^(18)F-FDG PET代谢参数对食管鳞癌放化疗效果的预测

Prognostic value of ^(18F)-fluorodeoxyglucose positron emission tomography for esophageal squamous cell carcinoma treated by chemoradiotherapy

目的探讨氟-18脱氧葡萄糖正电子发射型计算机断层扫描(18F-FDG PET)对食管鳞癌放化疗效果的预测。方法 56例接受三维适形或调强放射治疗的食管鳞癌患者纳入研究,中位剂量60 Gy(54~60 Gy),放疗期间同步顺铂20 mg/m2每周1次+紫杉醇45 mg/m2每周1次,连续6周。放疗前行18F-FDG PET/CT扫描,分析FDG PET最大标准摄取值(SUVmax)、平均SUV摄取值(SUVmean)、肿瘤代谢体积(MTV)与总体生存率(OS)和无进展生存率(PFS)的相关性。Kaplan-Meier计算生存率,Cox模型分析预后影响因素。结果入组患者ⅡA期14例,ⅡB期6例,Ⅲ期36例,中位随访34.4个月(6~63个月),1、3、5年OS分别为83.5%、49.8%、19.5%,PFS分别为69.7%、16.9%、8.5%。肿瘤原发灶SUVmax中位数14.6(3.3~35.1),SUVmean中位数6.7(2.6~27.8),MTV中位数33.6 cm3(8.9~149.0 cm3)。SUVmax、SUVmean、MTV均与OS有关(χ2值4.712~11.272,P值0.001~0.049);SUVmax、SUVmean与PFS有关(χ2值分别为10.659、6.670,P值均为0.001)。Cox模型预后分析显示除TNM分期外,MTV是OS的预测指标(Wald=9.844,P=0.002),SUVmax是PFS的预测指标(Wald=9.649,P=0.002)。结论 18F-FDG PET代谢参数能够对食管鳞癌放化疗效果进行预测。

Objective To investigate the prognostic value of 18F-fluorodeoxyglucose positron emission tomography（18F-FDG PET） for predicting overall survival（OS） and progression-free survival（PFS） in esophageal squamous cell carcinoma（ESCC） treated with three-dimensional radiotherapy and chemotherapy. Methods A total of 56 ESCC patients consecutively treated with definitive chemoradiotherapy were analyzed. Prescribed dose was 54-60 Gy with a median dose of 60 Gy. Six cycles of chemotherapy with Cisplatin 20 mg/m2 qw plus Paclitaxel 45 mg/m2 qw were administered concurrently. Each patient underwent 18F-FDG PET/CT for simulation, PET-based metabolic parameters, including the maximum standard uptake value（SUVmax）, mean SUV（SUVmean）, and metabolic target volume（MTV） were calculated and correlated with OS and PFS, which calculated by the Kaplan-Meier method, and multivariable Cox models were used to calculate the prognostic factors. Results The American Joint Committee on Cancer stage was ⅡA in 14 cases, ⅡB in 6 cases, and Ⅲ in 36 cases. With a median following-up time 34.4 months（6-63 months）, the OS and PFS at 1-, 3-, 5-year were 83.5%, 49.8%, 19.5%, and 69.7%, 16.9%, 8.5%, respectively. The median SUVmax, SUVmean, and MTV was 14.6（3.3-35.1） cm3, 6.7（2.6-27.8） cm3, and 33.6（8.9-149.0） cm3, respectively. SUVmax, SUVmean and MTV showed correlation with OS（χ2=4.712-11.272, P=0.049-0.001）, SUVmax and SUVmean was correlated with PFS（χ2=10.659, 6.670, P=0.001）. Cox regression revealed MTV was a predictor for OS beside of TNM stage（Wald=9.844, P=0.002）, while SUVmax was a predictor for PFS（Wald=9.649, P=0.002）. Conclusion The metabolic parameters of 18F-FDG PET were prognostic factors for treatment outcome in patients with ESCC.