18F-FDG PET/CT相关代谢参数对结直肠癌Kras基因突变的预测价值

Predictive value of 18F-FDG PET/CT related metabolic parameters for Kras mutation in colorectal cancer patients

目的 探讨18F-脱氧葡萄糖(FDG) PET/CT相关代谢参数对结直肠癌(CRC)患者Kras基因突变的预测价值。 方法 回顾性分析2011年11月至2017年8月在海军军医大学附属长海医院行18F-FDG PET/CT检查的150例CRC患者(男105例,女45例,中位年龄63岁)资料,检查后1个月内行手术并检测Kras基因。18F-FDG PET/CT相关代谢参数包括最大标准摄取值(SUVmax)、代谢体积(MTV;包括MTV2.5、MTV20%、MTV30%、MTV40%、MTV50%)、病灶糖酵解总量(TLG;包括TLG2.5、TLG20% 、TLG30%、TLG40%、TLG50%)。采用logistic回归分析和受试者工作特征(ROC)曲线分析处理数据。 结果 Kras基因突变型与野生型患者分别有78和72例。Logistic回归分析显示,SUVmax[比值比(OR)=1.176,95% CI:1.043~1.327]和MTV2.5(OR=1.125,95% CI:1.002~1.263)是CRC患者Kras基因突变的独立预测因素;以SUVmax=15.5、MTV2.5=23.79 cm3为阈值预测Kras基因突变的准确性分别为67.33%(101/150)和65.33%(98/150);两者对直肠及乙状结肠癌亚组Kras基因突变的预测效能更高,准确性分别为70.79%(63/89)和68.54%(61/89)。 结论 SUVmax和MTV2.5可预测CRC患者Kras基因突变,但预测效能与病理基因检测尚有差距。

Objective To explore the predictive value of 18F-fluorodeoxyglucose (FDG) PET/CT related metabolic parameters for Kras mutation in colorectal cancer (CRC) patients.Methods Retrospective analysis was conducted in 150 patients (105 males, 45 females, median age: 63 years) with CRC who underwent 18F-FDG PET/CT in Changhai Hospital of Navy Medical University between November 2011 and August 2017. The primary tumors were removed by surgery and patients received genetic testing within 1 month after PET/CT. 18F-FDG PET/CT related metabolic parameters were measured, including maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV;including MTV2.5, MTV20%, MTV30%, MTV40%, MTV50%), total lesion glycolysis (TLG;including TLG2.5, TLG20%, TLG30%, TLG40%, TLG50%). Logistic regression analysis and receiver operating characteristic (ROC) curve analysis were used to analyze the data.Results There were 78 Kras-mutated type patients and 72 wild-type patients. Logistic regression analysis showed that SUVmax (odds ratio (OR)=1.176, 95% CI: 1.043-1.327) and MTV2.5 (OR=1.125, 95% CI: 1.002-1.263) were predictors of Kras mutation. With SUVmax=15.5 and MTV2.5=23.79 cm3 as the cut-off value, the prediction accuracies of Kras mutation were 67.33%(101/150) and 65.33%(98/150), respectively. The accuracies of SUVmax and MTV2.5 for predicting Kras mutation were higher in recta or sigmoid colon cancers (70.79%(63/89) and 68.54%(61/89)). Conclusion SUVmax and MTV2.5 can predict Kras mutation in CRC patients, but there is a significant gap of predictive efficiency between PET/CT and gene detection.