Value of baseline 18F-FDG PET/CT metabolism parameters in patients with stage Ⅲ-Ⅳ lung adenocarcinoma before EGFR-TKI monotherapy
10.3760/cma.j.cn321828-20230601-00157
- VernacularTitle:Ⅲ～Ⅳ期肺腺癌患者EGFR-TKI单药治疗前基线 18F-FDG PET/CT代谢参数的价值
- Author:
Yan CUI
1
;
Xu LI
;
Congxia CHEN
;
Yue GUO
;
Zhiming YAO
Author Information
1. 北京医院核医学科、国家老年医学中心、中国医学科学院老年医学研究院，北京 100730
- Keywords:
Lung neoplasms;
Adenocarcinoma;
Genes, erbB-1;
Protein kinase inhibitors;
Positron-emission tomography;
Tomography, X-ray computed;
Fluorodeoxyglucose F18
- From:
Chinese Journal of Nuclear Medicine and Molecular Imaging
2024;44(7):390-395
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the efficacy and prognostic value of baseline 18F-FDG PET/CT metabolism parameters in patients with stage Ⅲ-Ⅳ lung adenocarcinoma before epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) monotherapy. Methods:From January 2012 to June 2020, 61 patients (19 males, 42 females; median age: 64 years) with stage Ⅲ-Ⅳ lung adenocarcinoma who underwent baseline 18F-FDG PET/CT imaging before EGFR-TKI monotherapy in 1 month in Beijing Hospital were retrospectively analyzed. The clinical data and metabolic parameters including SUV max, SUV max of lean body mass (SUL max), peak of SUV of lean body mass (SUL peak), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the hottest lesions on PET were analyzed. Patients were followed up to obtain the efficacy evaluation, progression-free survival (PFS) and overall survival (OS). ROC curve analysis was performed to obtain the optimal cut-off value of metabolic parameters to predict disease remission and prognosis. Kaplan-Meier method, log-rank test and Cox proportional risk regression model were used to analyze the prognostic factors. Results:After EGFR-TKI monotherapy, 42.9%(24/56) patients were in disease remission. The optimal cut-off values for predicting disease remission of SUL peak, SUV max, SUL max, MTV, and TLG were 5.9, 13.1, 11.1, 10.6 ml and 99.6 g, respectively. The remission rates of patients with SUV max>13.1, MTV>10.6 ml and TLG>99.6 g were significantly higher than those of patients with SUV max≤13.1(51.2%(21/41) vs 3/15; χ2=4.37, P=0.037), MTV≤10.6 ml (9/12 vs 36.6%(15/41); χ2=5.53, P=0.019) and TLG≤99.6 g (10/13 vs 35.0%(14/40); χ2=6.96, P=0.008). The follow-up period for survival was 0.05-6.80 years, and 10.3%(6/58) patients had no disease progression, and 44.3%(27/61) patients died. The optimal cut-off values of SUL peak, SUV max, SUL max, MTV, and TLG for PFS were 11.2, 17.0, 13.7, 2.7 ml and 14.8 g, and those for OS were 5.6, 14.3, 8.8, 2.8 ml and 37.3 g, respectively. Patients with never-smoking, SUV max≤17.0 and SUL peak≤11.2 had longer PFS ( χ2 values: 3.87-7.37, all P<0.05); never-smoking history (hazard ratio ( HR)=2.29, 95% CI: 1.08-4.87, P=0.031) and SUL peak≤11.2 ( HR=2.67, 95% CI: 1.35-5.27, P=0.005) were independent predictors for PFS. Patients with stage Ⅲ+ ⅣA, SUV max≤14.3, SUL peak≤5.6, SUL max≤8.8 and TLG≤37.3 g had longer OS ( χ2 values: 5.78-8.83, all P<0.05); stage Ⅲ+ ⅣA ( HR=2.81, 95% CI: 1.08-7.32, P=0.034) and SUL max≤8.8 ( HR=9.66, 95% CI: 1.25-74.91, P=0.030) were independent predictors for OS. Conclusions:Baseline 18F-FDG PET/CT imaging has good prospect in clinical application in patients with stage Ⅲ-Ⅳ lung adenocarcinoma before EGFR-TKI monotherapy. The higher baseline metabolic activity of tumor in the 18F-FDG PET/CT, the higher remission rate. Smoking history and SUL peak are independent predictors for PFS; SUL max and stage are independent predictors for OS.
