目的探究基线 18F-FDG PET/CT肿瘤及脂肪组织代谢参数预测晚期鼻咽癌患者免疫治疗效果及预后的价值。
方法回顾性分析2019年2月至2022年2月在中山大学肿瘤防治中心接受程序性死亡受体1(PD-1)抑制剂治疗的晚期鼻咽癌患者112例，其中男91例、女21例，年龄21～73岁。患者均行基线PET/CT检查，测量并计算肿瘤及脂肪组织的代谢参数。将患者分为临床获益组和非临床获益组，采用Mann-Whitney U检验或 χ 2检验评估组间差异；采用多因素Cox比例风险回归模型对无进展生存(PFS)进行预后分析并构建预后分层系统。
结果112例患者中，临床获益组85例，非临床获益组27例。非临床获益组与临床获益组的肿瘤原发灶(PT)-肿瘤代谢体积(MTV)分别为47.7(7.7，81.2)和14.0(5.7，27.1)cm 3，PT-病灶糖酵解总量(TLG)分别为228.9(27.4，492.8)和72.7(20.4，165.5)g，全身MTV(WB-MTV)分别为94.2(45.9，215.4)和61.3(31.6，104.3)cm 3，全身TLG(WB-TLG)分别为605.5(214.1，1 402.5)和319.2(172.4，632.8)g，内脏脂肪组织SUV max(SUV max-VAT)分别为0.77(0.55，0.91)和0.62(0.48，0.76)，差异均有统计学意义( Z值：-2.72～-1.96，均 P<0.05)；非临床获益组存在肺转移患者的占比高于临床获益组[44.4%(12/27)与23.5%(20/85); χ 2＝4.39， P＝0.036]。多因素分析结果显示，PT-MTV[风险比( HR)＝2.807，95% CI: 1.540～5.118， P＝0.001]和有无肺转移( HR＝1.691，95% CI: 1.012～2.823， P＝0.045)是PFS的独立预测因素。基于上述2个指标构建的PFS预后预测模型能够区分不同患者的预后。
结论基线肿瘤代谢参数和内脏脂肪组织SUV max与晚期鼻咽癌患者免疫治疗效果存在关联因素；PT-MTV和肺转移情况能够独立预测患者的PFS；所构建的预测模型能够对患者进行预后分层。
ObjectiveTo investigate the value of tumor and adipose tissue metabolic parameters from baseline 18F-FDG PET/CT in predicting the efficacy and prognosis of immunotherapy in patients with advanced nasopharyngeal carcinoma (NPC).
MethodsFrom February 2019 to February 2022, 112 patients (91 males, 21 females, age 21-73 years) with advanced NPC who were treated with programmed death-1 (PD-1) inhibitors at Sun Yat-Sen University Cancer Center were retrospectively included. All patients underwent baseline PET/CT examination. Tumor and adipose tissue metabolic parameters were measured and calculated. Patients were divided into clinical benefit and non-clinical benefit groups, and Mann-Whitney U test or χ 2 test was used to assess the differences between groups. Prognostic analysis of progression-free survival (PFS) was performed using multivariate Cox proportional hazards regression model and a prognostic stratification system was constructed.
ResultsOf the 112 patients, 85 were in the clinical benefit group and 27 were in the non-clinical benefit group. In non-clinical benefit group and clinical benefit group, the metabolic tumor volume (MTV) of primary tumor (PT-MTV) were 47.7(7.7, 81.2) and 14.0(5.7, 27.1)cm 3, total lesion glycolysis (TLG) of primary tumor (PT-TLG) were 228.9(27.4, 492.8) and 72.7(20.4, 165.5)g, whole-body MTV (WB-MTV) were 94.2(45.9, 215.4) and 61.3(31.6, 104.3)cm 3, whole-body TLG (WB-TLG) were 605.5(214.1, 1 402.5) and 319.2(172.4, 632.8)g, SUV max of visceral adipose tissue (SUV max-VAT) were 0.77(0.55, 0.91) and 0.62(0.48, 0.76), respectively ( Z values: from -2.72 to -1.96, all P<0.05). The proportion of patients with lung metastasis in non-clinical benefit group was higher than that in clinical benefit group (44.4%(12/27) vs 23.5%(20/85); χ 2=4.39, P=0.036). PT-MTV (hazard ratio ( HR)=2.807, 95% CI: 1.540-5.118, P=0.001) and the presence of lung metastases ( HR=1.691, 95% CI: 1.012-2.823, P=0.045) were independent predictive factors for PFS in multivariate analysis. The prognostic prediction model based on the two predictive factors was able to significantly differentiate the prognosis in patients.
ConclusionsBaseline tumor metabolic parameters and SUV max-VAT are associated with the efficacy of immunotherapy in patients with advanced NPC. PT-MTV and lung metastasis can independently predict PFS. The constructed prediction model can stratify patients′ prognosis.
包俊杰,刘立志,樊卫,等. 晚期鼻咽癌患者基线 18F-FDG PET/CT代谢参数预测免疫治疗效果及预后的价值 [J]. 中华核医学与分子影像杂志,2025,45(03)：138-143.
DOI:10.3760/cma.j.cn321828-20240320-00109版权归中华医学会所有。
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包俊杰：研究实施、统计学分析、论文撰写；刘立志：研究实施、数据收集、统计学分析；樊卫、林晓平：研究指导、论文修改
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