Introduction: FDG PET/CT is a robust imaging modality to diagnose and stratify prognoses for non-small cell lung carcinoma. However, the role of FDG PET/CT in operable lung adenocarcinoma patients has not been previously investigated in a large cohort with varying pathological stages. The prognostic value of volumetric parameters based on FDG PET/CT was investigated in patients with stage I–III lung adenocarcinoma receiving curative surgery. Methods: This retrospective study included 432 patients with lung adenocarcinoma undergoing preoperative FDG PET/CT between January 2016 and December 2017. Clinicopathologic variables, conventional image parameters, such as the maximum standardized uptake value (SUVmax) and mean SUV (SUVmean) of the primary tumor, and volumetric parameters, such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG), were included in Cox regression analysis. Subgroup analysis was conducted to compare hazard ratios (HRs) based on MTV in each pathological stage. A new staging system including volumetric parameters was suggested. Results: A total of 432 patients (median age: 62 years; interquartile range: 56–70 years; 225 males) were evaluated. Sex, age, presence of EGFR mutation, pathological stage, MTV, and TLG of the primary tumor were selected as statistically significant prognostic factors for overall survival irrespective of other variables (OS;p< 0.05 for all). Pathological stage, MTV, and TLG of the primary tumor were selected as statistically significant prognostic factors for disease-free survival irrespective of other variables (p< 0.05 for all). The suggested new staging system including MTV as an additional criterion showed better discrimination and prediction for OS than the conventional pathological staging system despite statistical insignificance (concordance index: 0.698 vs. 0.673). Conclusions: The volumetric parameters of the primary tumor based on preoperative FDG PET/CT were independent prognostic factors in addition to pathological stage in patients with operable lung adenocarcinoma. The suggested new staging system considering MTV predicted the prognoses better than the conventional pathological staging system.
引言：FDG PET/CT是诊断非小细胞肺癌并评估其预后的重要影像学手段。然而，FDG PET/CT在可手术肺腺癌患者中的作用，此前尚未在包含不同病理分期的大规模队列中进行研究。本研究旨在探讨基于FDG PET/CT的体积参数对接受根治性手术的I-III期肺腺癌患者的预后价值。 方法：这项回顾性研究纳入了2016年1月至2017年12月期间接受术前FDG PET/CT检查的432例肺腺癌患者。将临床病理变量、常规影像参数（如原发肿瘤的最大标准化摄取值和平均标准化摄取值）以及体积参数（如代谢肿瘤体积和病灶糖酵解总量）纳入Cox回归分析。进行亚组分析以比较各病理分期中基于代谢肿瘤体积的风险比。研究提出了一种包含体积参数的新分期系统。 结果：共评估了432例患者（中位年龄：62岁；四分位距：56-70岁；男性225例）。无论其他变量如何，性别、年龄、EGFR突变状态、病理分期、原发肿瘤的代谢肿瘤体积和病灶糖酵解总量均被确定为总生存期的统计学显著预后因素。同样，病理分期、原发肿瘤的代谢肿瘤体积和病灶糖酵解总量均被确定为无病生存期的统计学显著预后因素。尽管统计学差异不显著，但提出的包含代谢肿瘤体积作为附加标准的新分期系统，相较于传统病理分期系统，对总生存期显示出更好的区分和预测能力。 结论：在可手术肺腺癌患者中，基于术前FDG PET/CT的原发肿瘤体积参数是除病理分期之外的独立预后因素。提出的考虑代谢肿瘤体积的新分期系统比传统病理分期系统能更好地预测预后。
肿瘤(癌症)患者之家