目的 探讨表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKI)单药治疗前基线18F-FDG PET/CT代谢参数预测Ⅲ～Ⅳ期肺腺癌患者的疗效及预后价值.方法 回顾性收集2012年1月至2020年6月于北京医院EGFR-TKI单药治疗且治疗前1个月内完成基线18F-FDG PET/CT显像的61例Ⅲ～Ⅳ期肺腺癌患者(男19例、女42例,中位年龄64岁)的资料.分析临床资料及18F-FDG摄取最高病灶的代谢参数,包括SUVmax、瘦体质量SUVmax(SULmax)、瘦体质量SUV峰值(SULpeak)、肿瘤代谢体积(MTV)、病灶糖酵解总量(TLG).随访患者治疗后疗效、无进展生存(PFS)和总生存(OS).采用ROC曲线分析获得各代谢参数预测疾病缓解、疾病进展的最佳界值,采用Kaplan-Meier法、log-rank检验及Cox比例风险回归模型分析影响患者PFS和OS的预后因素.结果 疗效评估为疾病缓解者42.9％(24/56),SULpeak、SUVmax、SULmax、MTV、TLG 预测疾病缓解的最佳界值分别为 5.9、13.1、11.1、10.6 ml、99.6 g,SUVmax＞13.1 组、MTV＞10.6 ml 组、TLG＞99.6 g 组的疾病缓解率明显高于 SUVmax ≤13.1 组[51.2％(21/41)和 3/15;x2=4.37,P=0.037]、MTV≤10.6 ml 组[9/12 和 36.6％(15/41);x2=5.53,P=0.019]、TLG≤99.6 g 组[10/13 和 35.0％(14/40);x2=6.96,P=0.008].随访 0.05～6.80 年,10.3％(6/58)无疾病进展,44.3％(27/61)患者死亡.SULpeak、SUVmax、SULmax、MTV、TLG 预测 PFS 的最佳界值分别为 11.2、17.0、13.7、2.7 ml、14.8 g;预测 OS 的最佳界值分别为 5.6、14.3、8.8、2.8 ml、37.3 g.从未吸烟、SUVmax≤17.0、SULpeak≤11.2患者的PFS期明显延长(x2值:3.87～7.37,均P＜0.05),其中从未吸烟[风险比(HR)=2.29,95％CI:1.08～4.87,P=0.031]、SULpeak≤11.2(HR=2.67,95％CI:1.35～5.27,P=0.005)是 PFS 期延长的独立预测因子.Ⅲ+Ⅳ A 期、SUVmax ≤ 14.3、SULpeak ≤ 5.6、SULmax ≤8.8、TLG≤37.3 g 患者的 OS 期明显延长(x2 值:5.78～8.83,均 P＜0.05),其中 Ⅲ+ⅣA 期(HR=2.81,95％CI:1.08～7.32,P=0.034)、SULmax ≤8.8(HR=9.66,95％CI:1.25～74.91,P=0.030)是 OS 延长的独立预测因子.结论 Ⅲ～Ⅳ期肺腺癌患者EGFR-TKI单药治疗前基线18F-FDG PET/CT显像具有较好的临床应用价值,基线肿瘤代谢活性高者缓解率更高;吸烟史、SULpeak是PFS的独立预测因子,SULmax及分期是OS的独立预测因子.
Value of baseline 18F-FDG PET/CT metabolism parameters in patients with stage Ⅲ-Ⅳ lung adeno-carcinoma before EGFR-TKI monotherapy
Objective To investigate the efficacy and prognostic value of baseline18F-FDG PET/CT metabolism parameters in patients with stage Ⅲ-Ⅳ lung adenocarcinoma before epidermal growth factor receptor tyrosine kinase inhibitor(EGFR-TKI)monotherapy.Methods From January 2012 to June 2020,61 patients(19 males,42 females;median age:64 years)with stage Ⅲ-Ⅳ lung adenocarcinoma who un-derwent baseline 18F-FDG PET/CT imaging before EGFR-TKI monotherapy in 1 month in Beijing Hospital were retrospectively analyzed.The clinical data and metabolic parameters including SUVmax,SUVmax of lean body mass(SULmax),peak of SUV of lean body mass(SULpeak),metabolic tumor volume(MTV),and to-tal lesion glycolysis(TLG)of the hottest lesions on PET were analyzed.Patients were followed up to obtain the efficacy evaluation,progression-free survival(PFS)and overall survival(OS).ROC curve analysis was performed to obtain the optimal cut-off value of metabolic parameters to predict disease remission and prog-nosis.Kaplan-Meier method,log-rank test and Cox proportional risk regression model were used to analyze the prognostic factors.Results After EGFR-TKI monotherapy,42.9％(24/56)patients were in disease re-mission.The optimal cut-off values for predicting disease remission of SULpeak,SUVmax,SULmax,MTV,and TLG were 5.9,13.1,11.1,10.6 ml and 99.6 g,respectively.The remission rates of patients with SUVmax＞13.1,MTV＞10.6 ml and TLG＞99.6 g were significantly higher than those of patients with SUVmax ≤ 13.1(51.2％(21/41)vs 3/15;x2=4.37,P=0.037),MTV ≤10.6 ml(9/12 vs 36.6％(15/41);x2=5.53,P=0.019)and TLG≤99.6 g(10/13 vs 35.0％(14/40);x2=6.96,P=0.008).The follow-up period for sur-vival was 0.05-6.80 years,and 10.3％(6/58)patients had no disease progression,and 44.3％(27/61)patients died.The optimal cut-off values of SULpeak,SUVmax,SULmax,MTV,and TLG for PFS were 11.2,17.0,13.7,2.7 ml and 14.8 g,and those for OS were 5.6,14.3,8.8,2.8 ml and 37.3 g,respectively.Patients with never-smoking,SUVmax≤17.0 and SULpeak≤ 11.2 had longer PFS(x2 values:3.87-7.37,all P＜0.05);never-smoking history(hazard ratio(HR)=2.29,95％CI:1.08-4.87,P=0.031)and SULpeak ≤ 11.2(HR=2.67,95％CI:1.35-5.27,P=0.005)were independent predictors for PFS.Patients with stage Ⅲ+ⅣA,SUVmax≤14.3,SULpeak≤5.6,SULmax≤8.8 and TLG≤37.3 g had longer OS(x2 values:5.78-8.83,all P＜0.05);stage Ⅲ+ⅣA(HR=2.81,95％CI:1.08-7.32,P=0.034)and SULmax ≤8.8(HR=9.66,95％CI:1.25-74.91,P=0.030)were independent predictors for OS.Conclusions Baseline 18F-FDG PET/CT imaging has good prospect in clinical application in patients with stage Ⅲ-Ⅳ lung adenocarcinoma before EGFR-TKI monotherapy.The higher baseline metabolic activity of tumor in the 18F-FDG PET/CT,the higher remission rate.Smoking history and SULpeak are independent predictors for PFS;SULmax and stage are independent predictors for OS.
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