The relationship between PET/CT metabolic heterogeneity of primary lesions and metastatic lymph nodes in stage Ⅲnon-small cell lung cancer and the efficacy of radiotherapy and chemotherapy
DENG Lixia
ZHAO Qinglian
LIU Sukun
GAO Xiaopei
ZHANG Jianyang
BAI Xue
SONG Huimin
TIAN Xiaoyuan
GE Jianing
ZHANG Lidan
Abstract：Objective To investigate the predictive value of PET/CT metabolic heterogeneity parameters in primary tumors and metastatic lymph nodes for chemoradiation sensitivity and survival prognosis in stage Ⅲ non-small cell lung cancer(NSCLC).Methods This was a prospective cohort study enrolling 120 unresectable stage Ⅲ NSCLC patients from October 2020-December 2021.Patients were divided into a high metabolic heterogeneity group(SUVmax difference>25%,n=54)and a low metabolic heterogeneity group(SUVmax difference≤25%,n=66)based on the maximum standard uptake value(SUVmax)difference between primary tumors and metastatic lymph nodes from pretreatment PET/CT images.Metabolic heterogeneity parameters(including SUVmax,entropy,skewness,kurtosis,etc.),short-term efficacy[objective response rate(ORR),disease control rate(DCR)],toxicity reactions were analyzed,and Kaplan-Meier curves were plotted to compare progression-free survival(PFS),and the correlation between RECISTv1.1 and PET/CT metabolic assessment results was verified.Results Before treatment,the primary tumor SUVmax(8.78±2.32 vs.6.57±1.89),SUVmax difference(3.56±1.25 vs.0.82±0.51),SUVmax difference percentage[(38.53±12.37)%vs.(10.22±5.77)%],entropy(1.75±0.38 vs.1.12±0.25),skewness(0.82±0.45 vs.0.35±0.28),and kurtosis(3.15±1.20 vs.2.08±0.95)in the high metabolic heterogeneity group were significantly higher than those in the low metabolic heterogeneity group,while the lymph node SUVmax(5.23±1.56 vs.6.35±1.97)was significantly lower than that in the low metabolic heterogeneity group(all P<0.001).After treatment,the primary tumor SUVmax(4.21±1.53 vs.3.05±1.21),lymph node SUVmax(4.87±1.12 vs.3.26±1.03),SUVmax difference(0.45±0.31 vs.0.12±0.08),and SUVmax difference percentage[(9.82±5.63)%vs.(3.56±2.17)%]in the high metabolic heterogeneity group were still significantly higher than those in the low metabolic heterogeneity group(all P<0.001).The ORR(65.15%vs.40.74%,P=0.008)and DCR(89.39%vs.72.22%,P=0.016)in the low metabolic heterogeneity group were significantly higher than those in the high metabolic heterogeneity group.There was no significant difference in the incidence of acute and late toxic reactions between the two groups(P>0.05).The overall consistency rate between RECISTv1.1 and PET/CT metabolic assessment results was 87.50%,with a Kappa value of 0.78(P<0.001).Conclusion Metabolic heterogeneity between primary tumors and metastatic lymph nodes in stage Ⅲ NSCLC is closely associated with chemoradiation sensitivity and prognosis.SUVmax difference percentage may serve as a potential imaging indicator for predicting chemoradiation efficacy and progression-free survival,providing evidence for personalized treatment.
Keywords：non-small cell lung cancerstage ⅢPET/CTmetabolic heterogeneitychemoradiationprognosis
Publication Date：2025-12-28
Online Publishing Date：2026-01-12(First online date of this platform, not the publication date of the document)
Pages：6( 1179-1184 )