| Objective:The positron emission computed tomography/X-ray computed tomography?PET/CT?has been clinical recognized for the diagnosis and staging of lung cancer.There is also a certain value in predicting the prognosis of non-small cell lung cancer.However,there are few studies on the prediction of survival prognosis of small cell lung cancer?SCLC?.The aim of the study was to evaluate the prognostic value of Metabolic parameter on 18F-FDG PET/CT imaging in patients with small cell lung cancer before treatment.To improve the individualized treatment level of patients with small cell lung cancer.improve the prognosis,and benefit patients with small cell lung cancer.Methods:The clinical data of 54 small cell lung cancer patients?39 males,15 females,age rang:24y to 76y,average age 58.9±9.3 years?were enrolled from February 2012 to Septemberr 2018 were retrospectively analyzed.Through the radiomics software LIFEx,draw the region of interest?ROI?of the Small Cell Lung Cancer of primary lesion and the primary lesion+metastase lesions with 40%SUVmax,automatically calculate the SUVmax,MTV,TLG of the primary lesion MTVsum,TLGsumum of the primary lesion+metastase lesions;The images were independently diagnosed by two experienced nuclear medicine physicians.When the opinions were inconsistent,they were discussed and decided by the all physicians.All patients were followed up until November 30,2018.ROC curve,Kaplan-Meier survival analysis and Cox proportional hazard model were used to analyze the relationship between SUVmax,MTV,TLG,MTVsum,TLGsum,TNM staging,VALSG staging,age,gender,smoking,metastasis and treatment with small cell lung cancer.Result:1.Of 54 patiens,the follow-up data of 46 Small Cell Lung Cancer patients?31 males,15 females,age range:24y to74y,average age:59.5±9.3?were complete.8 patients were lost to follow-up,And the rate of missed follow-up was 14.81%?8/54?.Treatment of 46 Small Cell Lung Cancer patients:21 cases of chemotherapy,11 cases of radiotherapy+chemotherapy,6 cases of surgery,5 cases of surgery+chemotherapy,1 case of surgery+chemotherapy+radiotherapy,2 cases of traditional Chinese medicine.27?27/46,58.70%?cases of disease progression during follow-up,28?28/46,60.87%?of Small Cell Lung Cancer died during follow-up.2.examination result of 18F-FDG PET/CT before treatment:Among the follow-up data of 46 Small Cell Lung Cancer patients,29?63.04%?patients with small cell lung cancer had metastasis before treatment,including lymph node metastasis 26?56.52%?cases,bone metastasis 7?15.21%?cases,and lung metastasis 6?13.04%?cases,adrenal metastasis 2?4.35%?cases,liver metastasis 1?2.17%?cases,pancreas metastasis 1?2.17%?cases.17?36.97%?Small Cell Lung Cancer patients had no metastatic lesions other than the primary lesion at the time of initial diagnosis.According to the Veterans Administration Lung Cancer Study Group standard,the Limited stage was 35cases and the extensive stage was 11 cases.According to TNM staging,I stage9 cases,II stage 9 cases,III stage 17 cases,and IV stage 11 cases.3.The median which 46 patients with small cell lung cancer 18F-FDG PET/CT before treatment metabolic parameters SUVmax,MTV,TLG,MTVsum and TLGsum were 9.75?5.90,11.70?,47.5?17.75,124.50?cm3,223.0?66.25,603.75?,88.0?32.00,221.50?cm3,and 426.5?94.75,1205.25?.4.The relationship between VALSG staging and survival,the follow-up data of 46 Small Cell Lung Cancer patients median PFS of 10.0 months?95%CI:7.155-12.845 months?and median OS of 18.0 months?95%CI:15.136 to20.864 months?.According to VALSG staging,limited stage of patients with median PFS of 12.0 months and median OS 21.0 months were significantly longer than extensive stage of patients with median PFS of 6.0 months and median OS of 9.0 months,with statistical significance?X2=14.908 and 41.353,P=0.000 and 0.000?.5.The optimal thresholds for predicting PFS in small cell lung cancer patients by SUVmax,MTV,TLG,MTVsum,and TLGsum in 46 patients with small cell lung cancer before treatmeat by ROC curve were 11.55,41.5cm3,189.5,54cm3,and 263.5,respectively.The boundaries were divided into SUVmax,MTV,TLG,MTVsum,TLGsum high value group and low value group.Kaplan-Meier method was used to analyze the PFS survival between groups.Log-rank test was used to compare the survival difference between the two groups.The median PFS?7.0,8.0,8.0,8.0,8.0 months?was significantly shorter in the high-value group than in the low-group patients?12.0,17.0,17.0,20.0,20.0 months?,with statistical significance?X2=5.361,10.040,17.873,17.478,17.478,P=0.021,0.002,0.000,0.000,0.000?.6.The optimal thresholds for predicting the OS of small cell lung cancer patients by SUVmax,MTV,TLG,MTVsum,and TLGsum in 46 patients with small cell lung cancer befor treatmeat were 10.75,41.5 cm3,189.5,37.5 cm3,and 173,respectively,by ROC curve.The threshold values were divided into SUVmax,MTV,TLG,MTVsum,TLGsum high value group and low value group.Kaplan-Meier method was used to analyze OS survival between groups.Log-rank test was used to compare the survival difference between the two groups.The median OS?14.0,14.0,13.0,17.0,15.0 months?was significantly shorter in the high-value group than in the low-group patients?24.0,25.0,27.0,31.0,30.0 months?,with statistical significance?X2=11.215,18.623,28.240,15.804,18.710,P=0.001,0.000,0.000,0.000,0.000?.7.Cox proportional hazards model analysis:Through single factor analysis,it was found that TNM staging,VALG staging,whether metastasis,SUVmax,MTV,TLG,MTVsum,TLGsum were risk factors for PFS and OS,and multivariate analysis of risk factors showed that TLG?HR:3.154,95%CI:1.1958.324?and TNM staging?HR:0.010,95%CI:1.1663.120?were independent prognostic factors for PFS in patients with small cell lung cancer?P=0.020,0.010?.VALSG staging?HR:14.104,95%CI:2.939-67.62?was an independent prognostic factor for OS in patients with small cell lung cancer?P=0.001?.Conclusion:1.18F-FDG PET/CT metabolic parameters SUVmax,MTV,TLG,MTVsum,TLGsum are related to the survival of patients with newly diagnosed small cell lung cancer.The higher the value,the shorter the survival period.Pretreatment 18F-FDG PET/CT metabolic parameters SUVmax,MTV,TLG,MTVsum,TLGsum can predict the survival prognosis of patients with small cell lung cancer.2.TNM staging,VALSG staging,metastasis,SUVmax,MTV,TLG,MTVsum,TLGsum in patients with small cell lung cancer were associated with prognosis;TLG and TNM staging were small cell lung cancer patients with PFS independent prognostic factors;VALSG staging is an independent prognostic factor for OS in small cell lung cancer patients. |
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