- 期刊
Primary Tumor Total Lesion Glycolysis can Stratify the Risk of Lymph Node Metastasis in Patients with Non-Small Cell Lung Cancer
非小細胞肺癌主腫瘤全病灶糖解量可以對淋巴結轉移的風險進行分級
摘要
目的：本研究目的是評估非小細胞肺癌的主腫瘤特徵對於淋巴結轉移的預測價值，包括主腫瘤在氟化葡萄糖正子造影的最大標準攝取值、代謝腫瘤體積及全病灶糖解量。方法：共有104位非小細胞肺癌病人接受術前氟化葡萄糖正子造影和手術治療，主腫瘤特徵與術後病理淋巴結轉移結果進行分析。氟化葡萄糖正子造影的參數包括淋巴結最大標準攝取值、主腫瘤最大標準攝取值、平均標準攝取值、代謝腫瘤體積及全病灶糖解量均由OsiriX軟體計算。結果：非小細胞肺癌主腫瘤特徵包括腫瘤大小、分化程度、微小淋巴血管侵犯、最大標準攝取值、代謝腫瘤體積及全病灶糖解量與淋巴結轉移呈現顯著相關。多變數分析發現淋巴結最大標準攝取值與主腫瘤全病灶糖解量大於等於35是兩項獨立的預測因子。依照主腫瘤全病灶糖解量將病人分為兩組，對於低全病灶糖解量這組病人，傳統淋巴結最大標準攝取值閾值2.5的陰性預測值非常好達94.1%，但是陽性預測值非常差只有6.7%，在高全病灶糖解量這組病人，傳統淋巴結最大標準攝取值閾值2.5的陰性預測值下降到73.3%，而陽性預測值則提高到42.9%。結論：非小細胞肺癌病人淋巴結轉移與主腫瘤特徵有顯著相關，淋巴結最大標準攝取值與主腫瘤的全病灶糖解量大於等於35是兩項獨立的預測因子，利用主腫瘤全病灶糖解量對病人淋巴結轉移的風險進行分級，可以改善非小細胞肺癌病人的淋巴結分期判讀。
並列摘要
Purpose: The aim of this study is to evaluate the predictive value of primary tumor characteristics, including F-18 fluorodeoxyglucose positron emission tomography (FDGPET) parameters of tumor maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) for lymph node (LN) metastasis in patients with non-small cell lung cancer (NSCLC). Material and methods: One hundred and four patients with NSCLC who had undergone FDG-PET and sequential surgical treatment were enrolled into this retrospective study. The relationships between primary tumor characteristics and pathologic results of LN metastasis were examined. All of the measurements of LN SUVmax, primary tumor SUVmax, SUVmean, MTV, and TLG were performed using OsiriX. Results: Primary tumor characteristics of tumor size, grade, presence of microscopic lymphovascular invasion, tumor SUVmax, MTV, and TLG were significantly associated with LN metastasis. After adjustment with multivariate analysis, LN SUVmax and primary tumor TLG ≥ 35 were independent predictors for LN metastasis. Patients were stratified into low and high TLG groups. In the low TLG group, the negative predictive value (NPV) of conventional threshold of LN SUVmax ＜2.5 was excellent at 94.1%. By contrast, the positive predictive value (PPV) of LN SUVmax ≥2.5 was very low at 6.7%. In the high TLG group, the NPV was decreased to 73.3%. The PPV was much higher than that in the low TLG group at 42.9%. Conclusion: LN metastasis is associated with primary tumor characteristics. LN SUVmax and primary tumor TLG ≥35 are both independent predictors for LN metastasis. Primary tumor TLG can stratify the risk of LN metastasis and might improve LN staging in patients with NSCLC.