中国医学装备2025，Vol.22Issue(12)：24-29,6.DOI:10.3969/j.issn.1672-8270.2025.12.005
基于PET/CT代谢参数联合临床病理特征的Ⅲ期非小细胞肺癌预后模型构建与验证
Construction and validation of a prognostic model based on PET/CT metabolic parameters combined with clinicopathological features for stage Ⅲ NSCLC
摘要
Abstract
Objective:To construct a multidimensional prognostic model for stage Ⅲ non-small cell lung cancer(NSCLC)by integrating metabolic parameters of positron emission tomography/computed tomography(PET/CT)with clinicopathological features,and to validate its clinical application value in individualized treatment decision-making.Methods:A retrospective analysis was conducted on case data of 150 patients with stage Ⅲ NSCLC who received standardized treatment at the Baoding NO.1 Central Hospital,Hebei Province,between January 2019 and December 2023.The PET/CT metabolic parameters[maximum standardized uptake value(SUVmax),metabolic tumor volume(MTV),total lesion glycolysis(TLG)],and clinicopathological features[epidermal growth factor receptor(EGFR)mutation,neutrophil-to-lymphocyte ratio(NLR),cytokeratin 19 fragment(CYFRA21-1)],clinical scores,and pathological subtypes of all patients were collected.Patients were randomly divided into a training set(n=105)and a validation set(n=45)as a 7:3 ratio.Key variables were screened using the least absolute shrinkage and selection operator(LASSO)regression.A Cox proportional hazards model was subsequently constructed.Internal validation was performed via Bootstrap resampling(1,000 iterations)from original data set.Model performance was assessed by calculating the concordance index(C-index),calibration curves,and decision curve analysis(DCA).Results:Multivariate analysis identified the following independent risk factors:death's risk increased 0.9％with increasing per 1 cm3 whole-body metabolic tumor volume(MTVwb)[hazard ratio(HR)=1.009,95％confidence interval(CI):1.003-1.015,P=0.006],NLR≥3.5(HR=2.107,95％CI:1.424-3.119,P=0.001),and CYFRA21-1 level≥5.0 ng/ml(HR=1.735,95％CI:1.161-2.594,P=0.012).Conversely,patients with positive EGFR mutations demonstrated a 40.1％reduction in mortality risk(HR=0.599,95％CI:0.387-0.928,P=0.022).The C-index values of model were respectively 0.813(95％CI:0.761-0.865)in the training set and 0.795(95％CI:0.730-0.860)in the validation set.The slope of the calibration curve for the predictive model was close to 1(range:0.931-1.018).The prediction error of 1-year survival was≤1.52％.Decision curve analysis indicated that the highest net benefit value of the model reached to 0.469 when the range of threshold probability was 0.2-0.6.The expression of whole-body total lesion glycolysis(TLGwb)and programmed death-ligand 1(PD-L1)did not appear correlation with gender and survival(P＞0.05).Conclusion:The prognostic model that is constructed by this study,which integrates metabolic burden and host inflammatory markers,can significantly enhance predictive accuracy for survival of patients at stage Ⅲ NSCLC.It can provide valuable basis for formulating individualized follow-up period and optimizing therapeutic strategies.关键词
非小细胞肺癌(NSCLC)/预后模型/正电子发射计算机体层扫描(PET/CT)/代谢参数Key words
Non-small cell lung cancer(NSCLC)/Prognostic model/Positron emission tomography/computed tomography(PET/CT)/Metabolic parameters分类
医药卫生引用本文复制引用
张建阳,宋会民,田晓媛,葛佳宁,张力丹,白雪..基于PET/CT代谢参数联合临床病理特征的Ⅲ期非小细胞肺癌预后模型构建与验证[J].中国医学装备,2025,22(12):24-29,6.基金项目
河北省医学科学研究课题计划资助(20232029) （20232029）
保定市科技计划资助(2341ZF260) Medical Science Research Project of Hebei Province(20232029) （2341ZF260）
Baoding Science and Technology Plan Project(2341ZF260) （2341ZF260）
