宫颈癌治疗后^(18)F-氟脱氧葡萄糖PET/CT检查与鳞状细胞癌抗原水平的关系研究

Relationship of ^(18)F-FDG PET / CT Examination and Squamous Cell Carcinoma Antigen Levels after Cervical Cancer Treatment

背景^(18)F-氟脱氧葡萄糖(^(18)F-FDG)PET/CT检查在宫颈癌治疗后血清鳞状细胞癌(SCC)抗原水平升高患者中具有重要应用价值。对于宫颈癌治疗后临床怀疑复发及转移但SCC抗原水平处于参考范围内的患者行^(18)F-FDG PET/CT检查有无意义,以及宫颈癌治疗后,SCC抗原处于何种水平时适宜进行^(18)F-FDG PET/CT检查可以得到理想的病灶检出率,尚未见相关报道。目的探讨宫颈癌治疗后患者SCC抗原居于何种水平时适宜进行^(18)F-FDG PET/CT检查。方法回顾性分析2008年1月—2011年12月河北医科大学第四医院收治的78例宫颈癌患者的临床资料,均为SCC,并行根治性治疗(手术、手术+术后放疗、手术+术后化疗、手术+术后放化疗等),治疗后均进行了^(18)F-FDG PET/CT检查和SCC抗原水平测定。依据^(18)F-FDG PET/CT检查结果将患者分为PET/CT阳性组(62例)和PET/CT阴性组(16例)。依据SCC抗原水平将患者分成3组:<1.50μg/L组(24例),1.50~6.00μg/L组(31例),>6.00μg/L组(23例)。本组入选患者^(18)F-FDG PET/CT检查结果均经病理或随访结果证实。绘制SCC抗原水平预测^(18)F-FDG PET/CT阳性的ROC曲线。结果 PET/CT阳性组患者年龄、SCC抗原水平小于PET/CT阴性组(P<0.05)。<1.50μg/L组、1.50~6.00μg/L组、>6.00μg/L组。^(18)F-FDG PET/CT阳性率分别为66.7%、77.4%、95.7%,3组^(18)F-FDG PET/CT阳性率比较,差异有统计学意义(P<0.05);其中,>6.00μg/L组^(18)F-FDG PET/CT阳性率高于<1.50μg/L组,差异有统计学意义(P<0.05)。3组平均最大标准摄取值(SUVmax)分别为(4.9±2.9)、(6.3±3.2)、(6.4±2.4),差异无统计学意义(P>0.05)。通过ROC曲线分析,SCC抗原水平预测^(18)F-FDG PET/CT为阳性的最佳截断值为1.15μg/L,此时,灵敏度为83.6%,特异度为47.1%,本组患者在该截断值^(18)F-FDG PET/CT阳性率为86.7%。结论^(18)F-FDG PET/CT检查在SCC抗原水平较低时即可发现宫颈鳞癌复发及转移,患者SCC抗原水平升高时^(18)F-FDG PET/CT阳性率升高,当SCC抗原水平升至1.15μg/L以上时,适宜通过^(18)F-FDG PET/CT检查进行确诊。

Background^18F- Fluorodeoxyglucose（^18F-FDG） PET / CT has an important application value in patients with elevated serum squamous cell carcinoma（ SCC） antigen level after cervical cancer treatment. Relevant reports about whether there is significance of^18F-FDG PET / CT examination in normal antigen level of SCC patients with clinically suspected recurrence or metastasis after cervical cancer treatment,and reports about in what level of SCC antigens is suitable for^18F-FDG PET / CT examination to get ideal lesion detection rate have not been seen yet. Objective To investigate the suitable level of SCC antigen for^18F-FDG PET / CT examination in patients with cervical cancer after treatment. Methods Clinical data of 78 patients with cervical cancer who received treatment in Fourth Hospital of Hebei Medical University from January 2008 to December 2011 were retrospectively analyzed. All the subjects were diagnosed with squamous cell carcinoma. Radical treatment（ surgery,surgery ＋postoperative radiotherapy,surgery ＋ postoperative chemotherapy,surgery ＋ postoperative radiotherapy and chemotherapy） was carried out and after treatment examination of^18F-FDG PET / CT and detection of SCC antigen levels were made. According to result of^18F- FDG PET / CT,patients were divided into positive PET / CT group（ 62 cases） and negative PET / CT group（ 16 cases）.According to SCC antigen levels, patients were divided into three groups： antigen level 1. 50 μg / L group, antigen level between 1. 50 and 6. 00 μg / L group（ 31 case）,and antigen level 6. 00 μg / L group（ 23 case）. The^18F-FDG PET / CT examination results of the included patients were verified by pathology and follow- up results. SCC antigen level was drawn to predict ROC curve of positive^18F-FDG PET / CT. Results The age and SCC antigen level of positive PET / CT group were lower than those of negative PET / CT group（ P〈0. 05）. The positive rate of^18F-FDG PET / CT antigen level 1. 50 μg / L group,antigen level between 1. 50 and 6. 00 μg / L group,antigen level 6. 00 μg / L group were 66. 7 %,77. 4% and 95. 7%respectively. There was significant difference in the positive rate of^18F-FDG PET / CT among three groups（ P〈0. 05）; the positive rate of^18F-FDG PET / CT in antigen level 6. 00 μg / L group was significantly higher than that of antigen level 1. 50μg /L group（ P〈0. 05）. The average standard uptake value max（ SUVmax） of three groups was（ 4. 9 ± 2. 9）,（ 6. 3 ± 3. 2）and（ 6. 4 ± 2. 4）（ P〈0. 05）. There was no significant difference in SUVmax among three groups. By ROC analysis,the optimal cut- off value of the prediction of SCC antigen level on positive^18F-FDG PET / CT was 1. 15 μg / L,and at this moment the sensitivity and specificity was 83. 6% and 47. 1% respectively. The positive rate of^18F-FDG PET / CT of patients with this cutoff value was 86. 7%. Conclusion Recurrence and metastasis in cervical cancer can be found by^18F-FDG PET / CT when SCC antigen level is relatively low. The positive rate of^18F-FDG PET / CT increases with the SCC antigen level. It is suitable for diagnosis by^18F-FDG PET / CT examination when SCC antigen level reaches over 1. 15 μg / L.