复发小细胞肺癌患者血清NSE水平与肿瘤MTV及TLG的关系
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摘要
[研究背景]
肺癌是我国乃至全世界发病率及死亡率均较高的疾病,小细胞肺癌约占新发肺癌患者的20%左右,其具有恶性程度高,倍增时间短,侵袭性强,转移早而广泛的生物学特点。尽管对化疗敏感性很高,但95%的小细胞肺癌患者特别是在治疗后第1年复发。复发的肿瘤患者体内肿瘤负荷对肿瘤患者的预后有着紧密的关系,临床上常用CT下测量的肿瘤最大径或肿瘤体积来表示肿瘤的负荷,但是很多肿瘤的形状不规则,还存在许多难以辨认的坏死组织,因此对肿瘤负荷的估计不够准确。目前,18F-FDG PET/CT已用于肿瘤患者的诊断、分期及判断复发等,PET显像可以先于组织器官结构变化,从分子水平鉴别人体内的代谢变化,肿瘤代谢体积MTV具有PET的优点,总病变糖酵解(TLG)更是将平均SUV值考虑进来,这些均是在CT下的肿瘤负荷评估所不具有的优点。
[目的]
本文旨在分析复发小细胞肺癌患者血清NSE水平与肿瘤的MTV及TLG之间的关系,为PET-CT在复发小细胞肺癌中应用提供理论基础。
[资料和方法]
回顾性的收集了21例复发小细胞肺癌患者,病例选择标准为：初诊时诊断为复发小细胞肺癌；之前行至少4个周期依托泊苷联合铂类的化疗,并且在当时行化疗后的疗效评价为CR；这些患者在行18F-FDG PET/CT检查的同时也检测了血清NSE、CEA及Cyfra211的水平。其中11例患者血清NSE水平在正常范围内(小于17ng/ml),其余10例大于17ng/ml在PET图像上以SUV=2.5作为勾画ROI的阈值,逐层勾画,计算出肿瘤MTV及TLG统计学分析采用皮尔森相关性分析评估肿瘤标志物与肿瘤MTV及TLG的相关性,评估相关性后采用线性回归分析有无线性关系。
[结果]
血清NSE水平与肿瘤MTV及TLG均有线性关系(p值均小于0.001),皮尔森相关性分析显示血清NSE与肿瘤MTV及TLG有很强的相关性(r=0.787p<0.001；r=0.866p<0.001),但是我们没有发现血清CEA水平与肿瘤MTV及TLG之间有相关性,同样血清Cyfra211水平与肿瘤MTV及TLG之间也无相关性。在血清NSE水平正常的11例患者中,未发现NSE水平与肿瘤MTV及TLG之间有相关性(r=0.018p=0.958; r=-0.003, p=0.92),在其余10例血清NSE水平高于正常的患者中,发现血清NSE水平与肿瘤MTV及TLG之间有相关性(r=0.789p<0.01; r=0.872, p=0.01).
[结论]
本研究显示复发小细胞肺癌患者血清肿瘤标志物(CEA、NSE及Cyfra211)中,只有血清NSE水平与肿瘤MTV及TLG有线性相关性,并且血清NSE与肿瘤TLG之间较肿瘤MTV有更强的相关性系数。肿瘤MTV及TLG可以作为复发小细胞肺癌患者肿瘤负荷的敏感指标。对于血清NSE水平异常的患者,NSE越高则提示肿瘤负荷越大；NSE处于正常范围不代表没有复发,应联合其他辅助检查综合诊断,确诊复发后,PET-CT得到的MTV及TLG可用于肿瘤负荷的评估。
[Background]
In spite of high response rates to chemotherapy, recurrences occur around95%of patients with small cell lung cancer especially in the first year. Total tumor burden is frequently related to prognosis and tumor response to therapy. Currently, tumor maximum diameter determined by CT or MRI was widely used in clinical, but it has many disadvantages because the tumor shape is frequently irregular and it is hard to (?) distinguish tumor from necrotic tissue. FDG PET can overcome these disadvantages.
[Objectives]
The aim of the present study was to investigate the serum neuron-specific enolase(NSE) level in relation to the metabolic tumor volume(MTV) or total lesion glycolysis(TLG) by FDG PET in patients with recurrent small cell lung cancer.
[Methods]
Linear associations was found between serum NSE level and MTV or TLG (P<0.001). Pearson correlation analyses showed strong correlation between NSE level and MTV or TLG (r=0.787, P<0.001and r=0.866, P<0.001, respectively). However, we found no such linear associations and correlation between CEA level and Cyfra211level with MTV or TLG. In patients with normal NSE level, no correlation was found between NSE with MTV or TLG (r=0.018, P=0.958and r=-0.003, P=0.92, respectively), but the correlation was significant in patients with abnormal NSE level (r=0.789, P<0.01and r=0,872, P=0.01, respectively).
