Diagnostic performance and prognostic impact of FDG-PET in suspected recurrence of surgically treated non-small cell lung cancer
Diagnostic performance and prognostic impact of FDG-PET in suspected recurrence of surgically treated non-small cell lung cancer
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DOI：
10.1007/s00259-005-1919-4
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发表时间：
2006-01-01
影响因子：
9.1
通讯作者：
Kirsch, CM
中科院分区：
文献类型：
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作者：
Hellwig, D;Gröschel, A;Kirsch, CM
目的：肺癌复发和治疗后变化的鉴别仍然是放射影像学的一个问题，但FDG-PET可以通过可视化葡萄糖代谢来实现组织的生物学特征。我们评估了FDG-PET在疑似肺癌复发病例中的诊断性能和预后影响。方法：对连续62例肺癌手术治疗后疑似复发的患者进行73次FDG-PET扫描。以标准化摄取值（SUV）测量病灶对FDG的摄取。PET结果与活检或影像学随访确定的最终诊断进行比较。对SUV和临床参数作为预后因素进行分析。结果：FDG-PET正确识别55例复发中的51例，18例缓解中的16例给出真阴性结果（敏感性、特异性、准确性：93%、89%、92%）。复发肿瘤的SUV高于治疗后良性肿瘤（10.6 +/- 5.1 vs 2.1 +/- 0.6, p< 0.001）。复发肿瘤中FDG摄取较低的患者中位生存期更长（SUV< 11.18个月，SUV >= 11.9个月，p< 0.01）。手术和非手术再治疗的中位生存期没有差异（11个月vs 12个月，p= 0.0627），但主要在手术再治疗后观察到长期生存（3年生存率为38%）。对于随后接受手术治疗的患者，较低的FDG摄取预示着更长的中位生存期（SUV< 11.46个月，SUV >= 11.3个月，p< 0.001）。复发肿瘤的SUV是一个独立的预后因素（p< 0.05）。结论：FDG-PET能准确检测肺癌复发。复发肿瘤的SUV是一个独立的预后因素。FDG-PET有助于选择将受益于手术再治疗的患者。
Purpose: The differentiation of recurrent lung cancer and post-therapeutic changes remains a problem for radiological imaging, but FDG-PET allows biological characterisation of tissues by visualising glucose metabolism. We evaluated the diagnostic performance and prognostic impact of FDG-PET in cases of suspected relapse of lung cancer.Methods: In 62 consecutive patients, 73 FDG-PET scans were performed for suspected recurrence after surgical therapy of lung cancer. FDG uptake by lesions was measured as the standardised uptake value (SUV). PET results were compared with the final diagnosis established by biopsy or imaging follow-up. SUV and clinical parameters were analysed as prognostic factors with respect to survival.Results: FDG-PET correctly identified 51 of 55 relapses and gave true negative results in 16 of 18 remissions ( sensitivity, specificity, accuracy: 93%, 89%, 92%). SUV in recurrent tumour was higher than in benign post-therapeutic changes (10.6 +/- 5.1 vs 2.1 +/- 0.6, p< 0.001). Median survival was longer for patients with lower FDG uptake in recurrent tumour (SUV< 11: 18 months, SUV >= 11: 9 months, p< 0.01). Long-term survival was observed mainly after surgical re-treatment (3-year survival rate 38%), even if no difference in median survival for surgical or non-surgical re-treatment was detected ( 11 vs 12 months, p= 0.0627). For patients subsequently treated by surgery, lower FDG uptake predicted longer median survival ( SUV< 11: 46 months, SUV >= 11: 3 months, p< 0.001). SUV in recurrent tumour was identified as an independent prognostic factor ( p< 0.05).Conclusion: FDG-PET accurately detects recurrent lung cancer. SUV in recurrent tumour is an independent prognostic factor. FDG-PET helps in the selection of patients who will benefit from surgical re-treatment.