18F-FDG PET/CT显像评价非小细胞肺癌放化疗疗效及复发预测

目的:探讨非小细胞肺癌(NSCLC)患者放化疗前后18F- FDG摄取及其变化率与无进展生存期(PFS)的相关性,进行疗效反应分组,并与其他预后因子比较预测复发能力.方法:回顾性分析38例在放化疗前后于我科进行PET/CT检查的NSCLC患者,每例患者收集3组数据:治疗前SUV(SUV1)、治疗后SUV(SUV2)及治疗前后SUV变化率(△SUV％),分析三者与PFS的相关性,对相关性最强的因素进一步分析以确定划分治疗有无反应的临界值.结果:SUV1与PFS没有相关性(Pearson r=0.078,P=0.641);腺癌和非腺癌患者的SUV1具有显著性差异(P=0.025)；不同临床分期的NSCLC患者的SUV1不具有显著性差异(P=0.839).SUV2与PFS呈显著负相关(Pearson r=- 0.354,P=0.029)；腺癌患者SUV2小于非腺癌患者(P=0.017)；Ⅰ～Ⅲa期患者SUV2小于Ⅲb～Ⅳ期患者(P=0.016).△SUV％与PFS呈显著正相关(Pearson r=0.503,P=0.001)；Ⅰ～Ⅲa期患者△SUV％大于Ⅲb～Ⅳ期患者(P=0.003)；不同病理类型患者的△SUV％没有显著性差异(P=0.348).△SUV％＞ 30％为有反应组,PFS显著长于无反应组；有/无反应组(x2=7.556,P=0.006)及腺癌/非腺癌组(x2=5.551,P=0.018)生存曲线差异有统计学意义,前者x2值略大于后者,但差异无统计学意义(x2=0.205,P＞0.05).结论:△SUV％与PFS相关性最佳,大于30％视为治疗有反应；根据△SUV％的疗效评估可比临床分期稍准确预测复发,但无显著差异.分期相同的患者根据SUV值可进一步划分为不同危险组来决定随访密度或治疗方案.

18F-FDG PET/CT for Response Evaluation and Recurrence Prediction before and after Chemoradiotherapy for NSCLC

Purpose:To evaluate the correlation between FDG uptake and progression- free survival （PFS） before and after chemoradiotherapy in patients with NSCLC.Methods:Thirty - eight patients with NSCLC who underwent ¹⁸F - FDG PET examinations before and after treatment in our department were retrospectively studied.Three groups of data from every patient were evaluated:SUVl,SUV2 and SUV%.The correlation between them and PFS were analyzed,and the most significant one was determined to obtain a cut - off value,which can divide the responding and non - responding groups.Results: SUVl had no significant correlation with PFS（Pearson r = 0.078,P = 0.641）.There was a significant difference in SUVl between adenocarcinoma and other histological types（P = 0.025）;no significant difference in SUVl between different clinical stages of NSCLC（P = 0.0839）.SUV2 had significant negative correlation with PFS（Pearson r = - 0.354,P = 0.029）;SUV2 in alveolarcarcinoma group was significantly smaller than that in non - alveolarcarcinoma group（P = 0.017）;SUV2 in stageⅠ-Ⅲa groups was significantly smaller than that in stageⅢb -Ⅳgroups（P = 0.016）.SUV%had significant correlation with PFS（Pearson r = 0.503,P = 0.001）;SUV%in stageⅠ-Ⅲa groups was significantly smaller than that in stageⅢb-Ⅳgroups（P = 0.003）.There was no significant difference in△SUV%between different histological types（P = 0.348）.The SUV%of responding groups was less than 30%and the PFS was longer than that of non - responding groups.There were significant differences of survival curves between responding and non - responding groups（x² = 7.556,P = 0.006）,and between alveolarcarcinoma and non - alveolarcarcinoma patients（x² = 5.551,P = 0.018）.Conclusion:SUV%has the most significant correlation with PFS,it can be identified as responding groups when ASUV%is more than 30%;The treatment response assessed by SUV%might be superior than clinical stages in predicting recurrence,but there is no significant difference between them.And it may contribute to subdivide patients with the same TNM stage for appropriate follow - up or treatment strategies.