背景:99mTc-MAA在肿瘤内积累代表肺动脉灌注,这是可变的,可能有临床意义。我们评估了99mTc-MAA分布在非小细胞肺癌(NSCLC)患者肿瘤中的预后意义,以检测隐匿性淋巴结转移和淋巴管浸润。以及预测无复发生存率(RFS)。
方法:对术前行肺灌注SPECT/CT的临床N0状态NSCLC患者进行回顾性评估,并根据肿瘤中99mTc-MAA积累的视觉分级进行分类。视觉等级与定量参数进行比较,标准化肿瘤与肺比率(TLR)。99mTc-MAA积累与隐匿性淋巴结转移的预测价值,淋巴管浸润,并对RFS进行了评估。
结果:89例(37.2%)患者显示99mTc-MAA积累,150例(62.8%)患者显示99mTc-MAASPECT/CT缺陷。在积累群体中,45(50.5%)被归类为1级,40(44.9%)被归类为2级,4(4.5%)被归类为3级。TLR从0级(0.009±0.005)到1级(0.021±0.005,P<0.05)和2-3级(0.033±0.013,P<0.05)逐渐显著升高。在单因素分析中,以下因素是隐匿性淋巴结转移的重要预测因素:中心位置,组织学不同于腺癌,肿瘤大小大于3厘米,代表临床T2或更高,肿瘤内不存在99mTc-MAA积累。肺灌注SPECT/CT缺陷在多变量分析中仍然显著(奇数比3.25,95CI[1.24to8.48],p=0.016)。中位随访时间为31.5个月,缺损组的RFS显著缩短(p=0.008).单因素分析显示非腺癌的细胞类型,临床II-III期,病理II-III期,年龄大于65岁,肿瘤内99mTc-MAA缺陷是较短RFS的重要预测因子。然而,只有病理阶段保持统计学显著,在多变量分析中。
结论:术前肺灌注SPECT/CT中肿瘤内无99mTc-MAA积累是隐匿性淋巴结转移的独立危险因素,并且是临床上N0例NSCLC患者的不良预后因素。99mTc-MAA肿瘤分布可作为反映肿瘤血管和灌注的新的成像生物标志物,可与肿瘤生物学和预后相关。
BACKGROUND: 99mTc-MAA accumulation within the tumor representing pulmonary arterial perfusion, which is variable and may have a clinical significance. We evaluated the prognostic significance of 99mTc-MAA distribution within the tumor in non-small cell lung cancer (NSCLC) patients in terms of detecting occult nodal metastasis and lymphovascular invasion, as well as predicting the recurrence-free survival (RFS).
METHODS: Two hundred thirty-nine NSCLC patients with clinical N0 status who underwent preoperative lung perfusion SPECT/CT were retrospectively evaluated and classified according to the visual grading of 99mTc-MAA accumulation in the tumor. Visual grade was compared with the quantitative parameter, standardized tumor to lung ratio (TLR). The predictive value of 99mTc-MAA accumulation with occult nodal metastasis, lymphovascular invasion, and RFS was assessed.
RESULTS: Eighty-nine (37.2%) patients showed 99mTc-MAA accumulation and 150 (62.8%) patients showed the defect on 99mTc-MAA SPECT/CT. Among the accumulation group, 45 (50.5%) were classified as grade 1, 40 (44.9%) were grade 2, and 4 (4.5%) were grade 3. TLR gradually and significantly increased from grade 0 (0.009 ± 0.005) to grade 1 (0.021 ± 0.005, P < 0.05) and to grade 2-3 (0.033 ± 0.013, P < 0.05). The following factors were significant predictors for occult nodal metastasis in univariate analysis: central location, histology different from adenocarcinoma, tumor size greater than 3 cm representing clinical T2 or higher, and the absence of 99mTc-MAA accumulation within the tumor. Defect in the lung perfusion SPECT/CT remained significant at the multivariate analysis (Odd ratio 3.25, 95%CI [1.24 to 8.48], p = 0.016). With a median follow-up of 31.5 months, the RFS was significantly shorter in the defect group (p = 0.008). Univariate analysis revealed that cell type of non-adenocarcinoma, clinical stage II-III, pathologic stage II-III, age greater than 65 years, and the 99mTc-MAA defect within tumor as significant predictors for shorter RFS. However, only the pathologic stage remained statistically significant, in multivariate analysis.
CONCLUSIONS: The absence of 99mTc-MAA accumulation within the tumor in preoperative lung perfusion SPECT/CT represents an independent risk factor for occult nodal metastasis and is relevant as a poor prognostic factor in clinically N0 NSCLC patients. 99mTc-MAA tumor distribution may serve as a new imaging biomarker reflecting tumor vasculatures and perfusion which can be associated with tumor biology and prognosis.