Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Association between Bone Marrow Hypermetabolism on 18F-Fluorodeoxyglucose Positron Emission Tomography and Response to Chemotherapy in Non-Small Cell Lung Cancer

비소세포폐암 환자의 양전자방출 단층촬영에서 골수 대사활성도의 항암화학요법에 대한 반응 예측

  • Seol, Hee Yun (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Mok, Jeong Ha (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Yoon, Seong Hoon (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Kim, Ji Eun (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Kim, Ki Uk (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Park, Hye-Kyung (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Kim, Seong Jang (Department of Nuclear Medicine, Pusan National University Hospital) ;
  • Kim, Yun Seong (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Lee, Min Ki (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Park, Soon Kew (Department of Internal Medicine, Pusan National University School of Medicine)
  • 설희윤 (부산대학교 의학전문대학원 내과학교실) ;
  • 목정하 (부산대학교 의학전문대학원 내과학교실) ;
  • 윤성훈 (부산대학교 의학전문대학원 내과학교실) ;
  • 김지은 (부산대학교 의학전문대학원 내과학교실) ;
  • 김기욱 (부산대학교 의학전문대학원 내과학교실) ;
  • 박혜경 (부산대학교 의학전문대학원 내과학교실) ;
  • 김성장 (부산대학교병원 핵의학과) ;
  • 김윤성 (부산대학교 의학전문대학원 내과학교실) ;
  • 이민기 (부산대학교 의학전문대학원 내과학교실) ;
  • 박순규 (부산대학교 의학전문대학원 내과학교실)
  • Received : 2008.11.26
  • Accepted : 2008.12.24
  • Published : 2009.01.30
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Abstract

Background: $^{18}F$-Fluorodeoxyglucose positron emission tomography (FDG-PET) is widely used for the diagnosis and staging of non-small cell lung cancer (NSCLC). The aim of this study is to determine whether the bone marrow hypermetabolism seen on FDG-PET predicts a response to chemotherapy in patients with NSCLC. Methods: We evaluated the patients with advanced NSCLC and who were treated with combination chemotherapy. For determination of the standardized uptake value (SUV) of the bone marrow (BM SUV) on FDG-PET, regions of interest (ROIs) were manually drawn over the lumbar vertebrae (L1, 2, 3). ROIs were also drawn on a homogenous transaxial slice of the liver to obtain the bone marrow/ liver SUV ratio (BM/L SUV ratio). The response to chemotherapy was evaluated according to the Response Evaluation Criteria in Solid Tumor (RECIST) criteria after three cycles of chemotherapy. Results: Fifty-nine NSCLC patients were included in the study. Multivariate analysis was performed using a logistic regression model. The BM SUV and the BM/L SUV ratio on FDG-PET were not associated with a response to chemotherapy in NSCLC patients (p=0.142 and 0.978, respectively). Conclusion: The bone marrow hypermetabolism seen on FDG-PET can not predict a response to chemotherapy in NSCLC patients.

연구배경: 양전자방출 단층촬영은 최근 폐암의 진단과 병기 결정에 널리 사용된다. 본 연구에서는 비소세포폐암 환자에서 양전자방출 단층촬영에서의 골수 대사활성도의 증가가 항암화학요법에 대한 반응과 관련성이 있는지 알아보고자 하였다. 방 법: 조직학적으로 비소세포폐암으로 진단 받은 환자 중에 양전자 방출 단층촬영을 시행한 후 일차 항암화학 요법을 시행 받은 환자를 대상으로 하였다. 대상군의 양전자 방출 단층촬영상 골수 대사활성도는 요추 1, 2, 3번의 FDG 섭취를 측정하여 평가하였고, 항암화학요법에 대한 반응은 Response Evaluation Criteria in Solid Tumors (RECIST)를 이용하여 평가하였다. 결 과: 총 59명의 환자가 포함되었다. 대상군을 양전자 방출 단층촬영상 골수의 SUV가 1.37 이상인 군(21명, 35.6%)과 미만인 군(38명, 64.4%)으로 나누었고, 골수의 SUV와 간의 SUV의 비가 0.73 이상인 군(22명, 37.3%)과 미만인 군(37명, 62.7%)로 나누어 일차 항암화학요법에 대한 반응을 비교하였다. 골수의 SUV와 골수의 SUV와 간의 SUV의 비는 일차 항암화학요법에 대한 반응과 통계학적으로 유의한 차이가 없었다(p=0.142, 0.978). 결 론: 비소세포폐암 환자에서 양전자방출 단층촬영에서 나타난 골수 대사활성도는 항암화학요법에 대한 반응과 관련성이 없었다.

Keywords

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