非小细胞肺癌（NSCLC）的18F-FDG PET/CT显像原发灶代谢体积与转移的关系

目的 探讨非小细胞肺癌（NSCLC）的¹⁸F-FDG PET/CT显像原发灶代谢体积（MTV）与淋巴结和（或）远处转移的关系。方法 回顾性分析治疗前接受PET/CT全身扫描经病理检查证实的138例NSCLC患者，其中腺癌（腺癌组）92例、鳞癌（腺癌组）46例。分析两组间MTV的差异性，MTV与分化程度、年龄、病灶大小、密度及T分期等的相关性；采用二元Logistic回归分析预测转移的危险因素。结果 鳞癌组MTV明显高于腺癌组（F=28.390，P<0.001），整体（r=0.785、0.577）、鳞癌组（r=0.791、0.509）及腺癌组（r=0.720、0.439）MTV均与病灶大小、T分期呈正相关（P均<0.01），与年龄、病灶密度无明显相关性（P均>0.05），整体及腺癌组MTV与分化程度呈负相关（r=-0.631、-0.751，P均<0.01），鳞癌组MTV与分化程度无相关性（r=-0.351，P>0.05）；多因素Logistic回归分析仅MTV纳入回归方程（OR=1.096，P<0.001）；腺癌组与鳞癌组中，应用MTV评估转移的ROC曲线下面积分别为0.877、0.850（P<0.001），阈值分别为 2.49 cm³、18.49 cm³时，灵敏度、特异度分别为89.13%（41/46）、78.26%（36/46）和81.25%（26/32）、78.57%（11/14）。结论 NSCLC的¹⁸F-FDG PET/CT显像原发灶MTV是转移独立的影响因子，MTV越高提示发生转移的可能性越大。

Prognostic value of primary metabolic tumor volume on neoplasm metastasis in patients with non-small cell lung cancer

Objective To explore the relationship between the primary lesion metabolic tumor volume (MTV) of ¹⁸F -FDG PET/CT and lymph node metastasis and/or distant metastasis in patients with non-small cell lung cancer (NSCLC). Methods Totally 138 patients with NSCLC confirmed by pathology underwent ¹⁸F -FDG whole body PET/CT scans before treatment were analyzed retrospectively, including ninety-two patients with adenocarcinoma (AD, AD group) and forty-six patients with squamous cell carcinoma (SCC, SCC group). The difference of MTV between two groups was analyzed, The relationship between MTV and differentiation degree, age, lesion size, density and T stages were evaluated respectively. The prognostic factor of neoplasm metastasis were analyzed by Binary Logistic regression. Results The MTV in SCC group was significantly higher than that in AD group (F=28.39, P<0.001), MTV were positively related with lesion size and T stage (r=0.785, 0.577 in overall, 0.720, 0.439 in AD, 0.791, 0.509 in SCC, all P<0.01), but no relation to age and density (all P>0.05). MTV were negatively related with differentiation degree in both the overall analysis and AD group (r=-0.631 in overall, -0.751 in AD, P<0.01), but there was no relationship in SCC group. Only MTV was incorporated into the regression equation (OR=1.096, P<0.001) in multivariate Logistic regression analysis. The area under the ROC that MTV predict metastasis was 0.877 in AD group, 0.850 in SCC group (P<0.001). When cutoff value was 2.49 cm³,, 18.49 cm³, the sensitivity, specificity were 89.13% (41/46), 78.26% (36/46) and 81.25% (26/32), 78.57% (11/14) respectively. Conclusion MTV of NSCLC primary lesion on ¹⁸F-FDG PET/CT is an independent prognostic factor. The higher MTV means the higher metastasis potentiality.