^18F-脱氧葡萄糖正电子发射计算机体层摄影在肝动脉化疗栓塞术治疗原发性肝癌患者预后判断中的价值

Value of ^18F-FDG PET in preoperative TACE of hepatocellular carcinoma

目的探讨^18F-脱氧葡萄糖正电子发射计算机体层摄影（^18F-FDGPET-CT）在肝动脉化疗栓塞术（TACE）治疗原发性肝癌（HCC）患者预后判断中的价值。方法对TACE治疗前的85例HCC患者进行^18F-FDGPET检查，并测定肝脏原发肿瘤的最大标准摄取值（SUVmax）。生存率用Kaplan-Meier法计算，单因素分析采用Logrank法，多因素分析采用Cox回归模型。结果高代谢组（SUVmax≥5．0）63例，低代谢组（SUVmax〈5．0）22例，低代谢组和高代谢组的肿瘤SUVmax分别为3．89±0．80和7．71±2．78，差异有统计学意义（P〈0．001）。高代谢组患者的1、2、3年生存率分别为66．6％、26．9％和12．6％，低代谢组患者的1、2、3年生存率分别为81．8％、72．7％和63：6％，高代谢组和低代谢组患者的中位生存时间分别为16．0个月和48．0个月（P〈0．001）。单因素分析显示，肝内原发肿瘤SUVmax、有无肝硬化、Child分级、ECOG评分、肿瘤大小、肿瘤数目、有无门脉癌栓、BCLC分期和血清甲胎蛋白（AFP）水平与HCC患者的预后有关（均P〈0．05）。Cox多元回归分析显示，肿瘤SUVmax值、肿瘤大小、肿瘤数目和血清AFP水平是影响HCC患者预后的独立因素（均P〈0．05）。结论肝内原发肿瘤SUVmax可以作为判断TACE治疗HCC患者的预后因素。

Objective To evaluate the prognostic significance of ^18 F-FDG PET-CT SUVmax value in 85 patients with hepatocellular carcinoma （HCC） before transarterial chemoembolization （TACE）. Methods A retrospective analysis was conducted on 85 patients with HCC before TACE to evaluate the prognostic significance of SUVmax of mSF-FDG PET-CT. The survival rates were calculated using Kaplan- Meier method. Log-rank method was used for univariate analysis, and Cox regression model was used for multivariate analysis. Results The patients were divided into two groups before TACE： The high metabolic group （63 patients, with SUVmax value 7.71 ±2.78） and low metabolic group （22 patients, with SUVmax value 3.89± 0.80）. The SUVmax levels were statistically different （ P 〈 0. 001 ）. The 1-, 2- and 3-year survival rates of the 63 patients of high metabolic group were 66.6%, 26.9% and 12.6%, respectively. The 1-, 2- and 3-year survival rates of the 22 patients of low metabolic group were 81.8% ,72.7% and 63.6% , respectively. The median survival time of the high metabolic group was 16.0 months and that of the low metabolic group was 48.0 months （P = 0. 001 ）. Univariate analysis indicated that SUVmax value of the intrahepatic primary tumor, hepatic cirrhosis, Child-Pugh score, ECOG score, intrahepatic tumor size, number of tumors（ solitary or muhiple）, portal vein tumor thrombus, BCLC stage, and serum AFP level were significantly correlated with prognosis of the patients （P 〈 0.05 for all）. Multivariate analysis indicated that SUVmax value, tumor size 〉 8 cm, number of tumors （solitary or multiple ） and AFP level were independent prognostic factors （P 〈 0.05 for all）. Conclusion The SUVmax value of the primary intrahepatic tumor can be used as an important prognostic factor to predict the effect of TACE in patients with hepatocellular carcinoma.