Nuclear Medicine and Molecular Imaging

  • 제41권6호
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  • Pages.538-545
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  • 2007
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  • 1869-3474(pISSN)
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  • 1869-3482(eISSN)
대한핵의학회 (The Korean Society of Nuclear Medicine)
권호 표지

소세포폐암의 치료전 FDG섭취와 치료반응 및 재발과의 연관성

Correlation of Pre-treatment FDG Uptake to Therapeutic Response and Relapse in Patients with Small Cell Lung Cancer

  • 서영순 (전남대학교 의과대학 핵의학교실) ;
  • 권성영 (전남대학교 의과대학 핵의학교실) ;
  • 정신영 (전남대학교 의과대학 핵의학교실) ;
  • 송호천 (전남대학교 의과대학 핵의학교실) ;
  • 민정준 (전남대학교 의과대학 핵의학교실) ;
  • 김규식 (전남대학교 의과대학 호흡기내과학교실) ;
  • 김영철 (전남대학교 의과대학 호흡기내과학교실) ;
  • 범희승 (전남대학교 의과대학 핵의학교실)
  • Seo, Young-Soon (Departments of Nuclear Medicine, Chonnam National University Medical School) ;
  • Kwon, Seong-Young (Departments of Nuclear Medicine, Chonnam National University Medical School) ;
  • Jeong, Shin-Young (Departments of Nuclear Medicine, Chonnam National University Medical School) ;
  • Song, Ho-Chun (Departments of Nuclear Medicine, Chonnam National University Medical School) ;
  • Min, Jung-Joon (Departments of Nuclear Medicine, Chonnam National University Medical School) ;
  • Kim, Kyu-Sik (Departments of Pulmonology, Chonnam National University Medical School) ;
  • Kim, Young-Chul (Departments of Pulmonology, Chonnam National University Medical School) ;
  • Bom, Hee-Seung (Departments of Nuclear Medicine, Chonnam National University Medical School)
  • 발행 : 2007.12.31
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초록

목적: 소세포폐암 환자에서 치료 전 $^{18}F$-FDG PET/CT에서 $^{18}F$-FDG의 섭취 정도(maxSUV)와 치료에 대한 반응, 그리고 재발과의 연관성에 대해 연구하고자 하였다. 대상 및 방법: 조직학적으로 소세포암으로 진단된 환자 26명을 대상으로 하였다. 모든 환자에서 병기설정 목적으로 $^{18}F$-FDG PET/CT를 시행하였으며, 항암 또는 방사선 치료에 대한 반응 평가를 위해 정기적으로 흉부 CT 검사를 시행하여 추적 관찰하였다. 모든 환자에서 $^{18}F$-FDG섭취 정도의 매개변수로 maxSUV 값을 사용하였다. 항암 또는 방사선 치료 중 또는 치료 후 흉부 CT를 기준으로 반응군과 비반응군으로 나누었다. 독립표본 T 검정을 이용하여 두 환자군간의 maxSUV 값을 비교하였다. 상관 분석을 이용해 FDG 섭취 정도와 재발, 그리고 $^{18}F$-FDG섭취 정도와 재발까지의 기간과의 관계를 평가하였다. ROC곡선을 이용하여 반응군과 비반응군 사이의 진단적 maxSUV 값을 추정하였다. 결과: 추적 관찰한 흉부 CT결과를 토대로 하여 총 26명의 환자 중 21명(81%)은 반응군으로 5명(19%)은 비반응군으로 분류하였다. 반응군과 비반응군의 폐병소에서 평균 maxSUV 값은 각각 $14.15{\pm}3.72$와 $9.17{\pm}2.15$였고, 반응군에서의 maxSU 값이 비반응군에서보다 통계학적으로 유의하게 낮았다(p<0.05). 반응군과 비반응군 사이의 진단적 maxSUV 값을 구하기 위한 ROC 곡선에서 maxSUV가 8.99일 때 100%의 민감도를 보였다. marSUV 값과 진단에서부터 재발까지의 기간은 음의 상관관계를 보였다(p<0.05, r=-0.757). 결론: 소세포폐암 환자에서 치료 전 $^{18}F$-FDG PET/CT 에서의 $^{18}F$-FDG의 섭취정도가 비반응군에서보다 반응군에서 통계적으로 유의하게 낮았다. 치료 전 $^{18}F$-FDG PET/CT에서 $^{18}F$-FDG의 섭취가 높은 환자에서 더 일찍 재발하였다.

Purpose: We evaluated correlation of $^{18}F$-FDG uptakes, therapeutic response and relapse in pre-treatment $^{18}F$-FDG PET/CT in patients with SCLC. Materials and methods: We included 26 patients with pathologically proven small cell lung cancer. Total 102 lesions (26 lungs, 69 lymph nodes and 8 metastatic lesions) were evaluated. All patients underwent $^{18}F$-FDG PET/CT for staging. The maxSUV was used as a parameter of $^{18}F$-FDG uptake. The patients were divided into responders and non-responders according to response criteria on chest CT scan after 3 cycles of chemotherapy. We compared maxSUV between two groups by using independent t-test. To access correlation with $^{18}F$-FDG uptake and relapse, maxSUV and interval time to relapse was analyzed by correlation analysis. The cutoff value of maxSUV was evaluated by ROC curve. Results: Twelve-one patients (81%) were responders and five patients were non-responders on follow-up chest CT scan. The mean maxSUV of main lung lesions in responders and non-responders were $14.15{\pm}3.72$ and $9.17{\pm}2.15$, respectively. The maxSUV in the responders was significantly lower than that in non-responders (p<0.05). According to ROC curve, point of cut that predicts therapeutic response was 8.98 with 100% sensitivity and 57% specificity. The correlation analysis between $^{18}F$-FDG uptakes and interval time to relapse showed a significant negative correlation (p<0.05, r=-0.757). Conclusion: The pre-treatment $^{18}F$-FDG uptake of responders was significantly lower than that of non-responders. Patients with high $^{18}F$-FDG uptake in pre-treatment $^{18}F$-FDG PET/CT relapse earlier.

키워드

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