18F-FDG PET/CT分子影像多定量代谢参数与浸润性肺腺癌PD-L1表达水平的相关性对照研究
方娟娟 （ 山东省德州市第二人民医院医学影像与核医学科 ）
宋德炜 （ 山东省德州市第二人民医院医学影像与核医学科 ）
滕敏敏 （ 山东省德州市第二人民医院医学影像与核医学科 ）
张丽伟 （ 山东省德州市第二人民医院医学影像与核医学科 ）
李洪水 （ 山东省德州市第二人民医院放疗三科 ）
刘廷洲 （ 山东省德州市第二人民医院医学影像与核医学科 ）
于 波 （ 德州学院数学与大数据学院 ）
邵元伟* （ 山东省德州市第二人民医院医学影像与核医学科 ）
https://doi.org/10.37155/2717-5669-0503-57Abstract
目的：探究18F-FDG PET/CT分子影像多定量代谢参数与浸润性肺腺癌PD-L1表达水平之间的相关性。方 法：前瞻性观察德州市第二人民医院2022年1月-2023年12月经18F-FDG PET/CT检查并病理证实的浸润性肺腺癌患者， 收集患者临床资料、肿瘤组织PD-L1表达水平、测量治疗前患者18F-FDG PET/CT的多定量代谢参数；分别应用Pearson 卡方检验和Mann-Whitney U 检验进行分类变量和连续变量分析，应用单因素Logistic回归分析检验各参数在预测PD-L1 表达水平的统计学价值。结果：共纳入104例浸润性肺腺癌患者，ROC曲线分析及Mann-Whitney U检验结果发现，年 龄、肿瘤最大径、SUVmax、SUVmean、SUVpeak、MTV、TLG、SULmax、SULmean、SULpeak与PD-L1表达水平无 相关性（P > 0.05）；Logistic单因素分析发现，肿瘤组织分化程度与PD-L1表达水平相关（P < 0.05），性别与PD-L1 阳性与阴性表达有相关性（P < 0.05），而与PD-L1高、低表达无相关性（P > 0.05）。结论：18F-FDG PET/CT分子影 像多定量代谢参数在预测浸润性肺腺癌PD-L1表达水平方面显著性欠佳，有望大数据、多中心研究进一步验证。
Keywords
氟代脱氧葡萄糖；正电子发射计算机断层显像；分子影像；多定量代谢参数；浸润性肺腺癌；程序性死亡-配体1Full Text
PDFReferences
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advanced EGFR wild-type NSCLC patients treated with
erlotinib[J]. LUNG CANCER. 2016, 94:81-7. DOI: 10.1016/
j.lungcan.2016.01.024.
流行情况分析[J].中华肿瘤杂志,2024,46(3):221-231.
DOI:10.3760/cma.j.cn112152-20240119-00035.
[2] Bodor JN, Kasireddy V, Borghaei H. First-Line
Therapies for Metastatic Lung Adenocarcinoma Without a
Driver Mutation[J]. J Oncol Pract. 2018,14(9):529-535. doi:
10.1200/JOP.18.00250.
[3] Ruiz-Cordero R, Devine WP. Targeted Therapy and
Checkpoint Immunotherapy in Lung Cancer[J]. Surg Pathol
Clin. 2020,13(1):17-33. DOI: 10.1016/j.path.2019.11.002.
[4] Broderick SR. Adjuvant and Neoadjuvant
Immunotherapy in Non-small Cell Lung Cancer[J].
Thorac Surg Clin. 2020,30(2):215-220. DOI: 10.1016/
j.thorsurg.2020.01.001.
[5] Mok TSK, Wu YL, Kudaba I, et al. Pembrolizumab
versus chemotherapy for previously untreated, PD-L1-
expressing, locally advanced or metastatic non-small_x0002_cell lung cancer (KEYNOTE-042): a randomised,
open-label, controlled, phase 3 trial[J]. LANCET.
