【摘要】 目的 ¹⁸F-FDG PET/CT显像是协助非小细胞肺癌（non-small-cell lung cancer,NSCLC）术前分期的重要检查方法,但联合肺癌原发灶代谢和增殖状况预测淋巴结转移的研究较少。本研究通过联合¹⁸F-FDG PET/CT和病理资料,探讨FDG PET/CT代谢和细胞增殖对NSCLC N₁和N₂期淋巴结转移的预测价值。方法回顾性分析2007-10-01-2017-01-31北京医院收治的92例N₀^N₂期NSCLC患者,其均于¹⁸F-FDG PET/CT检查后1个月内行肿瘤切除和局部淋巴结清除。根据病理结果,分为无淋巴结转移组（N₀期组）69例和有淋巴结转移组（N₁+N₂期组）23例,分析NSCLC原发灶及清除淋巴结的PET/CT影像学及病理结果。计数资料采用χ2检验,计量资料行t检验。单因素分析筛选出的预测因子,再以多因素Logistic回归进行统计分析。采用受试者工作特征（receiver operating characteristic,ROC）曲线获得N₁、N₂期淋巴结转移的诊断阈值。结果男女各46例,年龄39⁸0岁,中位年龄65岁。N₀期组和N₁+N₂期组的NSCLC原发灶大小分别为2.2（1.6,3.0）和3.6（2.6,5.4）cm,最大标准摄取值（maximal standardized uptake value,SUVmax）分别为8.0±6.4和13.3±5.6,Ki-67值分别为10（5,40）%和30（20,60）%,均P<0.05。N₀期组低分化的NSCLC比例为23.2%,显著低于N₁+N₂期组的76.8%,P<0.01。两组的年龄、性别和病理类型之间差异均无统计学意义,均P>0.05。多因素Logistic分析显示,NSCLC原发灶大小和SUVmax值是预测淋巴结转移的独立影响因子。ROC曲线分析证实,原发灶大小2.75cm、原发灶SUVmax7.35是诊断N₁+N₂期淋巴结转移的阈值,其预测N₁+N₂期淋巴结转移的灵敏性分别为73.9%和95.7%,特异性分别为69.6%和56.5%,准确性分别为70.7%和66.3%,阳性预测值分别为44.7%和42.3%,阴性预测值分别为88.9%和97.5%。系列试验法联合SUVmax和大小标准分析,其预测N₁+N₂期淋巴结转移的灵敏性、特异性、准确性、阳性预测值和阴性预测值分别为73.9%、81.2%、79.3%、56.7%和90.3%。NSCLC原发灶细胞增殖率为低-中度（Ki-67≤50%）和高度（Ki-67>50%）的患者N₁+N₂期淋巴结转移率分别为22.1%和40%,P=0.254。NSCLC原发灶Ki-67≤50%的患者中,按原发灶SUVmax值≤7.35和SUVmax>7.35再次分成两组,各组N₁+N₂期淋巴结转移率分别为2.6%和42.1%,P<0.01。结论 NSCLC原发灶大小和SUVmax值是N₁+N₂期淋巴结转移的独立危险因素;原发灶SUV max预测NSCLC N₁+N₂期淋巴结转移的灵敏性高。原发灶SUVmax能强化细胞增殖率对N₁+N₂期淋巴结转移的预测能力。更多还原

【Abstract】 OBJECTIVE ¹⁸F-FDG PET/CT was the important examination method for preoperative non-small cell lung cancer（NSCLC）staging.There were few studies on combination metabolism and proliferation of NSCLC primary tumor in prediction lymph node metastasis.This study was to evaluate the value of the metabolism and proliferation situation of simple NSCLC by ¹⁸F-FDG PET/CT and the pathological in prediction of N₁ and N₂ lymph node metastasis.METHODS We retrospectively analyzed 92 patients with stage N₀-N₂ and M0 NSCLC who underwent lobectomy with systematic lymph node dissection within one month after the ¹⁸F-FDG PET/CT scan in Beijing Hospital,from October2007 to January 2017.These patients were divided into group N₁+N₂ and group N₀ according to if they were with and without stage N₁ and N₂ lymph node metastasis.Independent Samples t test andχ2 test were used in analyzing the data.The risk factors were identified finally with logistic regression analysis.The cut off value in detection of stage N₁ and N₂ lymph node metastases was determined by the ROC curve.RESULTS Both male and female patients were 46（50%,respectively）.The patients’ average age was 65.0±10.0（39-80）years old.The size,SUVmaxand Ki-67 of NSCLC primary tumor in group N₀ were significantly lower than those in group N₁+N₂[2.2（1.6,3.0）cmvs 3.6（2.6,5.4）cm,（8.0±6.4）vs（13.3±5.6）,10（5,40）% vs 30（20,60）%],all P <0.05.Meanwhile,the proportion of poor differentiation NSCLC in group N₀（23.2%）was significantly lower than that in group N₁+N₂（76.8%）,P<0.01.There were no significant differences between group N₀ and group N₁ in age,gender,tumor position and histopathology types,all P>0.05.The multivariate logistic regression revealed that the size and SUVmaxof NSCLC primary tumor measured by PET/CT were independent factors in prediction of stage N₁ and N₂ lymph node metastasis.According to the ROC curves,the cutoff values in prediction of stage N₁ and N₂ lymph node metastasis were that NSCLC primary tumor had size>2.75 cm or SUVmax>7.35.With the cut off values of size and SUVmax,the sensitivities in prediction of stage N₁ and stage N₂ lymph node metastasis were 73.9% and 95.7%,the specificities were 69.6% and 56.5%,the accuracies were 70.7% and66.3%,the positive predictive values（PPV）were 44.7% and 42.3%,the negative predictive values（NPV）were 88.9%and 97.5% respectively.Combination cut of values of SUVmax with size of NSCLC primary tumor as the predicators of lymph node metastasis,the sensitivity,specificity,accuracy,PPV and NPV were 73.9%,81.2%,79.3%,56.7%,and90.3%,respectively.22.1% patients with Ki-67≤50% of NSCLC primary tumor and 40% patients with Ki-67>50% had stage N₁ and N₂ lymph node metastasis,P=0.254.Among patients with Ki-67≤50% NSCLC primary tumor,2.6% and 42.1% patients with SUVmax≤7.5 and with SUVmax>7.5 NSCLC primary tumor had stage N₁ and N₂ lymph node metastasis,P<0.01.CONCLUSIONS Both size and SUVmaxof NSCLC primary tumor are independent risk factors to predict stage N₁ and N₂ metastasis.The SUVmaxhas higher sensitivity in prediction of the stage N₁ and N₂ lymph node metastasis than the size and it improves the ability of Ki-67 of NSCLC primary tumor in predicting the metastasis of stage N₁ and N₂ lymph node.更多还原