摘要
目的探讨^(18)F-氟脱氧葡萄糖(FDG)PET/CT代谢参数对初诊不同分期[广泛期(ES)和局限期(LS)]小细胞肺癌(SCLC)患者预后的预测价值。方法回顾性分析2019年1月至2020年12月于郑州大学第一附属医院初诊为SCLC的118例患者(LS-SCLC 42例、ES-SCLC 76例)的临床资料及影像资料,其中男性97例、女性21例,年龄(62.9±10.3)岁。收集患者的基本临床资料(年龄、性别、吸烟史、体重减轻情况),血清肿瘤标志物[癌胚抗原(CEA)、神经元特异性烯醇化酶(NSE)],PET/CT代谢参数[以40%最大标准摄取值(SUVmax)和标准摄取值(SUV)=2.5为临界值计算的全身肿瘤代谢体积(wbMTV_(40%)、wbMTV_(2.5))和全身病灶糖酵解总量(wbTLG40%、wbTLG2.5)],肿瘤、淋巴结、转移分期,美国退伍军人肺癌协会分期及免疫组织化学检查结果。以总生存期(OS)为观察指标。随访时间截至2023年11月30日。计量资料的组间比较采用Mann-WhitneyU检验;计数资料的组间比较采用χ^(2)检验。采用Kaplan-Meier法计算生存率,采用Log-rank检验比较生存差异以进行单因素分析;将单因素分析中差异有统计学意义的变量纳入Cox比例风险回归模型进行多因素分析;采用多因素分析中差异有统计学意义的指标绘制受试者工作特征(ROC)曲线并评估预测效能。结果76例ES-SCLC患者死亡62例(81.6%)、存活14例(18.4%),中位OS为15.0个月(95% CI:13.1~16.9);42例LS-SCLC患者死亡30例(71.4%)、存活12例(28.6%),中位OS为22.0个月(95%CI:15.8~28.2),2组患者中位OS的差异有统计学意义(Z=-2.22,P=0.026)。单因素分析结果显示,wbMTV_(2.5)(χ^(2)=6.01,P=0.014)、wbTLG2.5(χ^(2)=7.45,P=0.006)、血清CEA(χ^(2)=8.01,P=0.005)、年龄(χ^(2)=4.33,P=0.037)是影响ES-SCLC患者OS的预后因素;SUVmax(χ^(2)=3.90,P=0.048)、wbMTV_(2.5)(χ^(2)=3.86,P=0.049)、血清CEA(χ^(2)=7.93,P=0.005)是影响LS-SCLC患者OS的预后因素。多因素分析结果显示,血清CEA(HR=2.76,95%CI:1.31~5.82,P=0.008)是LS-SCLC患者OS的独立预后因素;血清CEA(HR=2.68,95%CI:1.49~4.81,P=0.001)、wbTLG2.5(HR=2.32,95%CI:1.38~3.90,P=0.002)、wbMTV_(2.5)(HR=2.17,95%CI:1.29~3.66,P=0.003)是ES-SCLC患者OS的独立预后因素。ROC曲线分析结果显示,ES-SCLC患者AUC为0.80(95%CI:0.68~0.93,P<0.001),灵敏度为85.5%,特异度为64.3%;LS-SCLC患者AUC为0.83(95%CI:0.68~0.97,P<0.001),灵敏度为86.7%,特异度为75.0%。结论^(18)F-FDG PET/CT代谢参数对SCLC患者预后具有预测价值,其中wbMTV_(2.5)和wbTLG2.5是ES-SCLC患者OS的独立预后因素,可为SCLC的临床治疗提供参考。
Objective To investigate the predictive value of ^(18)F-fluorodeoxyglucose(FDG)PET/CT metabolic parameters for the prognosis of patients newly diagnosed with small cell lung carcinoma(SCLC)of different stages(extensive stage(ES)and limited stage(LS)).Methods A retrospective analysis was conducted on the clinical and imaging data of 118 patients newly diagnosed with SCLC(42 LS-SCLC and 76 ES-SCLC)at the First Affiliated Hospital of Zhengzhou University from January 2019 to December 2020.The cohort comprised 97 males and 21 females,with an age of(62.9±10.3)years.Basic clinical data(age,sex,smoking history,and weight loss);serum tumor markers(carcinoembryonic antigen(CEA),neuron specific enolase(NSE));PET/CT metabolic parameters(whole-body metabolic tumor volume(wbMTV_(40%),wbMTV_(2.5))and whole-body total lesion glycolysis(wbTLG40%,wbTLG2.5)calculated using thresholds of 40% of maximum standardized uptake value(SUVmax)and standardized uptake value(SUV)=2.5);tumor,node,metastasis staging;Veterans Administration Lung Study Group of the United States staging;and immunohistochemistry results