[Results]
MTV or TLG of recurrent SCLC measured by FDG PET have linear correlation between serum NSE level, and TLG show greater correlation coefficient. In patients with abnormal NSE level, higher NSE level indicate greater MTV and TLG TLG and MTV may serve as sensitive marker of tumor burden in patients with recurrent small cell lung cancer.
[Conclusions]
MTV or TLG of recurrent SCLC measured by FDG PET have linear correlation between serum NSE level, and TLG show greater correlation coefficient. In patients with abnormal NSE level, higher NSE level indicate greater MTV and TLG TLG and MTV may serve as sensitive marker of tumor burden in patients with recurrent small cell lung cancer.
肺癌是我国乃至全世界发病率及死亡率均较高的疾病,小细胞肺癌约占新发肺癌患者的20%左右,其具有恶性程度高,倍增时间短,侵袭性强,转移早而广泛的生物学特点。尽管对化疗敏感性很高,但95%的小细胞肺癌患者特别是在治疗后第1年复发。复发的肿瘤患者体内肿瘤负荷对肿瘤患者的预后有着紧密的关系,临床上常用CT下测量的肿瘤最大径或肿瘤体积来表示肿瘤的负荷,但是很多肿瘤的形状不规则,还存在许多难以辨认的坏死组织,因此对肿瘤负荷的估计不够准确。目前,18F-FDG PET/CT已用于肿瘤患者的诊断、分期及判断复发等,PET显像可以先于组织器官结构变化,从分子水平鉴别人体内的代谢变化,肿瘤代谢体积MTV具有PET的优点,总病变糖酵解(TLG)更是将平均SUV值考虑进来,这些均是在CT下的肿瘤负荷评估所不具有的优点。
[目的]
本文旨在分析复发小细胞肺癌患者血清NSE水平与肿瘤的MTV及TLG之间的关系,为PET-CT在复发小细胞肺癌中应用提供理论基础。
[资料和方法]
回顾性的收集了21例复发小细胞肺癌患者,病例选择标准为：初诊时诊断为复发小细胞肺癌；之前行至少4个周期依托泊苷联合铂类的化疗,并且在当时行化疗后的疗效评价为CR；这些患者在行18F-FDG PET/CT检查的同时也检测了血清NSE、CEA及Cyfra211的水平。其中11例患者血清NSE水平在正常范围内(小于17ng/ml),其余10例大于17ng/ml在PET图像上以SUV=2.5作为勾画ROI的阈值,逐层勾画,计算出肿瘤MTV及TLG统计学分析采用皮尔森相关性分析评估肿瘤标志物与肿瘤MTV及TLG的相关性,评估相关性后采用线性回归分析有无线性关系。
[结果]
血清NSE水平与肿瘤MTV及TLG均有线性关系(p值均小于0.001),皮尔森相关性分析显示血清NSE与肿瘤MTV及TLG有很强的相关性(r=0.787p<0.001；r=0.866p<0.001),但是我们没有发现血清CEA水平与肿瘤MTV及TLG之间有相关性,同样血清Cyfra211水平与肿瘤MTV及TLG之间也无相关性。在血清NSE水平正常的11例患者中,未发现NSE水平与肿瘤MTV及TLG之间有相关性(r=0.018p=0.958; r=-0.003, p=0.92),在其余10例血清NSE水平高于正常的患者中,发现血清NSE水平与肿瘤MTV及TLG之间有相关性(r=0.789p<0.01; r=0.872, p=0.01).
[结论]
本研究显示复发小细胞肺癌患者血清肿瘤标志物(CEA、NSE及Cyfra211)中,只有血清NSE水平与肿瘤MTV及TLG有线性相关性,并且血清NSE与肿瘤TLG之间较肿瘤MTV有更强的相关性系数。肿瘤MTV及TLG可以作为复发小细胞肺癌患者肿瘤负荷的敏感指标。对于血清NSE水平异常的患者,NSE越高则提示肿瘤负荷越大；NSE处于正常范围不代表没有复发,应联合其他辅助检查综合诊断,确诊复发后,PET-CT得到的MTV及TLG可用于肿瘤负荷的评估。
[Background]
In spite of high response rates to chemotherapy, recurrences occur around95%of patients with small cell lung cancer especially in the first year. Total tumor burden is frequently related to prognosis and tumor response to therapy. Currently, tumor maximum diameter determined by CT or MRI was widely used in clinical, but it has many disadvantages because the tumor shape is frequently irregular and it is hard to (?) distinguish tumor from necrotic tissue. FDG PET can overcome these disadvantages.
