CAJ | 학술논문

背景与目的：PET/CT在非小细胞肺癌(non-small cell lung cancer，NSCLC)的预后判断中有重要价值，但单独针对Ⅲ期且接受靶向治疗患者的研究较少。本研究旨在探讨在这些患者中18F氟代脱氧葡萄糖(18F-fluorodeoxyghcose，18F-FDG)PET/CT基线标准摄取值(standard uptake value，SUV)与预后的相关性。方法：前瞻性分析复旦大学附属肿瘤医院放疗科2009年9月-2012年7月入组的17例接受西妥昔单抗(cetuximab，C225)联合顺铂+长春瑞宾(NP方案)诱导化疗及同期放化疗的患者，入组前两周内完成PET/CT检查。采用Cox回归风险比例模型对SUV-T、SUV-N、SUV-TOTAL、性别、年龄、组织学类型、TNM分期、功能状态评分(performance status，PS)、吸烟状态与患者生存时间进行单因素生存分析，差异有统计学意义者进行多因素生存分析。Log-rank检验及Kaplan-Meier法分别评估以SUV-T、SUV-N、SUV-TOTAL界值分组患者间生存期的差异并绘制生存曲线。结果：单因素预后分析提示，上述SUVmax、PS评分、吸烟状态与预后相关，其中SUV-T及SUV-N的界值是11、SUV-TOTAL为20。多因素分析结果显示，SUV-TOTAL(P=0.012)、SUV-T(P=0.025)、SUV-N(P=0.033)是影响本组患者生存的独立预后因素，其中SUV-TOTAL>20组患者的相对危险度(hazard ratio，HR)为14.7。结论：对于C225联合同步放化疗的患者，PET/CT局部区域、原发灶及纵隔淋巴结SUV值与预后有一定相关性，值得进一步大样本研究。将3者结合起来，可指导该治疗的合理应用。
배경여목적：PET/CT재비소세포폐암(non-small cell lung cancer，NSCLC)적예후판단중유중요개치，단단독침대Ⅲ기차접수파향치료환자적연구교소。본연구지재탐토재저사환자중18F불대탈양포도당(18F-fluorodeoxyghcose，18F-FDG)PET/CT기선표준섭취치(standard uptake value，SUV)여예후적상관성。방법：전첨성분석복단대학부속종류의원방료과2009년9월-2012년7월입조적17례접수서타석단항(cetuximab，C225)연합순박+장춘서빈(NP방안)유도화료급동기방화료적환자，입조전량주내완성PET/CT검사。채용Cox회귀풍험비례모형대SUV-T、SUV-N、SUV-TOTAL、성별、년령、조직학류형、TNM분기、공능상태평분(performance status，PS)、흡연상태여환자생존시간진행단인소생존분석，차이유통계학의의자진행다인소생존분석。Log-rank검험급Kaplan-Meier법분별평고이SUV-T、SUV-N、SUV-TOTAL계치분조환자간생존기적차이병회제생존곡선。결과：단인소예후분석제시，상술SUVmax、PS평분、흡연상태여예후상관，기중SUV-T급SUV-N적계치시11、SUV-TOTAL위20。다인소분석결과현시，SUV-TOTAL(P=0.012)、SUV-T(P=0.025)、SUV-N(P=0.033)시영향본조환자생존적독립예후인소，기중SUV-TOTAL>20조환자적상대위험도(hazard ratio，HR)위14.7。결론：대우C225연합동보방화료적환자，PET/CT국부구역、원발조급종격림파결SUV치여예후유일정상관성，치득진일보대양본연구。장3자결합기래，가지도해치료적합리응용。
Background and purpose:We investigated whether lfuorine-18 lfuorodeoxyglucose (18F-FDG) maximal standard uptake value (SUVmax) of the primary tumor (SUV-T), SUVmax of the regional lymph nodes (SUV-N) or the overall loco-regional lesion SUVmax (SUV-TOTAL) was related to survival of patients with stage Ⅲ non-small cell lung cancer (NSCLC) who received Cetuximab and combined definitive chemoradiotherpay. Methods:From September 2009 to July 2012, seventeen patients with unresectable stageⅢNSCLC receiving cetuximab with cisplatin/vinorelbine (NP) followed by concomitant NP and intensity-modulated radiotherapy (IMRT) at the Fudan University Shanghai Cancer Center were enrolled onto a prospectively study. All patients received positron emission tomography/computerized tomography (PET/CT) scans within 2 weeks before enrolment. Univariate analysis were used to assess the correlation between SUV-T, SUV-N, SUV-TOTAL, gender, age, histology, tumour-node-metastasis (TNM) stage, performance status (PS) as well as smoking status and survival. The factors which showed statistical signiifcance entered into multivariate Cox-regression model. Survival functions of different populations were estimated by Kaplan-Meier method and compared by Log-rank test. Results:In the univariate analysis, SUV-T, SUV-N, SUV-TOTAL, PS and smoking status were prognostic factors. The best cut-off values for SUV-T, SUV-N and SUV-TOTAL were 11, 11 and 20, respectively. Multivariate analysis revealed that SUV-TOTAL (P=0.012), SUV-T (P=0.025), and SUV-N (P=0.033) were independent predictors of survival with hazard ratio (HR) of 14.7, 11.2, and 6.2, respectively. Conclusion:Local, regional and locoregional maximal SUVs deifned by 18F-FDG PET-CT scanning may have a strong correlation with survival in this patients setting, which merits further study.