国际肿瘤学杂志 ›› 2025, Vol. 52 ›› Issue (10): 614-620.doi: 10.3760/cma.j.cn371439-20241115-00105

• 论著 • 上一篇    下一篇

18F-FDG PET/CT代谢参数在小细胞肺癌中的预后价值

来瑞鹤1, 盛丹丹2, 何健1, 丁重阳3, 耿羽智2()   

  1. 1南京大学医学院附属鼓楼医院核医学科,南京 210008
    2南京医科大学第二附属医院核医学科,南京 210011
    3南京医科大学第一附属医院核医学科,南京 210029
  • 收稿日期:2024-11-15 修回日期:2025-09-01 出版日期:2025-10-08 发布日期:2025-11-12
  • 通讯作者: 耿羽智 E-mail:gengyuzhi@126.com

Prognostic value of 18F-FDG PET/CT metabolic parameters in small cell lung cancer

Lai Ruihe1, Sheng Dandan2, He Jian1, Ding Chongyang3, Geng Yuzhi2()   

  1. 1Department of Nuclear Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
    2Department of Nuclear Medicine, Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, China
    3Department of Nuclear Medicine, First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
  • Received:2024-11-15 Revised:2025-09-01 Online:2025-10-08 Published:2025-11-12
  • Contact: Geng Yuzhi E-mail:gengyuzhi@126.com

摘要:

目的 评估18F-氟代脱氧葡萄糖(18F-FDG)PET/CT代谢参数在小细胞肺癌(SCLC)中的预后价值。 方法 回顾性分析2013年9月至2024年2月于南京大学医学院附属鼓楼医院行18F-FDG PET/CT检查且经组织病理学检查确诊的156例SCLC患者的临床资料和影像资料。以不同标准化摄取值(SUV)为阈值,采用LIFEx软件计算患者的肿瘤代谢体积(MTV)、病灶糖酵解总量(TLG)、线性回归斜率、累积SUV体积直方图曲线下面积(AUC-CSH)及变异系数(CV)。采用Cox比例风险模型行单因素、多因素分析,根据受试者操作特征(ROC)曲线确定的临界值对患者进行分组,采用Kaplan-Meier法绘制生存曲线并行log-rank检验。 结果 单因素分析显示,MTV40%HR=2.91,95%CI为1.55~5.47,P=0.001)、MTV60%HR=2.31,95%CI为1.29~4.17,P=0.005)、TLG40%HR=2.07,95%CI为1.19~3.60,P=0.010)、线性回归斜率(HR=0.45,95%CI为0.26~0.79,P=0.005)及CV40%HR=0.27,95%CI为0.08~0.84,P=0.024)均是SCLC患者无进展生存期(PFS)的影响因素。MTV40%HR=1.98,95%CI为1.22~3.22,P=0.005)、MTV60%HR=1.80,95%CI为1.12~2.88,P=0.015)、MTV80%HR=1.71,95%CI为1.08~2.74,P=0.024)、TLG40%HR=3.68,95%CI为1.59~8.49,P=0.002)、线性回归斜率(HR=0.49,95%CI为0.30~0.80,P=0.004)及AUC-CSH80%HR=0.44,95%CI为0.23~0.84,P=0.013)均是SCLC患者总生存期(OS)的影响因素。多因素分析显示,MTV40%HR=4.76,95%CI为1.11~20.50,P=0.036)是SCLC患者PFS的独立影响因素,TLG40%HR=3.19,95%CI为1.02~9.92,P=0.046)是SCLC患者OS的独立影响因素。ROC曲线分析显示,MTV40%预测SCLC患者PFS的最佳临界值为5.5 cm3,TLG40%预测SCLC患者OS的最佳临界值为41.5 g。生存分析表明,MTV40%≤5.5 cm3患者(n=33)的中位PFS未达到,MTV40%>5.5 cm3患者(n=123)的中位PFS为10.3个月,差异有统计学意义(χ²=12.09,P=0.001)。TLG40%≤41.5 g患者(n=35)的中位OS未达到,TLG40%>41.5 g患者(n=121)的中位OS为31.6个月,差异有统计学意义(χ²=10.55,P=0.001)。 结论 18F-FDG PET/CT代谢参数MTV40%是SCLC患者PFS的独立影响因素,TLG40%是SCLC患者OS的独立影响因素,二者或可作为评估SCLC患者预后的指标。

