- 期刊
The Impact of Whole-body (18)^F-Fluorodeoxy-DGlucose Positron Emission Tomography - Computed Tomography (PET-CT) on the Staging and Outcome of Small Cell Lung Cancer Patients
全身正子攝影對於肺小細胞癌診斷分期與存活的影響
摘要
背景：肺小細胞癌具有快速生長及極易遠端轉移之特性，臨床將其分為limited disease（LD）及extensive disease（ED）。治療差別在於LD需要同時放射線治療加化學治療，而ED單純化學治療。平均存活時間LD是10~14月，ED是5.6~7月。因此診斷分期的正確與否影響存活。在肺非小細胞癌診斷分期，正子攝影準確性高於傳統影像，對於遠端轉移更有其優異之處。近年來在肺小細胞癌診斷，正子攝影已有越來越多的研究證實對遠端轉移更能有效診斷。希望透過本研究以了解正子攝影對於肺小細胞癌分期與存活有何影響。方法：找出自2007年1月至2012年7月的新診斷肺小細胞癌病患並符合以下條件者共117名：年紀大於等於18歲，病理診斷未治療肺小細胞癌，Eastern Cooperative Oncology Group performance status（ECOG）小於等於2分，並且完成至少2次標準化學治療。依接受正子攝影與否分為二組，再依最後診斷分期為LD及ED。並記錄病患流行病學資料、身體狀況、生化血液檢查、伴隨疾病（糖尿病、高血壓、慢性阻塞性肺病、氣喘、癌症、心血管疾病、腦血管疾病、肺結核）、影像學檢查（胸部X光、胸腹電腦斷層、腦部電腦斷層或核磁造影、骨頭攝影、正子掃描、胸部超音波）、病理學（切片病理學及細胞學檢查、肋膜積液細胞學檢查）、放射線治療、化學治療。Kaplan-Meier curve及log-rank test來分析不同組別間存活差異，Cox's proportional hazards ratios做單變項及多變項分析。結果：經正子攝影檢查後，10名病患由LD改變為ED，而4名由ED改變為LD。經正子攝影分期為LD病患比起傳統診斷工具診斷為LD病患有較長的存活（15.9 ± 14.2月VS 9.5 ± 6.0月；HR: 2.672；log-rank testp=0.0247）但是對於ED病患，二者之間並無顯著差異（9.3 ± 4.6月VS 10.1 ± 8.2月；HR:0.968；log-rank test p=0.9080）。結論：正子攝影對於LD肺小細胞癌病患分期與預後較具有影響，但對於ED肺小細胞癌影響不顯著。
並列摘要
Background: Determining the appropriate therapy for small cell lung cancer (SCLC) is highly dependent on accurate staging, which may have an impact on disease outcome. We evaluated whether the introduction of whole-body positron emission tomography with the glucose analog (18)^F-fluoro-2-deoxy-D-glucose (FDG-PET) improved the accuracy of staging, adequacy of therapy and clinical outcome of SCLC patients. Methods: The study design included prospective recording and retrospective analysis. From September 2007 to July 2012, a total 117 of newly diagnosed SCLC patients (mean age: 62 years, male/female: 107/10, Eastern Cooperative Oncology Group performance status (ECOG): 0-2, were enrolled for analysis. Sixty-nine patients received conventional computed tomography (CT) for staging, and 48 patients underwent both FDG-PET and conventional image studies for staging. All patients received protocol-oriented therapy on an intention-to-treat basis Chang Gung Memorial Hospital. Results: The clinical stage was changed in 14 of the 48 (29%) patients after FDG-PET (10 from limited-stage disease (LD) to extensive-stage disease (ED), 4 from ED to LD), and 34 remained at the same stage. The patients with LD as determined by FDG-PET had a longer median survival than those with LD by conventional staging (15.9 ± 14.2 months versus 9.5 ± 6.0 months; HR: 2.672; log-rank test p=0.0247). The median survival of patients with ED identified by FDG-PET staging was 9.3 ± 4.6 months, compared to 10.1 ± 8.2 months by CT scan (HR: 0.968; log-rank test p=0.9080). Conclusions: For limited-stage SCLC patients, the application of FDG-PET had a positive impact on staging, management and outcome; however, there was less impact on extensive-stage SCLC.