摘要目的 探讨术前18F-脱氧葡萄糖(FDG) PET-CT对预测Ⅰ期非小细胞肺癌(NSCLC)完全切除术后复发风险的作用.方法 回顾性分析2005年6月至2012年6月中日友好医院182例术前行PET-CT检查的Ⅰ期NSCLC患者,其中男性121例,女性61例;年龄34～85岁,平均年龄68岁;ⅠA期98例,ⅠB期84例;腺癌137例,鳞状细胞癌35例,其他10例.对性别、年龄、吸烟史、18F-FDG最大标准化摄取值(SUVmax)、手术方式、病理特征和术后辅助化疗等可能影响预后的因子进行单因素和多因素分析,采用Kaplan-Meier曲线及Log-rank检验比较生存曲线的差异.结果 182例患者术后复发率为15.9％.单因素分析显示肿瘤SUVmax(t=3.278,P＜0.001)、病理分期(x2 =5.204,P=0.026)、血管浸润(x2=5.333,P=0.027)和脏层胸膜浸润(x2=7.697,P=0.009)对术后复发率的影响有统计学意义.多因素分析表明肿瘤SUVmax是术后复发的独立预后因素(HR=1.068,95％ CI:1.015 ～1.123,P=0.001).根据SUVmax对患者进行分层,SUVmax≤2.5、2.5＜SUVmax≤5.0、SUVmax＞ 5.0三组复发率分别为4/55(7.3％)、9/60(15.0％)、16/67(23.9％),差异有统计学意义(x2=6.278,P=0.043);5年无复发生存率分别为90.9％、82.7％、71.0％,差异有统计学意义(P =0.030).SUVmax较高者出现血管浸润阳性(x2=20.267,P=0.000)、胸膜浸润阳性(x2 =6.185,P-0.045)和病理Ⅰb期(x2=13.589,P=0.001)的比例增加.结论 术前SUVmax是Ⅰ期NSCLC术后复发的独立危险因素,对病理分期相同的患者可根据SUVmax进行风险分层并决定术后随访与治疗方案.

abstractsObjective To analyze the prognostic impact of preoperative 18 F-fluorodeoxyglucose (FDG) PET-CT on postoperative recurrence in patients with completely resected stage Ⅰ non-small cell lung cancer (NSCLC).Methods The clinic data of 182 patients with stage Ⅰ NSCLC who underwent 18 F-FDG PET-CT scan before surgical resection between June 2005 and June 2012 were reviewed retrospectively.There were 121 male and 61 female patients,with an average age of 68 years (range from 34 to 85 years).The pathological stage was Ⅰ A in 98 patients,Ⅰ B in 84 patients;the histology were adenocarcinoma in 137 patients,squamous cell carcinoma in 35 patients,and others in 10 patients.Clinicopathological factors including gender,age,smoking history,SUVmax,surgical procedure,pathological features and adjuvant chemotherapy were evaluated to identify the independent factors predicting postoperative recurrences by univariate and multivariate analysis.The survivals were calculated by the Kaplan-Meier method and differences in variables were analyzed by the Log-rank test.Results The postoperative recurrence rate was 15.9％.The univariate analysis identified that the SUVmax(t =3.278,P ＜ 0.001),p-stage(x2 =5.204,P =0.026),blood vessel invasion (x2 =5.333,P =0.027) and visceral pleural invasion(x2 =7.697,P =0.009)are factors for predicting postoperative recurrence.Only SUVmax was found to be a significant independent factor according to multivariate analysis(HR =1.068,95％ CI:1.015 to 1.123,P =0.001).The study population was stratified into three groups by SUVmax,patients with SUVmax ＞ 5.0 had significantly higher risk of recurrence (23.9％) than those with 2.5 ＜ SUVmax ≤ 5.0 (15.0％) and SUVmax≤ 2.5 (7.3％) (P =0.043);patients with SUVmax ≤ 2.5 had significantly better 5-year recurrence-free survival rate (90.9％) than those with 2.5 ＜ SUVmax≤5.0 (82.7％) and SUVmax≤2.5 (71.0％) (P =0.030).There was a trend toward higher probability of blood vessel invasion (x2 =20.267,P ＜ 0.001),visceral pleural invasion (x2 =6.185,P =0.045) and pathological stage Ⅰ B (x2 =13.589,P =0.001) with increased SUVmax.Conclusions Preoperative SUVmax of primary tumor is a predictor of postoperative relapse for stage Ⅰ NSCLC after surgical resection.Therefore,it can contribute to the risk stratification for patients with the same pathological stage and selecting the optimal postoperative follow-up and therapeutic strategy.