关键词: 小细胞肺癌, 氟脱氧葡萄糖F18, 正电子发射断层显像术, 体层摄影术,X线计算机, 预后, 代谢参数

Abstract:

Objective To evaluate the prognostic value of 18F-fluorodeoxyglucose (18F-FDG) PET/CT metabolic parameters in small cell lung cancer (SCLC). Methods A retrospective analysis was conducted on the clinical and imaging data of 156 SCLC patients, who underwent 18F-FDG PET/CT imaging and were diagnosed by histopathological examination at Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School from September 2013 to February 2024. The metabolic tumor volume (MTV), total lesion glycolysis (TLG), linear regression slope, area under the curve of cumulative standard uptake value (SUV) volume histogram (AUC-CSH), and coefficient of variation (CV) were calculated using LIFEx software with different SUV thresholds. Univariate and multivariate analyses were performed using Cox proportional hazards model. Patient stratification was based on the critical values determined by receiver operator characteristic (ROC) curve analysis. The survival curve was plotted using the Kaplan-Meier method and log-rank test was performed. Results Univariate analysis showed that MTV40%HR=2.91, 95%CI: 1.55-5.47, P=0.001), MTV60%HR=2.31, 95%CI: 1.29-4.17, P=0.005), TLG40%HR=2.07, 95%CI: 1.19-3.60, P=0.010), linear regression slope (HR=0.45, 95%CI: 0.26-0.79, P=0.005), and CV40% HR=0.27, 95%CI: 0.08-0.84, P=0.024) were factors affecting progression-free survival (PFS) in SCLC patients. MTV40%HR=1.98,95%CI: 1.22-3.22, P=0.005), MTV60%HR=1.80, 95%CI: 1.12-2.88, P=0.015), MTV80%HR=1.71, 95%CI: 1.08-2.74, P=0.024), TLG40%HR=3.68, 95%CI: 1.59-8.49, P=0.002), linear regression slope (HR=0.49, 95%CI: 0.30-0.80, P=0.004), and AUC-CSH80%HR=0.44, 95%CI: 0.23-0.84, P=0.013) were found to be factors affecting overall survival (OS) in SCLC patients. Multivariate analysis revealed that MTV40%HR=4.76, 95%CI: 1.11-20.50, P=0.036) was an independent factor influencing PFS, and TLG40%HR=3.19, 95%CI: 1.02-9.92, P=0.046) was an independent factor influencing OS in SCLC patients. ROC curve analysis identified the optimal cutoff value for MTV40% in predicting PFS as 5.5cm3 and the optimal cutoff value for TLG40% in predicting OS as 41.5 g in SCLC patients. Survival analysis showed that patients with MTV40%≤5.5 cm3n=33) had a median PFS that was not reached, while patients with MTV40%>5.5 cm3 n=123) had a median PFS of 10.3 months, with a statistically significant difference (χ²=12.09, P=0.001). For patients with TLG40%≤41.5 g (n=35), the median OS was not reached, whereas for TLG40%>41.5 g (n=121), the median OS was 31.6 months, with a statistically significant difference (χ²=10.55, P=0.001). Conclusions The 18F-FDG PET/CT metabolic parameter MTV40% is an independent factor influencing PFS, while TLG40% is an independent factor influencing OS in SCLC patients. The above two parameters may serve as indicators for assessing the prognosis of SCLC patients.

Key words: Small cell lung carcinoma, Fluorodeoxyglucose F18, Positron-emission tomography, Tomography, X-ray computed, Prognosis, Metabolic parameters