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    新辅助治疗后SUVmax是可手术非小细胞肺癌的预后标志物

    SUVmax After Neoadjuvant Therapy as a Prognostic Marker forOperable Non-Small Cell Lung Cancer

      摘要
    • 摘要:
      背景 最大标准化摄取值（maximum standardized uptake value，SUVmax）是不可手术Ⅲ~Ⅳ期非小细胞肺癌（non-small cell lung cancer，NSCLC）的预后因素。然而，SUVmax对接受了新辅助治疗的早期NSCLC的预后作用仍存在争议。本研究分析了这些患者的SUVmax与生存率之间的相关性。
      患者和方法  回顾性分析2008年1月至2017年12月广东省人民医院64例新辅助治疗后进行根治性手术的ⅠA~ⅢB期NSCLC。患者在新辅助治疗前后均进行正电子发射断层扫描/计算机断层扫描（Positron emission tomography/computed tomography，PET/CT）。使用Kaplan-Meier和log-rank法计算和比较无病生存期（disease-free survival，DFS）和总生存期（overall survival，OS）。通过COX比例风险模型确定预后因素，而代谢因素的预测效能通过受试者操作特征曲线（receiver operating characteristics curve，ROC）与ROC曲线下面积（area under the ROC curve，AUC）进行对比。
      结果 SUVmax2（新辅助治疗后的SUVmax）是DFS（P=0.019，AUC=0.702）和OS（P<0.001，AUC=0.746）的独立预后因素。在手术后42个月的ROC分析中，DFS（敏感性：0.566，特异性：0.818）和OS（敏感性：0.800，特异性：0.636）的SUVmax2的临界值为6。以SUVmax2临界值将患者分为两组：SUVmax2≥6，SUVmax2<6，并进行生存分析，提示SUVmax2对DFS（13.1个月 vs. 21.9个月；P=0.023）和OS（23.1个月 vs. 56.4个月；P<0.001）具有预后作用。
      结论 SUVmax2是新辅助治疗后NSCLC患者DFS和OS的潜在独立预后因素，可作为新辅助疗法后区分高危和低危患者的参数。

       

      Abstract:
      Background The maximum standardized uptake value (SUVmax) is a prognostic factor of inoperable advanced (stage Ⅲ and Ⅳ) non-small cell lung cancer (NSCLC). However, the role of SUVmax in early-stage NSCLC patients who underwent neoadjuvant therapy is debated. In this study, we examined the correlation between SUVmax and survival among these patients.
      Patients and methods  Sixty-four patients with stage ⅠA~ⅢB NSCLC who underwent neoadjuvant therapy followed by curative-intent surgery in Guangdong Provincial People’s Hospital were retrospectively reviewed from January 2008 to December 2017. Positron emission tomography/computed tomography (PET/CT) was performed before and after neoadjuvant therapy. Prognostic factors were determined by the COX proportional hazard model, while metabolic factors were compared by receiver operating characteristics curve (ROC) with area under the ROC curve (AUC) values. Disease-free survival (DFS) and overall survival (OS) were estimated and compared by Kaplan-Meier and log-rank analyses, respectively.
      Results  SUVmax2 (SUVmax after neoadjuvant therapy) was found to be an independent prognostic factor of DFS (P=0.019, AUC=0.702) and OS (P<0.001, AUC=0.746). The cutoff value of SUVmax2 was 6.0 in the ROC analysis at 42 months after surgery for DFS (sensitivity: 0.566, specificity: 0.818) and OS (sensitivity: 0.800, specificity: 0.636). The survival curves dichotomized at the SUVmax2 cutoff value were significantly correlated with DFS (SUVmax2≥6, SUVmax2<6, median: 13.1 months vs. 21.9 months; P=0.023) and OS (SUVmax2≥6, SUVmax2<6, median: 23.1 months vs. 56.4 months; P<0.001).
      Conclusion As a potential independent prognostic factor for DFS and OS in patients with NSCLC after neoadjuvant therapy, SUVmax2 may serve as a stratification parameter after neoadjuvant treatment for assessment of high and low-risk patients.

       

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