^18F-FDG PET／CT显像对肺癌临床治疗决策的影响

目的评价^18F-脱氧葡萄糖（FDG）PET／CT显像对肺癌分期、再分期及临床治疗决策的影响。方法收集2007年7—12月接受PET／CT检查的肺癌或肺癌经过手术、放疗或化疗至少1种治疗的患者为研究对象。通过临床医师填写问卷调查的方法了解患者临床治疗相关资料。PET／CT检查前及检查后问卷资料均齐全的病例为资料完整者。治疗方法主要分为手术、放疗、化疗、随访4种，改变主要分为不同治疗方式间和同一治疗方式内部2种。结果参考PET／CT检查前后问卷情况，资料完整符合要求的病例245例纳入研究进行分析，其中49．8％（122／245）为初次分期，50．2％（123／245）为治疗后再分期或治疗效果评价。PET／CT检查前后临床分期改变为26．5％（65／245），其中分期上调为17．1％（42／245），分期下调为9．4％（23／245），另外还有5．7％（14／245）的病例由于相应临床医师习惯参考PET／CT结果进行分期，故PET／CT检查影响临床分期32．2％（79／245）。PET／CT检查前后治疗方案改变为51．8％（127／245），不同治疗方式间改变为15．9％（39／245），同一治疗方式内部改变为35．9％（88／245）。结论^18F-FDG PET／CT显像可提高肺癌临床分期或再分期的准确性，进而影响肺癌临床治疗决策。

The impact of 18F-FDG PET/CT on the clinlcal strategies of patients with known or suspected lung cancer

Objective 18F-fluorodeoxyglucose (FDG) PET/CT is a whole-body molecular imaging modality with increasing application for staging,re-staging and guiding management in lung cancer.The objective of this study was to evaluate the impact of 18F-FDG PET/CT imaging on clinical strategies in lung cancer.Methods From July 2007 till Decemher 2007,18F-FDG PET/CT studies were performed in a total 245 lung cancer cases confirmed by pathology before or during treatment by at least one procedure of surgery,radiotherapy or chemotherapy.Clinical management data was acquired through questionnaires sent to the referring physicians.Cases with questionnaires completed both before and after the PET/CT scan were enrolled in this study.Treatment modality includes one of following:surgery,radiotherapy,chemotherapy and follow-up.Change in management was defined in 2 ways:inter-modality and intra-medality.Results Of a total 245 cases(166 males,79 females,and average age60.6 years),49.8%cases(122/245)were for initial staing,and 50.2%(123/245)for re-staging during or after completion of treatment.Staging was changed in 26.5%of initial staging cases(65/245),in which 17.1%(42/245)were up-graded,9.4% (23/245)were down-graded,while 5.7%(14/245)were staged according to the PET/CT result by the referring physicians.As a result,PET/CT affected 32.2%(79/245)of the lung cancer eases in TNM staging.PET/CT also changed treatment strategies in 51.8%(127/245)of the cases,including 15.9%(39/245)inter-modality and 35.9%(88/245)intra-modality.Conclusions 18F-FDG PET/CT improves the accuracy of TNM staging and re-staging in patients with known or suspected lung cancer.It also significantly affects management and treatment strategies.