癌,非小细胞肺%体层摄影术,发射型计算机%体层摄影术,X线计算机%脱氧葡萄糖%组织学
癌,非小細胞肺%體層攝影術,髮射型計算機%體層攝影術,X線計算機%脫氧葡萄糖%組織學
암,비소세포폐%체층섭영술,발사형계산궤%체층섭영술,X선계산궤%탈양포도당%조직학
Carcinoma,non-small cell lung%Tomography,emission-computed%Tomography,X-ray computed%Deoxyglucose%Histology
目的 探讨非小细胞肺癌(NSCLC)组织学类型和分化程度对其~(18)F-脱氧葡萄糖(FDG)PET/CT显像标准摄取值(SUV)的影响.方法 260例NSCLC患者,按组织学类型不同分为腺癌、鳞癌、腺鳞癌和其他类型4组,按组织分化不同分为Ⅰ(高分化)、Ⅱ(中分化)、Ⅲ(低分化+未分化)3个级别,回顾其治疗前的~(18)F-FDG PET/CT显像结果 ,测量肺内原发灶最大SUV(SUV_(max)).用多元回归分析方法 提取SUV_(max)的影响因素,采用协方差分析修正病灶大小(取最大长径)对SUV_(max)的影响后,比较不同组织学类型和分化程度NSCLC病灶SUV_(max)的差异.结果 260例患者共260个原发NSCLC病灶,腺癌161个(10个细支气管肺泡癌归于Ⅰ级腺癌,Ⅰ级15个、Ⅱ级88个、Ⅲ级58个),鳞癌74个(Ⅰ级6个、Ⅱ级39个、Ⅲ级29个),腺鳞癌15个(Ⅱ级7个、Ⅲ级8个),其他类型10个.只有病灶大小(F=87.046,P＜0.001)、分化程度(F=87.604,P＜0.001)和组织学类型(F=66.663,P＜0.001)被纳入SUV_(max)多元回归方程,标准化回归系数分别为0.436(t=8.910,P＜0.001),0.391(t=8.322,P＜0.001),0.190(t=3.885,P=0.0001).修正病灶大小对SUV_(max)的影响后,SUV_(max)由小到大依次为腺癌Ⅰ级＜腺癌Ⅱ级＜鳞癌Ⅰ级＜腺鳞癌Ⅱ级＜鳞癌Ⅱ级＜其他类型NSCLC＜腺癌Ⅲ级＜腺鳞癌Ⅲ级＜鳞癌Ⅲ级,其均数及95%可信区间分别为3.3(2.1～4.5)、6.0(5.5～6.6)、6.1(4.2～8.0)、6.6(4.8～8.4)、7.8(7.0～8.6)、8.1(6.6～9.6)、8.3(7.6～8.9)、8.7(7.0～10.4)、8.9(8.0～9.8).分化较好的Ⅰ、Ⅱ级腺癌SUV_(max)均分别低于Ⅰ、Ⅱ级鳞癌,差异有统计学意义(q值分别为-2.786,-1.776,P值分别为0.017,＜0.001),分化较差的Ⅲ级腺癌、鳞癌以及腺鳞癌间SUV_(max)差异均无统计学意义(q值分别为-0.593,-0.422,0.171,P值分别为0.288,0.642,0.860);随细胞分化变差,腺癌、鳞癌及腺鳞癌组病灶SUV_(max)升高,腺癌Ⅰ、Ⅱ、Ⅲ级间(q值分别为-2.720,-4.943,-2.223,P均＜0.001)以及鳞癌Ⅰ、Ⅲ级间(q=-2.751,P=0.012)SUV_(max)差异均有统计学意义.结论 NSCLC病灶的组织学类型和分化程度都可以影响其~(18)F-FDG摄取,分化程度对~(18)F-FDG摄取的影响意义更大.
