第一临床医学院知识库

目的 探索¹⁸F-FDG PET/CT 显像全身肿瘤代谢容积（Whole-body metabolic tumor volume，MTVwb）评价非小细胞肺癌（Non small cell lung cancer，NSCLC）患者预后的应用价值。方法 采用回顾性分析选取2011年7月至2016年3月在甘肃省人民医院PET/CT中心进行治疗前检查并经病理或后期随访确诊的全部NSCLC患者，最终纳入130例满足纳入排除标准的患者，获取其¹⁸F-FDG PET/CT 显像的图像以及部分临床资料。肿瘤代谢容积（Metabolic tumor volume ，MTV）测量的阈值设置为42%最大标准化摄取值（Maximum standard uptake value，SUVmax）。通过半自动方法测量MTVwb。该参数是肿瘤原发灶MTV、转移淋巴结MTV以及远处转移MTV三者相加之和。性别、年龄、临床TNM分期、MTVwb、MTVwb中位数、MTVwb四分位数与总生存期（Overall survival，OS）的关系可通过Log-rank 检验、Kaplan-Meier生存分析法以及Cox比例风险回归模型等方法分析；同时运用C-statistic值对比分析上述每个预后因素对预后评估的价值。

结果 以4.16 cm³作为MTVwb中位数， MTVwb中位数以下（＜4.16 cm³）的患者半数存活时间约为13.13（95%CI：8.5～21.5）个月，MTVwb中位数以上（≥4.16 cm³）的患者半数存活时间约为4.67（95%CI：3.97～8.6）个月；所有患者中位OS为5.82（0.1～55.6）个月。单因素分析采用Cox比例风险回归模型，结果显示临床TNM分期中Ⅳ期（P=0.001, HR=3.012）、MTVwb（P=0.000， HR=1.604）以及MTVwb中位数（P=0.002，HR=1.925）等是影响NSCLC患者预后的主要因素，对临床TNM分期以及MTVwb进行多因素分析，结果显示仅MTVwb（P=0.003，HR=1.466）是影响NSCLC患者预后的独立影响因素，且MTVwb的C值(0.634)＞临床TNM分期的C值(0.609)＞MTVwb中位数的C值(0.580)。结论 ¹⁸F-FDG PET/CT 显像中的MTVwb对NSCLC患者预后评估有较高的临床应用价值，与临床TNM分期、年龄以及性别等多种因素比较具有更好的预测预后价值。因此，MTVwb较临床TNM分期系统能够更好地评价NSCLC患者的预后，可能会更合理地预测NSCLC患者的总生存期，作为NSCLC患者总生存预测的独立影响因子。

Objective Whole-body metabolic tumor volume（MTVwb） to evaluate the prognosis value of measured by ¹⁸F-FDG PET/CT-based imaging in patients with non-small cell lung cancer（NSCLC）.Methods Using retrospective analysis, all patients with NSCLC who had undergone pre-treatment examination at the PET/CT center of People's Hospital of Gansu Province from July 2011 to March 2016 were identified and confirmed by pathology or late follow-up. Finally, 130 patients meeting the inclusion and exclusion criteria were enrolled to obtain images and some clinical data of ¹⁸F-FDG PET/CT imaging. Metabolic tumor volume （MTV）measurement threshold set to 42% maximum normalized uptake（SUVmax）. MTVwb was measured by semi-automatic method, and it is the sum of the MTV value of the primary tumor, the MTV value of the metabolic lymph node, and the MTV value of distant metastasis. The relationship between gender, age, clinical TNM staging, MTVwb , median of MTVwb, quartile of MTVwb and overall survival （OS） can be analyzed by Log-rank test, Kaplan-Meier survival analysis method and Cox proportional hazards regression model. Simultaneously, using C-statistic values to compare the value of each of the above prognostic factors on the prognosis.

Results Using 4.16 cm³as the median of MTVwb , the half survival time of patients with MTVwb below the median （＜4.16 cm³） about 13.13 （95% CI: 8.5～21.5） months, and the half survival time of patients with a median of MTVwb above （≥4.16 cm³） was approximately 4.67 （95% CI: 3.97～8.6）months. The median OS in all patients was 5.82 months （range, 0.1 to 55.6 months）. Univariate analysis was performed using the Cox proportional hazards regression model, the results showed IV stage of clinical TNM stage （P=0.001, HR=3.012）, MTVwb （P=0.000, HR=1.604）, and median of MTVwb （P=0.002, HR=1.925） was the main factor affecting the prognosis of patients with NSCLC. Multivariate analysis of clinical TNM stage and MTVwb showed that only MTVwb （P=0.003, HR=1.466） was an independent factor influencing the prognosis of patients with NSCLC. and the C-value for MTVwb （0.634）＞ C-value for clinical TNM stage （0.609）＞C-value for the median of MTVwb （0.580）.

Conclusion MTVwb in ¹⁸F-FDG PET/CT imaging has a higher clinical value in the evaluation of prognosis of NSCLC patients, and has better prognostic value compared with clinical TNM stage, age and gender. Therefore, the whole-body metabolic tumor volume （MTVwb） can better evaluate the prognosis of patients with NSCLC than the clinical TNM stage system, may more reasonably predict the overall survival of NSCLC patients, and as an independent predictor of overall survival of NSCLC patients.