非小细胞肺癌18F-FDG摄取与EGFR突变的关系

【目的】 探讨非小细胞肺癌原发病灶18F氟代脱氧葡萄糖(18F-FDG)摄取与表皮生长因子受体突变的相互关系,及应用最大标准化摄取值预测EGFR突变以期指导临床酪氨酸激酶抑制剂的应用。【方法】从2006年11月到2010年9月,收集66例在抗肿瘤治疗之前行EGFR突变检测及PET/CT扫描的NSCLC患者,用SUVmax描述原发病灶的18F-FDG摄取情况,采用荧光定量PCR法检测患者EGFR的突变情况,分析FDG摄取与EGFR突变的关系。【结果】 本组病例中EGFR的19号及21号外显子的突变率为33%,突变型患者原发灶的SUVmax低于野生型患者(10 ± 5,14 ± 6,P = 0.006)。SUVmax与EGFR突变存在负相关关系(r = -0.344,P = 0.005)。在用SUVmax预测EGFR突变时,受试者工作特征曲线下面积(area under receiver operating characteristic curve,AUC)是0.71,P = 0.006;当SUVmax取界值8.8时,约登指数达到最大值为0.44,SUVmax低于此界值的患者比高于此值的患者更容易发生EGFR突变(71%,20%,P = 0.000)。【结论】 原发病灶18F-FDG摄取与NSCLC患者EGFR突变存在着相关关系,低SUVmax的患者更容易发生EGFR突变,对非小细胞肺癌患者是否适用TKI治疗提供了一定的依据。

Relationship between 18F-FDG Uptake and EGFR Mutations in Non-Small Cell Lung Cancer

【Objective】 The relationship between 18F-fluoro-2-deoxy-glucose (18F-FDG) uptake of primary tumor and epidermal growth factor receptor (EGFR) mutations in patients with non-small cell lung cancer (NSCLC) was investigated in this study. EGFR mutations were predicted by maximum standard uptake value (SUVmax) for clinical application of tyrosine kinase inhibitors (TKI). 【Methods】 Totally 66 patients dated from November 2006 to September 2010 were collected, who underwent PET / CT examinations and EGFR mutation tests by fluorescent quantitative PCR before any anti-tumor therapies. The 18F-FDG uptake of primary lesions was described with SUVmax, then the relationship was analyzed. 【Results】 EGFR mutations within exons 19 and 21 were detected in 22 NSCLC patients (33%). The SUVmax was significantly lower in EGFR mutant-type than wild-type (10 ± 5, 14 ± 6, P = 0.006). The SUVmax and EGFR mutations were performed as negative correlation(r = -0.344, P = 0.005). For the prediction of EGFR mutations by SUVmax, the area under the receiver operating characteristic curve (AUC) was 0.71(P = 0.006), when the cut off value was 8.8, the Youden Index reached the maximum value (0.43). Patients with low SUVmax were more likely to carry EGFR mutations than those with high SUVmax (71%, 20%, P = 0.000). 【Conclusion】 The 18F-FDG uptake of primary tumor in NSCLC patients was negatively correlated with EGFR mutations, patients with lower SUVmax were more likely to harbor EGFR mutations. For the advanced NSCLC patient, it might be helpful to identify who is suitable to TKI treatment.