乳腺癌患者术前^(18)F-FDG PET/CT显像肿瘤代谢体积测定的预后价值

Prognostic value of metabolic tumor volume measured by ^(18)F-FDG PET/CT imaging in preoperative breast cancer patients

目的探讨乳腺癌患者术前2-氟-2-脱氧-D-葡萄糖(18F-FDG)PET/CT显像肿瘤代谢体积(MTV)测定的预后价值。方法回顾分析18例晚期女性乳腺浸润性导管癌患者术前18F-FDG PET/CT显像,通过三维感兴趣区测定MTV和最大标准摄取值(SUVmax),采用ROC曲线分析、Kaplan-Meier生存分析和log-rank检验、Cox回归风险分析评估其对无进展生存期(PFS)的影响。结果 ROC曲线分析MTV ROC曲线下面积(AUCs)0.908(95%置信区间CI 0.764~1.052,P=0.009)、SUVmax AUCs 0.823(95%CI 0.549~1.098,P=0.038),Stage AUCs 0.746(95%CI 0.488~1.004,P=0.115),Age AUCs 0.769(95%CI 0.526~1.012,P=0.085)。MTV、SUVmax的ROC下面积与从原点到右上角参考线下面积0.5比较,差异有统计学意义,MTV预测无进展生存期价值较高,SUVmax价值中等,MTV界值为6.35 cm3,SUVmax界值9.05。Kaplan-Meier生存分析MTV<6.35 cm3平均PFS时间45.5个月(95%CI 41.256~49.744),MTV≥6.35 cm3平均PFS时间26.13个月(95%CI22.87~29.39),2组间差异有统计学意义(P=0.001)。总PFS时间31.99月(95%CI 27.01~36.97),MTV≥6.35 cm3组中位PFS时间27.00月(95%CI 24.18~29.82)。Cox回归单变量分析MTV HR 3.179(95%CI 1.563~6.462,P=0.001)、SUVmax HR2.962(95%CI 1.494~5.875,P=0.002)、Stage HR 4.692(95%CI 1.375~16.013,P=0.014)、Age HR 1.063(95%CI 1.006~1.124,P=0.031);多变量分析MTV、Stage进入Cox回归方程,MTV HR 4.169(95%CI 1.691~10.281,P=0.002),Stage HR11.392(95%CI0.949~136.731,P=0.055),Cox风险模型表达式为h(t)=h0(t)exp(1.428MTV+2.433stage)。结论晚期女性乳腺浸润性导管癌患者术前18F-FDG PET/CT显像测定MTV对无进展生存期预测及肿瘤进展风险评估有较高的临床价值。

Objective To explore the prognostic value of metabolic tumor volume measured by 18F-FDG PET/CT imaging in preoperative breast cancer patients. Methods Preoperative 18F- FDG PET/CT imaging in 18 female patients with advanced breast infiltrating ductal cancer were reviewed, and the metabolic tumor volume （MTV） and maximum standardized uptake value （SU- Vmax） from 3-D ROI of local lesion were measured. The cut-off value of MTV for predicting aggression was determined by using a receiver operating characteristic （ROC） curve. The effects of progression free survival of patients was compared with MTV, SUVmax, stage, age by ROC curve analysis, Kaplan-Meier survival analysis and log-rank test, Cox Regression Hazard analysis. Results MTV AUCs was 0. 908（95 % CI 0. 764 - 1. 052, P = 0. 009）, SUVmax AUCs was 0. 823（95 % CI0. 549- 1. 098, P = 0. 038）, Stage AUCs was 0. 746（95 % CI0. 488 - 1. 004, P = 0. 115）, Age AUCs was 0. 769 （95 % CI 0. 526 - 1. 012, P = 0. 085）. The AUCs of MTV and SUVmax were significantly higher than reference line （P was 0. 009 and 0. 038 respectively）. The cutoff value of MTV for predicting agression was 6.3 5 mL by ROC curve analyzing, SUVmax was 9.0 5.Kaplan - Meier analyzing, Mean time of PFS was 4 5 . 5 months in MTV 〈 6 . 3 5 mL （ 9 5 % CI 41. 256 - 49. 744）, but MTV≥6.35 mL was 26. 128 months（95% CI 22.87 - 29.39）. Overall time of PFS was 31.99 months（95% CI 27.01- 36.97）. In MTV≥6.35 mL, median time of PFS was 27.00 months（95% CI 24.18- 29.82）. In univariate analysis COX Regression Hazard a, MTV HR 3. 179（95 % CI 1. 563 - 6. 462, P = 0. 001）, SUVmax HR 2. 962（95 % CI 1. 494 -5. 875,P=0.002）,StageHR4.692（95%CI1.375-16.013,P=0.014）,AgeHR 1. 063 （95 % CI 1. 006- 1. 124, P = 0. 031）. In multivariate analyses of COX Regression Hazard, the both variates of MTV and Stage were entered the Hazard function. MTV HR 4. 169 （95 % CI1. 691 - 10. 281,P = 0. 002） ,StageHR 11. 392（95 % CIO. 949 - 136. 731, P = 0. 0 5 5 ）. The formulaof Cox Regression Hazard function was h （ t ） = h0 （ t ） exp （ 1.4 2 8 MTV ＋ 2. 433stage）. Conclusion The metabolic tumor volume measured by 18F-FDG PET/CT imaging in preoperative female advanced infiltrating ductal carcinoma of breast（IDC） patients has a great clinical significance in predicting PFS and evaluating aggressive hazard.