目的 探討非小細胞肺癌(NSCLC)組織學類型和分化程度對其~(18)F-脫氧葡萄糖(FDG)PET/CT顯像標準攝取值(SUV)的影響.方法 260例NSCLC患者,按組織學類型不同分為腺癌、鱗癌、腺鱗癌和其他類型4組,按組織分化不同分為Ⅰ(高分化)、Ⅱ(中分化)、Ⅲ(低分化+未分化)3箇級彆,迴顧其治療前的~(18)F-FDG PET/CT顯像結果 ,測量肺內原髮竈最大SUV(SUV_(max)).用多元迴歸分析方法 提取SUV_(max)的影響因素,採用協方差分析脩正病竈大小(取最大長徑)對SUV_(max)的影響後,比較不同組織學類型和分化程度NSCLC病竈SUV_(max)的差異.結果 260例患者共260箇原髮NSCLC病竈,腺癌161箇(10箇細支氣管肺泡癌歸于Ⅰ級腺癌,Ⅰ級15箇、Ⅱ級88箇、Ⅲ級58箇),鱗癌74箇(Ⅰ級6箇、Ⅱ級39箇、Ⅲ級29箇),腺鱗癌15箇(Ⅱ級7箇、Ⅲ級8箇),其他類型10箇.隻有病竈大小(F=87.046,P＜0.001)、分化程度(F=87.604,P＜0.001)和組織學類型(F=66.663,P＜0.001)被納入SUV_(max)多元迴歸方程,標準化迴歸繫數分彆為0.436(t=8.910,P＜0.001),0.391(t=8.322,P＜0.001),0.190(t=3.885,P=0.0001).脩正病竈大小對SUV_(max)的影響後,SUV_(max)由小到大依次為腺癌Ⅰ級＜腺癌Ⅱ級＜鱗癌Ⅰ級＜腺鱗癌Ⅱ級＜鱗癌Ⅱ級＜其他類型NSCLC＜腺癌Ⅲ級＜腺鱗癌Ⅲ級＜鱗癌Ⅲ級,其均數及95%可信區間分彆為3.3(2.1～4.5)、6.0(5.5～6.6)、6.1(4.2～8.0)、6.6(4.8～8.4)、7.8(7.0～8.6)、8.1(6.6～9.6)、8.3(7.6～8.9)、8.7(7.0～10.4)、8.9(8.0～9.8).分化較好的Ⅰ、Ⅱ級腺癌SUV_(max)均分彆低于Ⅰ、Ⅱ級鱗癌,差異有統計學意義(q值分彆為-2.786,-1.776,P值分彆為0.017,＜0.001),分化較差的Ⅲ級腺癌、鱗癌以及腺鱗癌間SUV_(max)差異均無統計學意義(q值分彆為-0.593,-0.422,0.171,P值分彆為0.288,0.642,0.860);隨細胞分化變差,腺癌、鱗癌及腺鱗癌組病竈SUV_(max)升高,腺癌Ⅰ、Ⅱ、Ⅲ級間(q值分彆為-2.720,-4.943,-2.223,P均＜0.001)以及鱗癌Ⅰ、Ⅲ級間(q=-2.751,P=0.012)SUV_(max)差異均有統計學意義.結論 NSCLC病竈的組織學類型和分化程度都可以影響其~(18)F-FDG攝取,分化程度對~(18)F-FDG攝取的影響意義更大.
목적 탐토비소세포폐암(NSCLC)조직학류형화분화정도대기~(18)F-탈양포도당(FDG)PET/CT현상표준섭취치(SUV)적영향.방법 260례NSCLC환자,안조직학류형불동분위선암、린암、선린암화기타류형4조,안조직분화불동분위Ⅰ(고분화)、Ⅱ(중분화)、Ⅲ(저분화+미분화)3개급별,회고기치료전적~(18)F-FDG PET/CT현상결과 ,측량폐내원발조최대SUV(SUV_(max)).용다원회귀분석방법 제취SUV_(max)적영향인소,채용협방차분석수정병조대소(취최대장경)대SUV_(max)적영향후,비교불동조직학류형화분화정도NSCLC병조SUV_(max)적차이.결과 260례환자공260개원발NSCLC병조,선암161개(10개세지기관폐포암귀우Ⅰ급선암,Ⅰ급15개、Ⅱ급88개、Ⅲ급58개),린암74개(Ⅰ급6개、Ⅱ급39개、Ⅲ급29개),선린암15개(Ⅱ급7개、Ⅲ급8개),기타류형10개.지유병조대소(F=87.046,P＜0.001)、분화정도(F=87.604,P＜0.001)화조직학류형(F=66.663,P＜0.001)피납입SUV_(max)다원회귀방정,표준화회귀계수분별위0.436(t=8.910,P＜0.001),0.391(t=8.322,P＜0.001),0.190(t=3.885,P=0.0001).수정병조대소대SUV_(max)적영향후,SUV_(max)유소도대의차위선암Ⅰ급＜선암Ⅱ급＜린암Ⅰ급＜선린암Ⅱ급＜린암Ⅱ급＜기타류형NSCLC＜선암Ⅲ급＜선린암Ⅲ급＜린암Ⅲ급,기균수급95%가신구간분별위3.3(2.1～4.5)、6.0(5.5～6.6)、6.1(4.2～8.0)、6.6(4.8～8.4)、7.8(7.0～8.6)、8.1(6.6～9.6)、8.3(7.6～8.9)、8.7(7.0～10.4)、8.9(8.0～9.8).분화교호적Ⅰ、Ⅱ급선암SUV_(max)균분별저우Ⅰ、Ⅱ급린암,차이유통계학의의(q치분별위-2.786,-1.776,P치분별위0.017,＜0.001),분화교차적Ⅲ급선암、린암이급선린암간SUV_(max)차이균무통계학의의(q치분별위-0.593,-0.422,0.171,P치분별위0.288,0.642,0.860);수세포분화변차,선암、린암급선린암조병조SUV_(max)승고,선암Ⅰ、Ⅱ、Ⅲ급간(q치분별위-2.720,-4.943,-2.223,P균＜0.001)이급린암Ⅰ、Ⅲ급간(q=-2.751,P=0.012)SUV_(max)차이균유통계학의의.결론 NSCLC병조적조직학류형화분화정도도가이영향기~(18)F-FDG섭취,분화정도대~(18)F-FDG섭취적영향의의경대.
