FDG PET/CT摄取-体积指数对鼻咽癌预后的预测价值

Uptake volume index of 18F-FDG PET/CT for the prediction of prognosis in nasopharyngeal carcinoma

目的 研究鼻咽癌患者18F-脱氧葡萄糖（FDG）PET/CT代谢体积（MTV）及摄取-体积指数（UVI）与预后的关系.方法 回顾性分析该院2002年10月至2004年7月放疗前后分别行18F-FDG PET/CT检查的37例均经病理检查证实为Ⅰ～Ⅳa期的鼻咽癌患者.患者均行6 MV X射线适形调强放射治疗.治疗后随访5年,并用Kaplan-Meier法、Log-rank检验及Cox比例风险模型分析MTV及UVI与预后的关系.结果 全组患者5年总生存率（OS）为70.3%（26/37）,5年无瘤生存率（DFS）为62.2%（23/37）.MTV＜30 cm3的患者5年OS为82.6%（19/23）和DFS为73.9%（17/23）,均高于MTV≥30 cm3的患者的50.0%（7/14）和42.9%（6/14）,差异有统计学意义（x2=5.28和4.84,P均＜0.05）.UVI＜150的患者5年OS为87.5%（21/24）,5年DFS为79.2%（19/24）,均高于UVI≥150的患者[38.5%（5/13）和30.8%（4/13）],差异均有统计学意义（x2=10.72和11.04,P＜0.01）.多因素分析显示,UVI和代谢缓解对鼻咽癌患者的预后有统计学意义.结论 18F-FDGPET/CT UVI和代谢缓解与鼻咽癌患者的预后密切相关.UVI高的患者以及放疗后未达到代谢完全缓解的患者预后较差,可能需要接受更加积极的治疗.

Objective To evaluate the prognostic value of serial 18F-fluorodeexyglucose （FDG） PET/CT in patients with nasopharyngeal carcinoma （NPC）.Methods Thirty-seven NPC patients who had 18F-FDG PET/CT scan before and after external beam intensity-modulated radiotherapy, were studied retrospectively.All patients were followed for five years.Correlation analysis between metabolic tumor volume （MTV）/uptake volume index （UVI） and survival was performed by Kaplan-Meier analysis, Log-rank test and multivariate Cox model.Results The 5-year overall survival （OS） and disease-free survival （DFS） rates were 70.3% （26/37） and 62.2% （ 23/37 ）, respectively.Patients with a lower MTV （MTV〈30 cm3） had significantly higher 5-year OS （ 82.6% （ 19/23 ） ） and DFS （73.9% （ 17/23 ）） rates than those with a higher MTV （OS：50.0% （7/14）,x2 =5.28, P〈0.05 DFS：42.9% （6/14）,x2 =4.84, P〈0.05）.Patients with a lower UV1 （UVI〈150） had significantly higher 5-year OS（ 87.5%（ 21/24 ）） and DFS （79.2% （19/24）） rates than those with a higher UVI （OS：38.5% （5/13）,x2 =10.72, P〈0.01 DFS：30.8% （4/13）, x2 =11.04, P〈0.01）.Multivariate analysis showed that UVI and metabolic response （MR） were independent predictors of DFS.Conclusions Tumor volume parameters, UVI and MR, are independent prognostic factors for patients with NPC.Patients with a high UVI may benefit from more aggressive treatment.