18F-FDG PET/CT 与常规CT评价非小细胞肺癌早期化疗疗效的对照研究*

目的:探讨18F-FDGPET/CT 的早期肿瘤代谢疗效与常规CT依据R ECIST 标准（实体瘤疗效评价标准），评价非小细胞肺癌（non-smallcelllungcancer ，NSCLC ）化疗最佳客观疗效之间的关系。方法:收集2009年9 月至2014年12月山西省肿瘤医院经病理学确诊初治不可切除的局部晚期和晚期非小细胞肺癌（NSCLC ）患者40例，行含铂双药方案全身化疗。PET/CT按SUV 标准（化疗1 个周期后肺部原发癌灶的最高SUV 值下降> 30%）评价肿瘤客观疗效，CT采用RECIST标准评价。配对计数资料采用χ2检验和κ 系数检验，将第1 个周期化疗后的代谢缓解率分别与第1 周期及第2 周期化疗后的最佳客观疗效进行比较，判断两者之间是否具有差异性及一致性。结果:第1 个周期化疗后按SUV 值评价的代谢缓解率与化疗后RECIST评价标准之间差异具有统计学意义（χ2= 5.063，P < 0.05），并且具有较差的一致性（κ = 0.240，P = 0.085），与2 个周期化疗后RECIST评价标准差异无统计学意义（χ2=2.083，P > 0.05），并且具有较好的一致性（κ = 0.413，P = 0.006）；18F-FDGPET/CT 预测NSCLC 2 个周期化疗后最佳客观疗效的灵敏度、特异度、准确度、阳性预测值和阴性预测值分别为 82.4%（14/ 17）、60.9%（14/ 23）、70.0%（28/ 40）、60.9%（14/ 23）和82.4（14/17）% 。结论:18F-FDGPET/CT 能够预测局部晚期和晚期NSCLC 化疗后按RECIST标准评价的最佳客观疗效；18F-FDGPET/CT 相对于常规CT可以更早并准确的评价NSCLC 的化疗疗效。 

A comparative study of 18F-FDG PET/CT and CT in the early evaluation of response to chemotherapy in patients with non-small cell lung cancer

Objective:The relationship between the effect of early metabolism in 18F-FDG PET/CT and conventional CT based on the RE-CIST standard to evaluate the best objective response after chemotherapy in patients with non-small cell lung cancer (NSCLC). Meth-ods:We studied 40 patients with unresectable locally advanced or advanced NSCLC that were confirmed pathologically. The patients were 35 years old to 78 years old and included 31 males and 9 females. Three patients have unresectable stageⅢA, 8 patients have stageⅢB, 29 patients have stageⅣ, 12 patients have squamous cell carcinoma, and 28 patients have adenocarcinoma. The PET/CT for the effect of chemotherapy was evaluated in NSCLC according to the SUV standard (SUVmax reduction>30%of primary lung can-cer after one cycle of chemotherapy), and the CT for the effect of chemotherapy was evaluated on the basis of NSCLC according to the RECIST standard. The objectives of the study are as follows:compare the differences and consistency between 18F-FDG PET/CT metabol-ic response after the first cycle of chemotherapy and the RECIST best objective response after the first or second cycle of chemothera-py with the paired chi-square test and kappa test;calculate the 18F-FDG PET/CT to predict the best objective response of two cycles of chemotherapy according to RECIST on the basis of NSCLC in terms of sensitivity, specificity, accuracy, positive predictive value, and neg-ative predictive value;compare the differences in SUVmax reduction between the metabolic remission group and metabolic no relief group with the two-sample t-test. All statistical methods were 0.05 for the inspection level, and P<0.05 was considered statistically sig-nificant difference (SPSS19.0). Results:Differences were found between the first cycle of chemotherapy for the RECIST best objective response and 18F-FDG PET/CT metabolic response (χ2=5.063, P=0.021), and the results had bad consistency (Kappa=0.240, P=0.085). No differences were observed between the second cycle of chemotherapy for the RECIST best objective response and 18F-FDG PET/CT metabolic response (χ2=2.083, P=0.146);the results had good consistency (Kappa=0.413, P=0.006). The sensitivity, specificity, accura-cy, positive predictive value, and negative predictive value were 82%, 61%, 70%, 61%, and 82%, respectively. The differences in SUV-max reduction between the metabolic remission group and metabolic no relief group with the two-sample t-test were statistically sig-nificant (P<0.001). Conclusion: 18F-FDG PET/CT may predict the best objective response to chemotherapy for NSCLC patients. Com-pared with conventional CT, 18F-FDG PET/CT can be an early and accurate way to evaluate the chemotherapy effect in NSCLC.