非小细胞肺癌原发灶PET/CT SUVmax 与免疫细胞亚群浸润的相关性及其临床意义

吴占波; 赵宁; 申学杰; 潘娜; 王扬; 金昊; 魏枫; 任秀宝

doi:10.3969/j.issn.1000-8179.2017.03.179

非小细胞肺癌原发灶PET/CT SUVmax 与免疫细胞亚群浸润的相关性及其临床意义

Correlation of PET/CT SUVmax with infiltration level of immune cells in patients with non-small cell lung cancer and its clinical significance

摘要

摘要:
目的通过分析¹⁸F-脱氧葡萄糖（fluorodeoxyglucose，FDG）在非小细胞肺癌（non-small cell lung cancer，NSCLC）原发灶最大标准摄取值（maximum standardized uptake value，SUVmax）与免疫细胞亚群浸润的相关性，初步探讨其在肺癌治疗及判断预后中的指导价值。
方法回顾性分析2008年4月至2014年8月在天津医科大学肿瘤医院收治且接受正电子发射断层扫描/计算机体层摄影（positron emission tomography/computed tomography，PET/CT）检查及肺癌根治术的NSCLC患者119例，其中鳞癌32例、腺癌87例，应用免疫组织化学方法检测肿瘤原发灶CD3⁺肿瘤浸润淋巴细胞（tumor infiltrating lymphocytes，TILs）、CD8⁺TILs、CD68⁺肿瘤相关树巨噬细胞（tumor-associated macrophages，TAMs）、CD163⁺TAMs及CD11c⁺树突状细胞（dendritic cells，DCs）的浸润水平，采用Pearson法分析各免疫细胞亚群与SUVmax的相关性，同时采用Kaplan-Meier法及多因素Cox回归模型分析患者的生存状况。
结果肿瘤原发灶SUVmax与CD8⁺TILs（r=0.332，P＜0.001）和CD163⁺TAMs（r=0.223，P=0.015）的浸润水平呈正相关，而与CD3⁺TILs、CD68⁺TAMs和CD11c⁺DCs的浸润水平无明显相关性。单因素分析提示TNM分期、SUVmax、肿瘤大小及免疫浸润细胞CD163⁺TAMs和CD11c⁺DCs与患者的预后有关，多因素分析仅TNM分期和肿瘤大小为患者的独立预后因素。
结论肿瘤原发灶PET/CT SUVmax与部分免疫细胞亚群浸润水平显著相关，提示¹⁸F-FDG PET/CT可间接反应肿瘤微环境的免疫状态，这对NSCLC患者预后判断以及采取及时有效的干预治疗措施具有重要的指导价值。

Abstract:
Objective This study assessed the relationship between ¹⁸F-FDG maximum standard uptake value (SUVmax) and infiltration level of immune cells in patients with non-small cell lung cancer (NSCLC) and explored its significance in NSCLC treatment and prognosis.
Methods From April 2008 to August 2014, 119 patients with NSCLC (32 squamous cell carcinoma cases and 87 adenocarcinoma cases) who underwent primary tumor resection and PET/CT imaging at Tianjin Medical University Cancer Institute and Hospital were collected and retrospectively analyzed. The infiltration levels of CD3⁺ tumor infiltrating lymphocytes (TILs), CD8⁺ TILs, CD68⁺ tumor-associated macrophages (TAMs), CD163⁺ TAMs, and CD11c⁺ dendritic cells (DCs) were determined using immunohistochemistry. Moreover, the correlation between infiltration level of immune cells and SUVmax was analyzed via Pearson correlation analysis. Survival outcomes were analyzed using the Kaplan-Meier method and multivariate Cox proportional hazard model.
Results A positive correlation was found between SUVmax and the infiltration level of CD8⁺ TILs (r=0.332; P＜0.001) and CD163⁺ TAMs (r=0.223; P=0.015). However, no significant correlation was noted between SUVmax and infiltration levels of CD3⁺ TILs, CD68⁺ TAMs, and CD11c⁺ DCs. Univariate analysis showed that TNM staging, SUVmax, tumor size, and infiltration levels of CD163⁺ TAMs and CD11c⁺ DCs were correlated with patient prognosis. Multivariate analysis demonstrated that TNM stage and tumor size were independent prognostic factors.
Conclusion The present study showed a direct association between SUVmax and the infiltration level of immune cells, thereby suggesting a potential role for ¹⁸F-FDG PET/CT to indirectly reflect the immune status of the tumor microenvironment. This study can be used as a crucial reference for the prognosis and selection of NSCLC patient candidates for timely and effective intervention.

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