Revisiting the prognostic value of preoperative (18)F-fluoro-2-deoxyglucose ( (18)F-FDG) positron emission tomography (PET) in early-stage (I & II) non-small cell lung cancers (NSCLC).
Revisiting the prognostic value of preoperative (18)F-fluoro-2-deoxyglucose ( (18)F-FDG) positron emission tomography (PET) in early-stage (I & II) non-small cell lung cancers (NSCLC).
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DOI：
10.1007/s00259-009-1291-x
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发表时间：
2010-04
影响因子：
9.1
通讯作者：
Wong, Ching-Yee Oliver
中科院分区：
文献类型：
--
作者：
Agarwal, Mohit;Brahmanday, Govinda;Bajaj, Sunil K.;Ravikrishnan, K. P.;Wong, Ching-Yee Oliver
目的是确定术前18f -氟-2-脱氧葡萄糖（18F-FDG）正电子发射断层扫描（PET）测定的原发肿瘤的最大标准化摄取值（SUVmax）是否是总生存的独立预测因子，并根据病理分期分层后评估其预后价值。对363例早期（I和II）非小细胞肺癌（NSCLC）患者进行回顾性临床病理回顾，这些患者在尝试根治性切除术之前进行了术前18F-FDG PET检查。接受过任何辅助或新辅助化疗或放疗的患者被排除在外。主要结局指标是总生存时间。绘制受试者工作特征（ROC）曲线，以找出SUVmax的最佳截止值，从而获得预测总生存期的最大灵敏度和特异性。生存曲线以SUVmax中值和SUVmax最佳截断值分层，采用Kaplan-Meier法估计，采用log-rank检验评估统计学差异。应用多因素比例风险（Cox）回归分析检验SUVmax与其他预后因素预测总生存的独立性。中位随访时间为981天（2.7年）。所有受试者的中位SUVmax为5.9，IA期为4.5，IB期为8.4，IIB期为10.9。所有受试者的最佳SUVmax临界值为8.2。对于特定阶段，无法确定最佳截止时间。在单变量分析中，SUVmax每增加一倍[即，SUVmax每增加log （base 2）个单位]与死亡风险增加1.28倍相关[95%置信区间（CI）： 1.03-1.59, p = 0.029]。单因素分析显示，根据病理分期对数据进行分层时，SUVmax的生存率无显著差异（IA、IB和IIB期分别为p = 0.119、p = 0.818和p = 0.882）。多变量分析表明，SUVmax不是总生存的独立预测因子（p < 0.05）。术前PET测定的SUVmax每增加一倍，早期（I和II） NSCLC死亡风险增加1.28倍。术前SUVmax不是总生存的独立预测因子。
The aims were to determine if the maximum standardized uptake value (SUVmax) of the primary tumor as determined by preoperative 18F-fluoro-2-deoxyglucose (18F-FDG) positron emission tomography (PET) is an independent predictor of overall survival and to assess its prognostic value after stratification according to pathological staging. A retrospective clinicopathologic review of 363 patients who had a preoperative 18F-FDG PET done before undergoing attempted curative resection for early-stage (I & II) non-small cell lung cancer (NSCLC) was performed. Patients who had received any adjuvant or neoadjuvant chemotherapy or radiation therapy were excluded. The primary outcome measure was duration of overall survival. Receiver-operating characteristic (ROC) curves were plotted to find out the optimal cutoff values of SUVmax yielding the maximal sensitivity plus specificity for predicting the overall survival. Survival curves stratified by median SUVmax and optimal cutoff SUVmax were estimated by the Kaplan-Meier method and statistical differences were assessed using the log-rank test. Multivariate proportional hazards (Cox) regression analyses were applied to test the SUVmax’s independency of other prognostic factors for the prediction of overall survival. The median duration of follow-up was 981 days (2.7 years). The median SUVmax was 5.9 for all subjects, 4.5 for stage IA, 8.4 for stage IB, and 10.9 for stage IIB. The optimal cutoff SUVmax was 8.2 for all subjects. No optimal cutoff could be established for specific stages. In univariate analyses, each doubling of SUVmax [i.e., each log (base 2) unit increase in SUVmax] was associated with a 1.28-fold [95% confidence interval (CI): 1.03–1.59, p = 0.029] increase in hazard of death. Univariate analyses did not show any significant difference in survival by SUVmax when data were stratified according to pathological stage (p = 0.119, p = 0.818, and p = 0.882 for stages IA, IB, and IIB, respectively). Multivariate analyses demonstrated that SUVmax was not an independent predictor of overall survival (p > 0.05). Each doubling of SUVmax as determined by preoperative PET is associated with a 1.28-fold increase in hazard of death in early-stage (I & II) NSCLC. Preoperative SUVmax is not an independent predictor of overall survival.
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