metabolic Tumor Burden from 18F-FDG PET in Surgical Patients with Non-small-cell Lung Cancer
Prognostic Value of Metabolic Tumor Burden from 18F-FDG PET in Surgical Patients with Non-small-cell Lung Cancer
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DOI：
10.1016/j.acra.2012.07.002
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发表时间：
2013-01-01
影响因子：
4.8
通讯作者：
Pu, Yonglin
中科院分区：
文献类型：
--
作者：
Zhang, Hao;Wroblewski, Kristen;Pu, Yonglin
目的：评估代谢肿瘤负荷的预后价值，通过 2-脱氧-2-(F-18)氟-D-葡萄糖 (F-18-FDG) 正电子发射断层扫描 (PET)/计算机断层扫描 (CT) 上的代谢肿瘤体积 (MTV) 和总病灶糖酵解 (TLG) 测量，独立于当前的国际抗癌联盟/美国癌症肿瘤、淋巴结和转移联合委员会（TNM）阶段；与非小细胞肺癌 (NSCLC) 手术患者的标准化摄取值 (SUV) 进行比较。 材料和方法：本研究回顾性分析了 104 名连续进行 F-18-FDG PET/CT 扫描的诊断为 I 至 IV 期 NSCLC 的手术患者（47 名男性，57 名女性，PET/CT 扫描中位年龄为 67.92 岁）。 F-18-FDG PET/CT 扫描是根据国家癌症研究所指南进行的。测量全身肿瘤MTV（MTVWB）、全身肿瘤TLG（TLG（WB））、全身肿瘤最大标准化摄取值（SUVmaxWB）以及全身肿瘤平均标准化摄取值（SUVmeanWB）。 67 名幸存者的 PET/CT 随访中位时间为 42.07 个月（范围 2.82-80.95 个月）。统计方法包括 Kaplan-Meier 曲线、Cox 回归和 C 统计。使用一致性相关系数（CCC）分析两个观察者之间 SUVmaxWB、SUVmeanWB、MTVWB 和 TLG(WB) 的观察者间变异性。结果：SUVmaxWB、SUVmeanWB、MTVWB 和 TLG(WB) 的观察者间变异性非常低，CCC 大于 0.882。分期与总生存期 (OS) 存在统计学上显着的关联。与 I 期相比，III 期和 IV 期的风险比 (HR) 分别为 3.60 (P = .001) 和 4.00 (P = .013)。 MTVWB 与 OS 显着相关，In(MTVWB) 每增加 1 个单位，HR 为 1.40/1.32 (P = .004/.039)，在调整分期和其他预后因素（包括放化疗和外科手术）之前/之后。 TLG(WB) 与调整分期和其他预后因素之前和之后的 OS 具有统计学显着相关性。调整前和调整后，In(TLG(WB)) 每增加 1 个单位，HR 分别为 1.26 (P = .011) 和 1.25 (P = .031)。患有导致全肺切除术（HR = 2.82，P = .035）或肺段切除术（HR = 3.44，P = .044）的受试者的生存率明显低于需要肺叶切除术的受试者。 OS 与年龄、性别、肿瘤组织学、In(SUVmaxWB) 和 In(SUVmeanWB) 之间没有统计学显着相关性（所有 P > .05）。随访期间有 37 例死亡。结论：通过 FDG PET 上的 MTVWB 和 TLG(WB) 测量的基线全身代谢肿瘤负荷是一项独立于临床分期和其他预后因素（包括放化疗和手术操作）的预后测量，观察者间变异性较低，可用于进一步对 NSCLC 手术患者进行风险分层。这项研究还表明，MTV 和 TLG 是比 SUVmax 和 SUVmean 更好的预后指标。这些结果需要在前瞻性研究中在更大的队列中进行验证。
Objective: To assess the prognostic value of metabolic tumor burden as measured with metabolic tumor volume (MTV) and total lesion glycolysis (TLG) on 2-deoxy-2-(F-18)fluoro-D-glucose (F-18-FDG) positron emission tomography (PET)/computed tomography (CT), independent of current Union Internacional Contra la Cancrum/American Joint Committee on Cancer tumor, node, and metastasis (TNM) stage; in comparison with that of standardized uptake value (SUV) in surgical patients with non-small-cell lung cancer (NSCLC).Material and Methods: This study retrospectively reviewed 104 consecutive surgical patients (47 males, 57 females, median age at PET/CT scan of 67.92 years) with diagnosed stage I to IV NSCLC who had baseline 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 tumors in the whole body (MTVWB), TLG of tumors in the whole body (TLG(WB)), the maximum standardized uptake value of tumors in the whole body (SUVmaxWB) as well as the mean standardized uptake value of tumor in the whole body (SUVmeanWB) were measured. The median follow-up among 67 survivors was 42.07 months from the PET/CT (range 2.82-80.95 months). Statistical methods included Kaplan-Meier curves, Cox regression, and C-statistics. The interobserver variability of SUVmaxWB, SUVmeanWB, MTVWB, and TLG(WB) between two observers was analyzed using concordance correlation coefficients (CCCs).Results: The interobserver variability of SUVmaxWB, SUVmeanWB, MTVWB and TLG(WB) was very low with CCCs greater than 0.882. There was a statistically significant association of stage with overall survival (OS). The hazard ratio (HR) of stage III and stage IV as compared with stage I was 3.60 (P = .001) and 4.00 (P = .013), respectively. The MTVWB was significantly associated with OS with a HR for 1-unit increase of In(MTVWB) of 1.40/1.32 (P = .004/.039), before/after adjusting for stage and other prognostic factors including chemoradiation therapy, and surgical procedure, respectively. TLG(WB) had a statistically significant association with OS before and after adjusting for stage and the other prognostic factors. The HR for 1-unit increase in In(TLG(WB)) was 1.26 (P = .011) and 1.25 (P = .031), before and after the adjustment, respectively. Subjects with conditions that led to pneumonectomy (HR = 2.82, P = .035) or segmental resection (HR = 3.44, P = .044) had significantly worse survival than those needing lobectomy. There was no statistically significant association between OS and age, gender, tumor histology, In(SUVmaxWB), and In(SUVmeanWB) (all P > .05). There were 37 deaths during follow-up.Conclusion: Baseline whole-body metabolic tumor burden as measured with MTVWB and TLG(WB) on FDG PET is a prognostic measure independent of clinical stage and other prognostic factors including chemoradiation therapy and surgical procedure with low interobserver variability and may be used to further risk stratify surgical patients with NSCLC. This study also suggests that 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.