摘要
目的:1.研究非小细胞肺癌患者~(18)F-FDG PET/CT的显像特点。2.探讨非小细胞肺癌组织VEGF表达与~(18)F-FDG摄取之间的关系。3.研究非小细胞肺癌患者血清VEGF水平与~(18)F-FDG PET/CT显像的关系。
方法:1.PET/CT显像与非小细胞肺癌组织VEGF表达间关系的研究:40例非小细胞肺癌患者,其中腺癌14例、鳞癌20例、腺鳞癌4例、肺泡癌2例,均行全身PET/CT显像检查,并取术后肿块组织作VEGF免疫组化检测。另有15例肺部良性病变患者作为对照组,同样条件下行全身PET/CT显像检查和取术后肿块组织作VEGF免疫组化检测。采用Mattern半定量分析方法,对肿块组织VEGF表达进行总评分。测定所有PET/CT显像者的SUV,分别对肺部良、恶性病变和不同病理类型的非小细胞肺癌的SUV进行比较;并分别对肺部良、恶性病变肿块组织VEGF表达评分、非小细胞肺癌组织VEGF表达评分与SUV相关性进行统计学分析。
2.PET/CT显像与非小细胞肺癌患者血清VEGF表达间关系的研究:40例非小细胞肺癌患者(鳞癌19例、腺癌19例、肺泡癌2例)、20例肺部良性病变患者(良性对照组)均行全身PET/CT显像检查和血清VEGF检测,并检测20例健康体检者的血清VEGF水平作为血清VEGF的健康对照。分别对非小细胞肺癌组与健康对照组和肺部良性病变组血清VEGF水平进行比较,对肺鳞癌、腺癌的血清VEGF水平进行比较,并对非小细胞肺癌患者血清VEGF的表达与肿块SUV的相关性、非小细胞肺癌患者血清VEGF表达与PET/CT的T分期和N分期关系进行统计学分析,以及对非小细胞肺癌患者有、无远处转移者的血清VEGF表达进行比较。
结果:1.80例非小细胞肺癌患者平均SUV(4.50±2.78)明显高于35例良性病变组(2.05±0.63),p＜0.05。
2.对20例肺鳞癌、14例腺癌、7例炎性假瘤的肿块组织VEGF表达评分进行分析,发现三者之间VEGF表达评分比较无明显统计学差异,P值均＞0.05;8例肺结核瘤与前三组比较有统计学差异,P值均＜0.05。
3.40例非小细胞肺癌组织VEGF表达与SUV显著相关,VEGF评分越高,SUV越高,r=0.478,P＜0.01。术后随访病例中半年内复发组VEGF评分也明显高于未复发组。
4.非小细胞肺癌患者血清VEGF水平为600.27±324.73 pg/mL,明显高于健康对照组血清VEGF水平176.75±109.85 pg/mL和良性病变组水平290.55±144.90pg/mL,P＜0.05。
5.非小细胞肺癌患者血清VEGF水平与肿块SUV显著相关,VEGF水平越高,SUV越高,r=0.609,P＜0.01。
6.按照PET/CT检查结果将40例非小细胞肺癌患者进行T、N、M分期。T分期中T1期组与T3期、T4期组之间,T2期组与T4期组之间血清VEGF表达水平均有统计学差异,P值均＜0.05;N分期中SUV≥2.5组和SUV＜2.5组之间血清VEGF表达水平有统计学差异(t=2.53,P＜0.05);M分期中有远处转移组和无远处转移组之间血清VEGF表达水平有统计学差异(t=-3.20,P＜0.05)。
结论:1.非小细胞肺癌患者的~(18)F-FDG SUV与肿瘤组织VEGF表达评分呈正相关,测定SUV对于预测非小细胞肺癌肿瘤组织中血管增生情况具有重要的临床价值。
2.非小细胞肺癌组织中VEGF表达越高,其术后发生复发和/或转移的可能性越大。VEGF表达评分可考虑作为患者预后和近期复查的参考指标。
3.按T、N、M分期进行分组的不同非小细胞肺癌患者血清VEGF水平均有统计学差异,检测血清VEGF在一定程度上可预测非小细胞肺癌的临床分期并进行预后。
Objective:1.To evaluate the character of ~(18)F-FDG PET/CT imagingin patients with NSCLC.2.To probe the association betweeen ~(18)F-FDG absortion and the expression level of VEGF in NSCLC.3.To evaluate the relationship between serum level of VEGF and ~(18)F-FDG PET/CT imaging.
Methods: 1.40 patients were enrolled including 20 squamous cell carcinoma, 14 adeno carcinoma, 4 bronchial alveolar carcinoma and 4 adenosquamous carcinoma ;another,15 patients with benign lesion were enrolled including 8 tuberculoma and 7 inflammatory pseudotumor. All the patients were taken the ~(18)F-FDG PET/CT imaging of the whole body before operation,then the tumor tissue was obtained after the operation. The VEGF expression status was measured by SABC method, the half-quantitation score of the VEGF expression was taken by mattern analysis.
2.40 patients were enrolled including 19 squamous cell carcinoma, 19 adenocarcinoma and 2 bronchial alveolar carcinoma; Another 20 patients with benign lesion were enrolled including 12 tuberculoma,2 pulmonary infection,4 inflammatory pseudotumor and 2 pneumosilicosis.
The serum of patients was collected before the ~(18)F-FDG PET/CT imaging, the srum level of the VEGF examined by ELISA method.
Results: 1.The average SUV was significantly higher in patients with NSCLC group than in patients with benign lesion .(p<0.05).
2.The half-quantitation score of the VEGF expression have no significantly difference in the squamous cell carcinoma, adenocarcinoma and inflammatory pseudotumor. The score of the VEGF expression was significantly lower in tumor tissue of tuberculoma than in tumor tissue of squamous cell carcinoma and adenocarcinoma.
3.There was a significant correlation between VEGF expression of carcinoma tissue and SUV of ~(18)F-FDG,(r=0.478,P<0.01). Futher more,the score of the VEGF expression was significantly higher in patients with metastasis and/or recurrence after operation than in Patients with no metastasis and/or recurrence.
4.The serum level of VEGF was significantly higher in patients with NSCLC than in control group and in patients with benign lesion (P<0.05).
5.There was a significant correlation between serum level of VEGF and SUV of ~(18)F-FDG(r=0.609,P<0.01).
6. According to the results of PET/CT imaging. There was a significantly correlation between serum level of VEGF and clinical stage. Conclusion:1.There was a significant correlation between the SUV of ~(18)F-FDG and VEGF expression of carcinoma tissue, the determination of SUV may be predict clinical value of the vascular proliferation incarcinoma tissue.
2.The score of VEGF expression was significantly higher in patients with metastasis and/or recurrence after operation than in Patients with no metastasis and/or recurrence. The score of the VEGF expression may be considered as a screening index of the patients,whether they should recheck or not after operation.
3.There was a significant correlation between serum level of VEGFand clinical stage.Serum level of VEGF may be regarded as a prognosticfactor in lung cancer.
引文
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