CAJ | 학술논문

目的分别用实体瘤疗效评价标准(RECIST)和PET实体瘤疗效评价标准(PERCIST)评估非小细胞肺癌的治疗效果,探讨其差异性及互补性.方法回顾性收集49例至少行2次PET-CT检查,未手术的非小细胞肺癌患者资料,比较靶病灶治疗前后的直径、标准摄取值变化百分比,用配对资料t检验比较其均数有无差异;然后分别参照RECIST和PERCIST标准分级后,用卡方检验比较其分级评价结果的构成比有无差异,并分析差异来源及意义.另外对33例有2处靶病灶的患者比较单一靶病灶和2处靶病灶对RECIST标准疗效评价的影响.结果 49例患者第1靶病灶治疗前、后的直径分别为(3.52±1.65)、(2.39±1.43) cm,标准摄取值分别为8.78±4.18、5.06±3.62.变化百分比分别为0.30±0.27、0.28±0.64,两者间比较差异无统计学意义(t=0.176,P＞0.05),但仅比较标准摄取值减低的患者时则差异有统计学意义(直径和标准摄取值的下降百分比分别为0.31±0.29和0.52±0.28,t=-4.08,P＜0.01).RECIST和PERCIST标准的分级评价结果为:完全缓解分别为1、13例;部分缓解分别为25、16例;稳定分别为22、15例;进展分别为1、5例;其中33例患者的分级不一致;其构成比的差异有统计学意义(x2=16.252,P＜0.01);33例患者单一靶病灶和2处靶病灶按RECIST标准评价后有5例分级发生改变,但差异无统计学意义(x2=1.171,P＞0.05).结论 PERCIST标准评价的非小细胞肺癌治疗效果与RECIST标准比较有一定差异,主要表现为敏感度更高,但和预后的关系有待确认.RECIST标准中不同数量的靶病灶可能会引起部分评价分级发生改变.
목적 분별용실체류료효평개표준(RECIST)화PET실체류료효평개표준(PERCIST)평고비소세포폐암적치료효과,탐토기차이성급호보성.방법 회고성수집49례지소행2차PET-CT검사,미수술적비소세포폐암환자자료,비교파병조치료전후적직경、표준섭취치변화백분비,용배대자료t검험비교기균수유무차이;연후분별삼조RECIST화PERCIST표준분급후,용잡방검험비교기분급평개결과적구성비유무차이,병분석차이래원급의의.령외대33례유2처파병조적환자비교단일파병조화2처파병조대RECIST표준료효평개적영향.결과 49례환자제1파병조치료전、후적직경분별위(3.52±1.65)、(2.39±1.43) cm,표준섭취치분별위8.78±4.18、5.06±3.62.변화백분비분별위0.30±0.27、0.28±0.64,량자간비교차이무통계학의의(t=0.176,P＞0.05),단부비교표준섭취치감저적환자시칙차이유통계학의의(직경화표준섭취치적하강백분비분별위0.31±0.29화0.52±0.28,t=-4.08,P＜0.01).RECIST화PERCIST표준적분급평개결과위:완전완해분별위1、13례;부분완해분별위25、16례;은정분별위22、15례;진전분별위1、5례;기중33례환자적분급불일치;기구성비적차이유통계학의의(x2=16.252,P＜0.01);33례환자단일파병조화2처파병조안RECIST표준평개후유5례분급발생개변,단차이무통계학의의(x2=1.171,P＞0.05).결론 PERCIST표준평개적비소세포폐암치료효과여RECIST표준비교유일정차이,주요표현위민감도경고,단화예후적관계유대학인.RECIST표준중불동수량적파병조가능회인기부분평개분급발생개변.
Objective To compare the PET response criteria in solid tumors (PERCIST) and response evaluation criteria in solid tumors (RECIST) in the evaluation of therapeutic response in 49 non-small-cell lung cancer(NSCLC) patients.Methods Forty-nine NSCLC patients who received chemotherapy but no surgery were studied.Therapeutic responses were evaluated using 18 F-FDG PET and CT according to the RECIST and PERCIST methods.The PET-CT scans were obtained before chemotherapy and about 2 or 6 weeks after completion of chemotherapy.Firstly the reduction rates of tumor diameter and reduction rates of tumor standardized uptake value were compared with paired t-test.Then the response was classed into 4 levels according to RECIST and PERCIST:PD and PMD =1,SD and SMD =2,PR and PMR =3,CR and CMR =4.Pearson and Chi-square test was used to compare the proportion of four levels in RECIST and PERCIST.Finally one target lesion and two target lesions were compared for RECIST therapeutic evaluation in 33 cases with two target lesions.Results The diameter was (3.52 ± 1.65) cm before the therapy and (2.39 ± 1.43)cm after the therapy.The standardized uptake value was 8.78 ±4.18 vs.5.06 ±3.62 before and after therapy for the first target lesions in 49 patients.The differences of reduction rates between tumor diameter and standardized uptake value were not significant because of selection bias (0.32 ± 0.27 vs.0.28 ±0.64,t =0.176,P ＞0.05).However,there was a significant difference when the reduction rate was compared only in 39 patients in which the standardized uptake values were reduced after therapy (0.39 ± 0.29 vs.0.52 ±0.28,t =-4.08,P ＜0.01).The results of classification were 1/13 for CR/CMR,25/16 for PR/PMR,22/15 for SD/SMD,1/5 for PD/PMD,and 33 cases had no consistent results from RECIST and PERCIST.There was a significant difference in response classification between RECIST and PERCIST (x2 =16.252,P ＜ 0.01).No significant difference was found between one target lesion and two target lesions for RECIST evaluation results in 33 cases (x2 =1.171,P ＞ 0.05),but results of response classification were changed in 5 cases.Conclusions PERCIST criteria may be more sensitive in NSCLC therapeutic evaluation comparing to RECIST criteria.There is a higher proportion with CMR and PMD in PERCIST,but its effect on the prognosis is not yet clear.The number of target lesions may affect the results of therapeutic evaluation with RECIST criteria.