Prognostic Significance of Intratumoral Metabolic Heterogeneity on 18F-FDG PET/CT in Pathological N0 Non-Small Cell Lung Cancer
Prognostic Significance of Intratumoral Metabolic Heterogeneity on 18F-FDG PET/CT in Pathological N0 Non-Small Cell Lung Cancer
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DOI：
10.1097/rlu.0000000000000867
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发表时间：
2015-09-01
影响因子：
10.6
通讯作者：
Ahn, Byeong-Cheol
中科院分区：
文献类型：
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作者：
Kim, Do-Hoon;Jung, Ji-hoon;Ahn, Byeong-Cheol
目的探讨肿瘤内代谢异质性对F-18-FDG预处理PET/CT对肺癌根治性手术切除后病理N0 （pN0）患者预后的影响。方法119例（M/F = 79/40，平均年龄64.6 9.0岁）均行F-18- fdg PET/CT预处理，术后诊断为pN0的腺癌（ADC, n = 67）或鳞状细胞癌（SQCC, n = 52）。测量原发病变的异质性因子（Heterogeneity factor， HF）及其他代谢参数(SUVmax、代谢性肿瘤体积（metabolic tumor volume， MTV）、病灶糖酵解总量（total lesion glycolysis， TLG），并分析结果是否复发。计算原发性病变的HF，定义为体积阈值函数从20%到80%的导数。采用Kaplan-Meier法和Cox比例风险模型对复发进行单因素和多因素分析。结果ADC与SQCC患者的SUVmax、MTV、TLG、HF差异有统计学意义。119例患者中41例（34.5%）复发（ADC, 25/67 = 37.3% vs SQCC, 16/52 = 30.8%）。单因素分析结果表明，ADC的SUVmax、MTV、TLG和HF以及SQCC的TLG和HF是复发的预测因子。在多变量分析中调整性别、年龄和组织学分级后，ADC的高SUVmax、MTV、TLG和HF显示出与复发风险增加相关。结论F-18-FDG PET/CT前处理的代谢参数和原发肿瘤异质性可预测ADC型pN0 NSCLC患者的复发，但不能预测SQCC型患者的复发。
Purpose The aim of the study was to evaluate the prognostic significance of intratumoral metabolic heterogeneity on pretreatment F-18-FDG PET/CT in patients with lung cancer who were pathologically N0 (pN0) after curative surgical resection.Methods We examined 119 patients (M/F = 79/40; mean age, 64.6 9.0 years) who had undergone pretreatment F-18-FDG PET/CT and were diagnosed as pN0 after curative surgery for adenocarcinoma (ADC; n = 67) or squamous cell carcinoma (SQCC; n = 52). Heterogeneity factor (HF) and other metabolic parameters (SUVmax, metabolic tumor volume [MTV] and total lesion glycolysis [TLG]) for the primary lesions were measured, and the results were analyzed for recurrence. The HF, defined as the derivative of the volume-threshold function from 20% to 80%, was computed for primary lesions. Univariate and multivariate analyses for recurrence were performed using the Kaplan-Meier method and using the Cox proportional hazards model.Results SUVmax, MTV, TLG, and HF were statistically different between patients with ADC and SQCC. Forty-one (34.5%) of 119 patients experienced recurrence (ADC, 25/67 = 37.3% vs. SQCC, 16/52 = 30.8%). Results of univariate analysis indicate that SUVmax, MTV, TLG, and HF in ADC and TLG and HF in SQCC were predictors for recurrence. After adjusting for sex, age, and histological grade in multivariate analysis, high SUVmax, MTV, TLG, and HF in ADC exhibited an association with increased risk of recurrence.Conclusions Metabolic parameters and heterogeneity of primary tumor on pretreatment F-18-FDG PET/CT can predict recurrence in pN0 NSCLC patients of ADC type who have undergone curative surgery but not in patients of SQCC type.