[Objectives]
The aim of the present study was to investigate the serum neuron-specific enolase(NSE) level in relation to the metabolic tumor volume(MTV) or total lesion glycolysis(TLG) by FDG PET in patients with recurrent small cell lung cancer.
[Methods]
Linear associations was found between serum NSE level and MTV or TLG (P<0.001). Pearson correlation analyses showed strong correlation between NSE level and MTV or TLG (r=0.787, P<0.001and r=0.866, P<0.001, respectively). However, we found no such linear associations and correlation between CEA level and Cyfra211level with MTV or TLG. In patients with normal NSE level, no correlation was found between NSE with MTV or TLG (r=0.018, P=0.958and r=-0.003, P=0.92, respectively), but the correlation was significant in patients with abnormal NSE level (r=0.789, P<0.01and r=0,872, P=0.01, respectively).
[Results]
MTV or TLG of recurrent SCLC measured by FDG PET have linear correlation between serum NSE level, and TLG show greater correlation coefficient. In patients with abnormal NSE level, higher NSE level indicate greater MTV and TLG TLG and MTV may serve as sensitive marker of tumor burden in patients with recurrent small cell lung cancer.
[Conclusions]
MTV or TLG of recurrent SCLC measured by FDG PET have linear correlation between serum NSE level, and TLG show greater correlation coefficient. In patients with abnormal NSE level, higher NSE level indicate greater MTV and TLG TLG and MTV may serve as sensitive marker of tumor burden in patients with recurrent small cell lung cancer.
引文
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[2]Murray N, Turrisi AT 3rd. A review of first-line treatment for small-cell lung cancer. J Thorac Oncol.2006.1(3):270-8.
[3]Ferraldeschi R, Baka S, Jyoti B, Faivre-Finn C, Thatcher N, Lorigan P. Modern management of small-cell lung cancer. Drugs.2007.67(15): 2135-52.
[4]von PJ. The role of topotecan in treating small cell lung cancer: second-line treatment. Lung Cancer.2003.41 Suppl 4:S3-8.
[5]邹雄.肿瘤标志在肿瘤早期诊断中的研究与应用进展.中华检验医学杂志.2002.25(2)：71-72.
[6]宋丽华,宋现让,张锡芹等.小细胞肺癌患者预后因素分析.中华肿瘤杂志.2004.26(7)：413-416.
[7]王莉,贾志凌,于忠和,柴丽娜,李红英.血清Pro-GRP和NSE检测在小细胞肺癌中的意义.临床肺科杂志.2010.15(9)：1235-1236.
[8]Gambhir SS, Czernin J, Schwimmer J, Silverman DH, Coleman RE, Phelps ME. A tabulated summary of the FDG PET literature. J Nucl Med.2001.42(5 Suppl):1S-93S.
[9]Choi MY, Lee KM, Chung JK, et al. Correlation between serum CEA level and metabolic volume as determined by FDG PET in postoperative patients with recurrent colorectal cancer. Ann Nucl Med.2005.19(2):123-9.
[10]Johnson CR, Khandelwal SR, Schmidt-Ullrich RK, Ravalese J 3rd, Wazer DE. The influence of quantitative tumor volume measurements on local control in advanced head and neck cancer using concomitant boost accelerated superfractionated irradiation. Int J Radiat Oncol Biol Phys. 1995.32(3):635-41.
[11]Ebert W, Muley T, Drings P. Does the assessment of serum markers in patients with lung cancer aid in the clinical decision making process. Anticancer Res.1996.16(4B):2161-8.
[12]Jorgensen LG, Osterlind K, Hansen HH, Cooper EH. The prognostic influence of serum neuron specific enolase in small cell lung cancer. Br J Cancer.1988.58(6):805-7.
[13]Jorgensen LG. Neuron specific enolase in small cell lung cancer. Clinical and biochemical evaluation. Dan Med Bull.1999.46(1):1-12.
[14]Quoix E, Charloux A, Popin E, Pauli G. Inability of serum neuron-specific enolase to predict disease extent in small cell lung cancer. Eur J Cancer.1993.29A(16):2248-50.
[15]Bonner JA, Sloan JA, Rowland KM Jr, et al. Significance of neuron-specific enolase levels before and during therapy for small cell lung cancer. Clin Cancer Res.2000.6(2):597-601.
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