2019, 393(10183):1819-1830.DOI: 10.1016/S0140-
6736(18)32409-7.
[6] Ullah A, Pulliam S, Karki NR, et al. PD-L1 OverExpression Varies in Different Subtypes of Lung Cancer: Will
This Affect Future Therapies? CLINICS PRACT. 2022, 12
(5): 653-671. DOI: 10.3390/clinpract12050068.
[7] 中华医学会肿瘤学分会,中华医学会杂志社. 中
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志，2023,103(27):2037-2074.DOI:10.3760/cma.j.cn112137-
20230510-00767.
[8] Aguiar PN, De Mello RA, Hall P, et al. PD-L1 expression as a predictive biomarker in advanced
non-small-cell lung cancer: updated survival data[J].
IMMUNOTHERAPY-UK. 2017,9 (6): 499-506. DOI:
10.2217/imt-2016-0150.
[9] Takeuchi S, Khiewvan B, Fox PS, et al. Impact of
initial PET/CT staging in terms of clinical stage, management
plan, and prognosis in 592 patients with non-small-cell lung
cancer[J]. EUR J NUCL MED MOL I. 2014,41 (5): 906-14.
DOI: 10.1007/s00259-013-2672-8.
[10] Bar-Shalom R, Rosengarten O, Heching N,
et al. [FDG PET/CT FOR TREATMENT RESPONSE
ASSESSMENT IN CANCER][J]. Harefuah. 2021,160 (7):
462-467. PMID: 34263575.
[11] Ai L, Xu A, Xu J. Roles of PD-1/PD-L1 Pathway:
Signaling, Cancer, and Beyond[J]. ADV EXP MED BIOL.
2020,1248:33-59. DOI: 10.1007/978-981-15-3266-5_3.
[12] Cha JH, Chan LC, Li CW, et al. Mechanisms
Controlling PD-L1 Expression in Cancer[J]. MOL CELL.
2019, 76 (3): 359-370. DOIi: 10.1016/j.molcel.2019.09.030.
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WHO classification of tumours. Thoracic tumours[ M]. 5th
ed. Lyon:IARC Press,2021:67-69.
[14] 刘建宇,郑飞,朱宗平,等.非小细胞肺癌PD-L1 蛋
白表达与18F-FDG PET/CT 代谢指标的关系研究[J].国际放
射医学核医学杂志,2023,47(3):141-147.DOI:10.3760/cma.
j.cn121381-2022209011-00282.
[15] 徐鑫,李继会,戴娜,等.
18F-FDG PET/CT 代
谢参数与非小细胞肺癌 PD-L1 表达相关性研究[J].
中国肿瘤临床,2022,49(7):338-344.DOI:10.12354/
j.issn.1000-8179.2022.20211927.
[16] Brody R.Zhang YD,Ballas M,et al. PD-L1
expression in advanced NSCLC: insights into risk stratifi
ication and treatment selection from a systematic literature
review[J].Lung Cancer,2017,112:200-215.DOI: 10.1016/
j.lungcar n.2017.08.005.
[17] Jreige M, Letovanec I, Chaba K, et al. 18F-FDG
PET metabolic-to-morphological volume ratio predicts PDL1 tumour expression and response to PD-1 blockade in
non-small-cell lung cancer [J]. EUR J NUCL MED MOL I.
2019,46 (9): 1859-1868. DOI: 10.1007/s00259-019-04348-x.
[18] Nakamura H, Saji H, Shinmyo T, et al. Close
association of IASLC/ATS/ERS lung adenocarcinoma
subtypes with glucose-uptake in positron emission
tomography [J]. LUNG CANCER. 2014,87 (1): 28-33. DOI:
10.1016/j.lungcan.2014.11.010.
[19] 王 芳，张飞飞.
18F-FDG PET/CT代谢参数与非
小细胞肺癌组织中PD-L1表达的相关性[J].现代肿瘤医
学,2023,31(07):1307-1310.DOI:10.3969/j.issn.1672-4992.
