背景:间质性肺病(ILD)急性加重(AE)是肺癌切除术围手术期最严重的并发症之一。本研究旨在探讨肺癌合并ILD患者术前2-脱氧-2-[18F]氟-D-葡萄糖(18F-FDG)PET/CT表现与AE的相关性。
方法:我们回顾性分析了210例非小细胞肺癌肺切除术患者的临床资料。评估临床数据与PET图像和AE之间的关系。将患者分为AE(+)组和AE(-)组进行多因素logistic回归分析。进行受试者工作特征(ROC)曲线分析,并使用曲线下面积(AUC)评估预测值。
结果:在210名患者中,48例(22.8%)根据胸部CT诊断为ILD。其中,9例(18.75%)患者在肺切除术后发生AE,定义为AE(+)组。与AE(-)组相比,AE(+)组的ILD病程更长。AE(+)组有AE和慢性阻塞性肺疾病(COPD)病史的患者多于AE(-)组。与AE(-)组相比,AE()组非癌性间质性肺炎(IP)区域和癌症的最大标准化摄取值(SUVmax)明显更高。单因素Logistic回归分析显示,COPD,非癌IP区域的SUVmax,癌症的SUVmax,手术方式与AE显著相关。ILD的过程[OR(95CI)2.919;P=0.032],非癌IP区的SUVmax[OR(95CI)7.630;P=0.012]和D-二聚体水平[OR(95CI)38.39;P=0.041]被确定为肺癌手术后ILD患者AE的独立预测因子。当这三个指标结合起来,我们发现术后AE的预测性能明显优于单纯非癌IP区域的SUVmax[0.963(95%CI0.914-1.00);敏感性,100%,特异性87.2%,P<0.001vs.0.875(95%CI0.789~0.960);灵敏度,88.9%,特异性,76.9%,P=0.001;AUC差异=0.088,Z=1.987,P=0.04]。
结论:ILD病程的组合,非癌IP区域的SUVmax和D-二聚体水平对伴随间质病变的患者AE的发生具有很高的预测价值。
BACKGROUND: Acute exacerbation (AE) of interstitial lung disease (ILD) is one of the most serious complications during perioperative period of lung cancer resection. This study aimed to investigate the correlation between preoperative 2- deoxy-2-[18F]fluoro-D-glucose (18F-FDG) PET/CT findings and AE in lung cancer patients with ILD.
METHODS: We retrospectively reviewed the data of 210 patients who underwent lung resection for non-small cell lung cancer. Relationships between clinical data and PET images and AE were evaluated. The patients were divided into an AE(+) and an AE(-) group for multivariate logistic regression analysis. Receiver operating characteristic (ROC) curve analysis was conducted and the area under curve (AUC) was used to assess the predictive values.
RESULTS: Among 210 patients, 48 (22.8%) were diagnosed with ILD based on chest CT. Among them, 9 patients (18.75%) developed AE after lung resection and were defined as AE(+) group. The course of ILD was longer in AE(+) group compared to AE(-) group. More patients in AE(+) group had a history of AE and chronic obstructive pulmonary disease (COPD) than in AE(-) group. The maximum standardized uptake value (SUVmax) of the noncancerous interstitial pneumonia (IP) area and cancers in AE(+) group was significantly higher compared to AE(-) group. Univariate logistic regression analysis showed that AE, COPD, SUVmax of the noncancerous IP area, SUVmax of cancer, surgical method were significantly correlated with AE. The course of ILD[OR(95%CI) 2.919; P = 0.032], SUVmax of the noncancerous IP area[OR(95%CI) 7.630;P = 0.012] and D-Dimer level[OR(95%CI) 38.39;P = 0.041] were identified as independent predictors for AE in patients with ILD after lung cancer surgery. When the three indicators were combined, we found significantly better predictive performance for postoperative AE than that of SUVmax of the noncancerous IP area alone [0.963 (95% CI 0.914-1.00); sensitivity, 100%, specificity 87.2%, P < 0.001 vs. 0.875 (95% CI 0.789 ~ 0.960); sensitivity, 88.9%, specificity, 76.9%, P = 0.001; difference in AUC = 0.088, Z = 1.987, P = 0.04].
CONCLUSIONS: The combination of the course of ILD, SUVmax of the noncancerous IP area and D-Dimer levels has high predictive value for the occurrence of AE in patients with concomitant interstitial lesions.