were collected.Overall survival(OS)was the primary endpoint.The patients were followed up until November 30,2023.The Mann-Whitney U test was used for intergroup comparisons of measurement data,and theχ^(2) test was used for count data.Survival rates were calculated using the Kaplan-Meier method,and survival differences were compared with the Log-rank test for univariate analysis.Variables with statistical significance in univariate analysis were included in a Cox proportional hazards regression model for multivariate analysis.Receiver operating characteristic(ROC)curve were constructed for indicators significant in multivariate analysis to evaluate predictive efficacy.Results Among the 76 patients with ES-SCLC,62 died(81.6%)and 14 survived(18.4%),with a median OS of 15.0 months(95%CI:13.1–16.9).Among the 42 patients with LS-SCLC,30 died(71.4%)and 12 survived(28.6%),with a median OS of 22.0 months(95%CI:15.8–28.2).The difference in median OS between the two groups was statistically significant(Z=−2.22,P=0.026).Univariate analysis showed that wbMTV_(2.5)(χ^(2)=6.01,P=0.014),wbTLG2.5(χ^(2)=7.45,P=0.006),serum CEA(χ^(2)=8.01,P=0.005),and age(χ^(2)=4.33,P=0.037)were prognostic factors for OS in patients with ES-SCLC,whereas SUVmax(χ^(2)=3.90,P=0.048),wbMTV_(2.5)(χ^(2)=3.86,P=0.049),and serum CEA(χ^(2)=7.93,P=0.005)were prognostic factors for patients with LS-SCLC.Multivariate analysis indicated that serum CEA(HR=2.76,95%CI:1.31–5.82,P=0.008)was an independent prognostic factor for OS in patients with LS-SCLC,whereas serum CEA(HR=2.68,95%CI:1.49–4.81,P=0.001),wbTLG2.5(HR=2.32,95%CI:1.38–3.90,P=0.002),and wbMTV_(2.5)(HR=2.17,95%CI:1.29–3.66,P=0.003)were independent prognostic factors for patients with ES-SCLC.ROC curve analysis showed an area under the curve(AUC)of 0.80(95%CI:0.68–0.93,P<0.001)for patients with ES-SCLC,with a sensitivity of 85.5%and specificity of 64.3%.By contrast,the AUC for patients with LS-SCLC was 0.83(95%CI:0.68–0.97,P<0.001),with a sensitivity of 86.7%and specificity of 75.0%.Conclusions ^(18)F-FDG PET/CT metabolic parameters have predictive value for the prognosis of patients with SCLC.Specifically,wbMTV_(2.5) and wbTLG2.5 are independent prognostic factors for OS in patients with ESSCLC,providing insights for clinical treatment.
作者
李宏旭
韩星敏
陈平
王瑞华
程兵
杨萌
楚沛
王庆祝
Li Hongxu;Han Xingmin;Chen Ping;Wang Ruihua;Cheng Bing;Yang Meng;Chu Pei;Wang Qingzhu(Department of Nuclear Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《国际放射医学核医学杂志》
2025年第10期615-624,共10页
International Journal of Radiation Medicine and Nuclear Medicine