20233.07.024.
[20] Lopci E, Toschi L, Grizzi F, et al. Correlation of
metabolic information on FDG-PET with tissue expression of
immune markers in patients with non-small cell lung cancer
(NSCLC) who are candidates for upfront surgery [J]. EUR J
NUCL MED MOL I. 2016, 43 (11): 1954-61.DOI: 10.1007/
s00259-016-3425-2.
[21] Zasadny KR, Wahl RL. Standardized uptake values
of normal tissues at PET with 2-[fluorine-18]-fluoro-2-deoxyD-glucose: variations with body weight and a method for
correction[J]. RADIOLOGY. 1993,189 (3): 847-50. DOI:
10.1148/radiology.189.3.8234714.
[22] Fraum TJ, Crandall JP, Ludwig DR, et al.
Repeatability of Quantitative Brown Adipose Tissue
Imaging Metrics on Positron Emission Tomography with
18F-Fluorodeoxyglucose in Humans[J]. CELL METAB. 2019,
30 (1): 212-224.DOI: 10.1016/j.cmet.2019.05.019.
[23] Crandall JP, Gajwani P,O JH, et al. Repeatability
of brown adipose tissue measurements on FDG PET/CT
following a simple cooling procedure for BAT activation.
PLoS One [J]. 2019,14 (4): e0214765. DOI: 10.1371/journal.
pone.0214765.
[24] Akagunduz OO, Savas R, Yalman D, et al. Can
adaptive threshold-based metabolic tumor volume (MTV)
and lean body mass corrected standard uptake value (SUL)
predict prognosis in head and neck cancer patients treated
with definitive radiotherapy/chemoradiotherapy?[J]. NUCL
MED BIOL. 2015, 42 (11): 899-904. DOI: 10.1016/
j.nucmedbio.2015.06.007.
[25] 李雪艳,王大维,于丽娟,等.
18F-FDG PET/CT在
预测非小细胞肺癌EGFR突变状态及PD-L1表达状态中
的应用价值[J].海南医学院学报,2022,28(17):1343-1349.
DOI:10.13210/j.cnki.jhmu.20220520.001
[26] Hu WD, Wang HC, Wang YB, et al. Correlation
study on 18F-FDG PET/CT metabolic characteristics of
primary lesion with clinical stage in lung cancer[J]. Q JNUCL MED MOL IM. 2019,65 (2): 172-177. DOI: 10.23736/
S1824-4785.19.03146-7.
[27] Wahl RL, Jacene H, Kasamon Y, et al. From
RECIST to PERCIST: Evolving Considerations for PET
response criteria in solid tumors[J]. J NUCL MED. 2009,50
Suppl 1:122S-50S.DOI: 10.2967/jnumed.108.057307.
[28] 谢雯莹,贺洋,傅晓,等.肺腺癌相关组织学特征
与 PD-L1 表达 EGFR 基因突变类型的关系[J].中国肿瘤
临床,2022,49(15) ,769-774.DOI:10.12354/.issn.1000-8179.
2022.20220096.
[29] 刘香丽,赵明理,王娇,等.PD-L1、Ki-67、
TP53、EGFR在肺腺癌组织中的表达及意义[J].肿瘤基
础与临床,2023,36(04):324-327.DOI:10.3969/i.issn. 1673-
5412.2023.04.010.
[30] Winther-Larsen A, Fledelius J, Sorensen BS,
et al. Metabolic tumor burden as marker of outcome in
advanced EGFR wild-type NSCLC patients treated with
erlotinib[J]. LUNG CANCER. 2016, 94:81-7. DOI: 10.1016/
j.lungcan.2016.01.024.
Copyright © 2024 方娟娟,宋德炜,滕敏敏,张丽伟,李洪水,刘廷洲,于 波,邵元伟*
Publishing time:2024-09-30
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