正电子发射断层扫描和计算机断层扫描相结合对EGFR基因突变的非小细胞肺癌患者的各种靶向治疗方案效果的比较评估

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论证。在俄罗斯的医学文献中，还没有专门研究正电子发射断层扫描与计算机断层扫描相结合，对非小细胞肺癌和EGFR基因患者使用酪氨酸激酶抑制剂进行各种靶向治疗方案的效果进行比较评估。

目的 — 研究使用RECIST1.1标准和代谢指数SUVmax和 SUVmean的变化比较评估非小细胞肺癌和EGFR基因突变患者对酪氨酸激酶抑制剂靶向单药治疗和联合治疗肿瘤反应的可能性。

材料和方法。分析了2019年至2022年期间105名非小细胞肺癌患者的18F-氟脱氧葡萄糖（18F-FDG）正电子发射和计算机断层扫描相结合的研究方案，其中包括75名EGFR基因活化突变的患者。辐射负载因人而异，范围为45至90mSv。18F-FDG放射性药物的容积活性为260-500MBq。 评估了治疗前和治疗开始后1.5-2.0个月内最大靶灶直径总和以及代谢指数SUVmax和 SUVmean的变化。在17名非小细胞肺癌患者中，正电子发射断层扫描和计算机断层扫描相结合变化的观察持续时间至少为12个月。

结果。根据接受酪氨酸激酶抑制剂贝伐单抗或贝化疗结合综合治疗的第2组和第3组EGFR基因突变非小细胞肺癌患者的正电子发射和计算机断层扫描相结合的数据和代谢指数SUVmax和SUVmean的变化，发现疾病进展的频率（P=0.043和P=0.029）明显低于第1组患者和对照组（4.2% vs 20.0-21.8%）。部分治疗反应（P=0.092）检测率较高的趋势（58.3% vs 40.0%）也不明显。 治疗早期最大靶灶直径之和的类似变化在统计学上并不显著（p=0.187）。研究表明，在对部分非小细胞肺癌患者的长期观察中，至少有50%的病例中，最大直径总和的变化重复了第一次对照研究中发现的SUVmax和SUVmean的相应变化。

结论。根据正电子发射和计算机断层扫描相结合的数据和代谢指数SUVmax和SUVmean的变化表明，对照组患者酪氨酸激酶抑制剂贝伐珠单抗或化疗的单药靶向结合的综合治疗早期反应，与酪氨酸激酶抑制剂靶向单药治疗或化疗的反应相比，尽管根据RECIST1.1标准靶灶最大直径的变化趋势无统计意义，但疾病代谢进展的频率明显降低。至少有50%的病例在治疗早期代谢指数SUVmax和SUVmean的变化超过了靶向病灶最大直径总和的类似变化，根据 RECIST1.1标准，这些变化可用于及时识别有进一步发展的高风险患者群体。

作者简介

Vladislav A. Strutynsky

Lomonosov Moscow State University; JSC “Medicine”

编辑信件的主要联系方式.
Email: Rammen2@yandex.ru
SPIN 代码: 6810-5644
俄罗斯联邦, Moscow; Moscow

Valentin E. Sinitsyn

Lomonosov Moscow State University

Email: Vsini@mail.ru
ORCID iD: 0000-0002-5649-2193
SPIN 代码: 8449-6590

MD, Dr. Sci. (Medicine), Professor

俄罗斯联邦, Moscow

Oksana E. Platonova

JSC “Medicine”

Email: Platonova@medicina.ru
ORCID iD: 0000-0003-0093-7285

MD, Cand. Sci. (Medicine)

俄罗斯联邦, Moscow

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2. Fig. 1. Dynamics of combined positron emission tomography and computed tomography parameters of patient V. (63 years old) with non-small cell lung cancer stage IIB (T1bN1M0) and mutation in the EGFR gene (treatment with gefitinib): a — baseline study; b, c, d — 1st, 2nd and 3rd control studies.

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3. Fig. 2. Dynamics of combined positron emission tomography and computed tomography parameters with 18F-FDG of patient O. (65 years old) with stage IA non-small cell lung cancer and mutation in the EGFR gene (treatment with erlotinib): a — baseline study; b, c — 1st and 2nd control studies.

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