The Value Of Whole Body-positron Emission Tomography/computer Tomography In The Treatment, Diagnosis And Prognosis Of NSCLC

BackgroundThe conventional examinations for diagnosis and staging of lung cancer include chest x-ray,computer tomography,ultrasonic examination,magnetic resonance imaging and so on.These non-invasive examinations are applied extensively and are mature techniques,but they can not obtain satisfactory results for clinical diagnosis and staging of lung cancer.Although the invasive examinations(flexible bronchoscope,percutaneous lung biopsy,mediastinoscope) and pathological diagnosis are the base of final diagnosis of lung cancer,they are not good for repeatability and can not acquire the comprehensive evaluation of staging and can not evaluate prognosis and curative effect of NSCLC.Especially,they are insufficient in the early diagnosis of NSCLC and some patients refuse to receive these examinations. Therefore.we need new diagnostic methods for improving the system of diagnosis, treatment and evaluation.After 1990's,FDG-PET began to be applied to the diagnosis and treatment of malignant tumor.The image to express the state of organization metabolism can thoroughly show the characteristics of high glycolysis ratio and the high uptaking glucose ratio of malignant cell.The image to syncretize the metabolic image of PET and the structure image of CT can more exactly locate the tumor,reflect the tumor density and margin,and evaluate the invasive range of tumor.Today,we still lack a great deal of clinical integrity data about PET/CT in NSCLC and we have not a PET/CT diagnostic standard for NSCLC,therefore it needs to acquire more study results.ObjectiveThe optimization of lung cancer therapeutic regimen should base on the accurate lung cancer staging.But a lot of examinations must be performed before the definition of diagnosis and staging of the disease.The disadvantage of the procedure,at first, will take many days and,secondly,the invasive performances may be refused by the patients,therefore the patients will lose tumor treatment as early as possible.Can the whole-PET/CT reflect the state of NSCLC more effectively than the conventional tests to derive the better results of diagnosis,treatment and prognosis and simplify the procedure? The aim of the study will explore the value of PET/CT in the diagnosis, treatment and prognosis of NSCLC.Methods1.To collect the PET/CT data of lung cancer patients from Jan 17,2005 to Jan 17, 2007 and remain the serum samples of the patients.All of the patients were diagnosed of NSCLC by pathological diagnosis through the methods of invasive performance.2.To compare the final diagnosis ratios of PET/CT,chest CT,flexible bronchoscope and transthoracic needle cutting biopsy.3.According to the results of PET/CT,to analyze the value of the first SUV and the SUV of late scan.To explore the ideal value of SUV in NSCLC diagnosis.4.To compare the TNM staging between PET/CT and conventional examinations and explore the difference of them in recall ratio and distribution.To detect the concentration of VEGF-C by sandwich enzyme-linked immunosorbent assay to assist the diagnosis of lymph node whir chest CT.5.To follow up all patients until Mar 31,2008.To analyze the survival data by Kaplan-Meier method and COX hazards proportional method.To evaluate the value of PET/CT and common prognostic factors in the group of patients.Results1.To enroll 86 NSCLC patients,67 male(63±14),19 female(57±13),sex ratio 3.5:1,38 adenocarcinoma,37 squamous cell carcinoma,5 Adenocarcinoma with mixed subtypes and 3 Large cell carcinoma. 2.In the group of patients,the final diagnosis was 90.89%(78/86),chest CT 76.47 %(66/86),flexible bronchoscope biopsy 80%(36/45) and transthoracic needle cutting biopsy 90%(45/50).There was significant difference in PET/CT and chest CT.3.The mean SUV was 8.27±4.90(1.6～21.9) in the group.The SUV of late scan to be detected by 46 patients was 8.35±5.29.Paired-Samples T test shows that they were significant difference,P=0.003.The second-time SUV was below the first time SUV in 13 patients(13/46),but the reducing percent was lower than 20%.The first-time SUV was lower 2.5 in 4 patients,but they were lower than their second-time SUV,and tumor's diameter were all under 2.0cm.4.N1,N2,N3 was respectively 10,24 and 26 to be diagnosed by PET/C,and 9,29 and 6 by chest CT/VEGF-C.There was significant difference between them in recall ratio and distribution(P=0.006 and P=0.004).5.There was 38 patients belonging toⅣstage of NSCLC to be diagnosed by PET/CT,osseous metastasis in 16 patients,liver metastasis 6,brain metastases 4, adrenal gland metastasis 1,multiple metastasis 11;And respectively 16,4,2,1,6 by conventional examination,29 in all.There was no significance between them in in recall ratio and distribution(P=0.2216 and P=0.712).6.Died 59 and consored 27 until the final date,Mar 31,2008.As the cutting-point was respectively 3.5,5,7 and 10,the survival hazard was increasing,P=0.044,0.047, 0,034.The SUV of PET/CT is also a good predictor.7.The analysis with Kaplan-Meier method shows that staging by PET/CT,ECOG PS,weight loss,and times of chemotherapy was relative to survival.The analysis with COX hazards proportional method shows that PET/CT was a good predictor,and superior to ECOG PS(P=0.058) and times of chemotherapy(P=0.078).Conclusions1.The general characteristics including the distribution of age,the duration of highest incidence,sex ratio and the distribution of pathological type were in line with clinical characteristics of NSCLC.2.The final diagnosis with PET/CT was superior to chest CT,and equal to flexible bronchoscope and transthoracic needle cutting biopsy. 3.The first time SUV was higher than 2.5 a lot and it shows that SUV above 2.5 was a good critical point to diagnose NSCLC more than 90%.But when it'diameter is lower than 2.0cm and the SUV lower and 2.5,the NSCLC could not be excluded.The SUV of late scan was a significant reference.4.Diagnosis of lymph node metastasis by PET/CT is significant superior to chest CT/VEGF-C.Chest CT/VEGF-C can improve the value of lymph node metastasis of adenocarcinoma with conventional examinations,but it needs more study data if to be applied to clinical test.5.The SUV of PET/CT was a good predictor to NSCLC.The higher SUV is the shorter survival days are.Likewise,NSCLC TNM with PET/CT was also a good predictor.The higher staging is the shorter survival days are.