非小细胞肺癌不同病理亚型Ki-67增殖指数与18F-FDG PET/CT代谢参数的相关性

目的 探讨非小细胞肺癌（NSCLC）不同病理亚型细胞增殖核抗原Ki-67（简称Ki-67）增殖指数与18F-氟脱氧葡萄糖（FDG） PET/CT代谢参数的相关性。 方法 回顾性分析2018年3月至2020年8月于武汉大学人民医院经组织病理学检查确诊为NSCLC的134例患者的临床资料，其中男性86例、女性48例，年龄39~85（63.9±9.1）岁。所有患者术前均行18F-FDG PET/CT和高分辨率CT（HRCT）显像。从PET/CT图像中提取代谢参数，包括最大标准化摄取值（SUV_max）、肿瘤代谢体积（MTV）、糖酵解总量（TLG）；从HRCT图像中获取肿瘤大小和CT形态学特征。采用Mann-Whitney U 和Kruskal-Wallis检验比较不同临床病理特征间PET/CT代谢参数、Ki-67增殖指数的差异；采用Pearson和Spearman相关性分析对不同病理亚型的PET/CT代谢参数与Ki-67增殖指数进行相关性分析。 结果 134例NSCLC患者在肿瘤分期、肿瘤大小、病理亚型、淋巴结转移、CT形态学特征间的Ki-67增殖指数、SUV_max、MTV、TLG的差异均有统计学意义（Z=2.634~84.842，均P<0.001）。所有患者的Ki-67增殖指数与SUV_max、MTV、TLG均呈线性正相关（r=0.787、0.309、0.651，均P<0.001）。低分化型腺癌（实体+微乳头状为主型腺癌）的Ki-67增殖指数与SUV_max、MTV、TLG均存在相关性（r=0.492、0.652、0.603，均P<0.05）；而高分化型腺癌（贴壁为主型腺癌）的SUV_max和TLG、中分化型腺癌（腺泡+乳头状为主型腺癌）的SUV_max 与Ki-67增殖指数呈线性相关（r=0.568、0.567、0.671，均P<0.05）。 结论 NSCLC的Ki-67增殖指数与18F-FDG PET/CT代谢参数SUV_max、MTV、TLG均有相关性，且与SUV_max的相关性最高。NSCLC不同病理亚型的Ki-67增殖指数与不同的18F-FDG PET/CT代谢参数相关性程度不同。

Correlation between Ki-67 proliferation index and 18F-FDG PET/CT metabolic parameters in different pathological subtypes of non-small cell lung cancer

Objective To investigate the correlation between the proliferation index of proliferating nuclear antigen Ki-67 (called Ki-67) in different pathological subtypes of non-small cell lung cancer (NSCLC) and the metabolic parameters of 18F-fluorodeoxyglucose (FDG) PET/CT. Methods The clinical data of 134 patients with NSCLC diagnosed by histopathological examination in Renmin Hospital of Wuhan University from March 2018 to August 2020 were retrospectively analyzed. The patients included 86 males and 48 females, aged 39–85 (63.9±9.1) years old. All patients underwent 18F-FDG PET/CT and high-resolution CT (HRCT) imaging before surgery. Metabolic parameters, including maximum standardized uptake value (SUV_max), tumor metabolic volume (MTV), and total lesion glycolysis (TLG), were extracted from the PET/CT images. Tumor size and CT morphological features were obtained from the HRCT images. Mann-Whitney U and Kruskal-Wallis tests were used to compare the differences in PET/CT metabolic parameters and Ki-67 proliferation indexes among different clinicopathological features. Pearson and Spearman correlation analysis were used to correlate PET/CT metabolic parameters with Ki-67 proliferation index in different pathological subtypes. Results Significant differences were found in Ki-67 proliferation index, SUV_max, MTV, and TLG among the 134 NSCLC patients in terms of tumor stage, tumor size, pathological type, lymph node metastasis, and CT morphological features (Z=2.634–84.842, all P<0.001). The Ki-67 proliferation index in all patients was positively correlated with SUV_max, MTV, and TLG (r=0.787, 0.309, 0.651; all P<0.001). The Ki-67 proliferation index of poorly differentiated adenocarcinoma (solid + micropapillary predominant type) was correlated with SUV_max, MTV, and TLG (r=0.492, 0.652, 0.603; all P<0.05). However, the SUV_max and TLG in the well-differentiated adenocarcinoma group (adenocarcinoma predominantly adherent) and the SUV_max in the moderately differentiated adenocarcinoma group (acinar+papillary predominant adenocarcinoma) were correlated linearly with the Ki-67 proliferation index (r=0.568, 0.567, 0.671; all P<0.05). Conclusions The Ki-67 proliferation index of NSCLC was correlated with 18F-FDG PET/CT metabolic parameters SUV_max, MTV, and TLG. The highest correlation was obtained with SUV_max. The correlation degree of Ki-67 proliferation index with different 18F-FDG PET/CT metabolic parameters varied in different NSCLC pathological subtypes.