Objective To determine the effect of histotype and histodifferentiation on the maximum standardized uptake value (SUV_(max)) of non-small cell lung cancer (NSCLC) ~(18)F-fluorodeoxyglucose (FDG) PET/CT imaging.Methods Two hundred and sixty patients with NSCLc underwent ~(18)F-FDG PET/CT imaging.They were classified according to (1) histotype:as adenocarcinoma (AC),squamous cell carcinoma(SQC),adenosquamous carcinoma (ASC) and other type carcinoma (OTC),and (2) histodifferentiation:as grade Ⅰ (well-differentiated),grade Ⅱ (moderate-differentiated) and grade Ⅲ (poor-differentiated).The SUV_(max) and size(long diameter)of the primary lesions were measured.Multivariate regression analysis was used to analyze the relationship between the SUV_(max) and variable factors including histotype,histodifferentiation,lesion size,age,sex,body height,body weight,body mass index (BMI),blood glucose level,dose,and rate of dose.Results Two hundred and sixty patients had 260 primary NSCLC tumors.There were 161 AC(15 grade Ⅰ,88 grade Ⅱ,58 grade Ⅲ),74 SQC(6 grade Ⅰ,39 grade Ⅱ,29 grade Ⅲ),15 ASC(7 grade Ⅱ,8 gradeⅢ)and OTC(8 large cell,2 carcinosarcoma).Only lesion size (F=87.046.P＜0.001),histodifferentiation (F=87.604,P＜0.001) and histotype (F=66.663,P＜0.001) were included for multivariate regression analysis with SUV_(max).After adjustment for lesion size,the SUV_(max)(mean and 95%confidence interval) in ascending order was AC Ⅰ:3.3(2.1-4.5),ACⅡ:6.0(5.5-6.6),SQCⅠ:6.1(4.2-8,0),ASC Ⅱ:6.6(4.8-8.4),SQCⅡ.7.8(7.0-8.6),OTC:8.1(6.6-9.6),AC Ⅲ:8.3(7.6-8.9),ASC Ⅲ:8.7(7.0-10.4),and SQC Ⅲ:8.9(8.0-9.8).11he SUV_(max) of AC Ⅰ was significantly lower than that of SQC Ⅰ(q=-2.786,P=0.017),same for AC Ⅱ and SQC Ⅱ(q=-1.776,P＜0.001),but no statistically significant differences were found among AC Ⅲ,ASC Ⅲ and SQC Ⅲ(q=-0.593,-0.422,0.171,P=0.288,0.642,0.860,respectively).For the same histotype lesions,the difference of SUV_(max) among AC Ⅰ,Ⅱ and Ⅲ was statistically significant(q=-2.720,-4.943,-2.223,all P＜0.001),as also for SQC Ⅰ and Ⅲ(q=-2.751,P=0.012).Conclusion Histotype and histodifferentiation are significant correlative factors for ~(18)F-FDG uptake of NSCLC,with histodifferentiation being the factor with greater impact.
