胰腺癌患者术前PET/CT对术后复发及预后预测价值分析

Correlation and predictive value of preoperative ^(18)F-FDG PET/CT for postoperative recurrence in patients with resectable pancreatic cancer

目的探讨胰腺癌患者术前18 F-脱氧葡萄糖(18-fluorodeoxyglucose,18F-FDG)PET/CT检查与术后复发和生存期的关系。方法选取内蒙古自治区人民医院2010-01-01-2013-12-02行手术治疗的胰腺导管腺癌患者48例,均经病理学确诊。所有患者术前半个月内接受过≥1次PET/CT扫描,记录最大标准化摄取值(maximum standardized uptake value,SUVmax)。以无复发生存期≥12个月为结果状态变量,应用受试者工作特征曲线(receiver operating characteristic curve,ROC)评估SUVmax预测术后复发的情况,并分析SUVmax与术后复发及生存期的关系。结果 48例患者随访2~49个月,中位随访时间11个月。48例患者无复发中位生存期为13个月,总生存期中位时间为26个月。SUVmax预测术后复发的ROC曲线下面积为0.809,最佳临界值为5.9,灵敏度和特异度分别为88.0%和73.9%。血清CA19-9水平、淋巴结浸润和SUVmax是胰腺癌患者无复发生存期的独立影响因素,HR(95%CI)分别为2.37(1.23~4.51)、1.98(1.17~3.82)和2.73(2.02~4.24)。血清CA19-9水平、SUVmax、组织分化程度和淋巴结浸润是胰腺癌患者总生存期的独立影响因素,HR(95%CI)分别为2.28(1.55~3.52)、2.25(1.33~3.91)、1.49(1.07~2.15)和1.68(1.14~2.41)。结论 SUVmax可在一定程度上预测胰腺癌患者术后复发和生存情况,术前PET/CT检查对治疗方案的制定具有临床参考价值。

OBJECTIVE To evaluate the correlation and predictive value of preoperative 18-fluorodeoxyglucose（18F-FDG）PET/CT for postoperative recurrence in patients with resectable pancreatic cancer.METHODS We enrolled48 patients with pancreatic cancer who preoperatively underwent PET/CT examinations within 6months before operation in Inner Mongolia Autonomous Region people＇s Hospital.The pathological examination showed ductal adenocarcinoma.For statistical analysis,the maximal standardized uptake value（SUVmax）of PET/CT was measured.A receiver operating characteristics（ROC）curve was constructed to estimate the predictive power of SUVmax for recurrence.The relationship between SUVmax and recurrence as well as survival time were analyzed.RESULTS The patients were followed up for 2-49 months with a median of 11 months.The median progression-free survival（PFS）was 13 months and the median overall survival（OS）was 26 months.The area under the curve（AUC）of the SUVmax was 0.809 and the optimal operating point was 5.9.The multivariate analysis revealed that lymph node metastasis,CA19-9and SUVmax were independent influencing factors for PFS the HR（95%CI）were 2.37（1.23-4.51）,1.98（1.17-3.81）and 2.73（2.02-4.24）respectively.CA19-9,histological type and differentiation,SUVmax and lymph node metastasis were independent influencing factors for OS,the HR（95%CI）were 2.28（1.55-3.52）,2.25（1.33-.3.91）and 1.68（1.14-2.41）respectively.CONCLUSION The SUVmax of preoperative PET/CT has positive effects on prediction of postoperative recurrence and survival for patients with resectable pancreatic cancer.