^(18)F-FDG PET/CT在结肠癌术前TNM分期中的价值及SUVmax与患者临床特征的相关性研究

Clinical value of ^(18)F-FDG PET/CT in preoperative TNM staging and SUVmax in patients with colon cancer

目的:探讨PET/CT在结肠癌术前TNM分期中的临床价值及病灶最大标准化摄取值(maximum standardized uptake value,SUVmax)的临床意义。方法:回顾性分析44例经术后病理证实为结肠癌患者的PET/CT影像学资料,评价PET/CT术前TNM分期的准确性。分别按患者年龄和性别,病灶部位、长径、TNM分期、美国癌症联合会(American Joint Committee on Cancer,AJCC)分期、病理类型及组织学分化程度、癌胚抗原(carcinoembryonic antigen,CEA)、糖类抗原199(carbohydrate antigen 199,CA199)、CA242进行分组,分析各组间SUVmax值差异有无统计学意义,并用受试者工作特征(receiver operating characteristic,ROC)曲线评价SUVmax对组织学分化程度的诊断效能。结果:PET/CT对T分期、M分期的诊断结果与术后病理分期的一致性较好(Kappa=0.776、1.0;P<0.05),而对N分期的诊断结果与术后病理分期的一致性一般(Kappa=0.493;P<0.05)。病灶SUVmax与患者年龄和性别、病灶部位、CA199、CA242无关(P>0.05);与病灶长径、TNM分期、AJCC分期、病理类型及分化程度、CEA有关(P<0.05)。ROC曲线下面积(area under curve,AUC)为0.862,阈值14.6,以此阈值来判断组织学分化程度的灵敏度和特异度均为77.8%。结论:PET/CT可用于术前TNM准确分期。SUVmax与病灶的长径、TNM分期、AJCC分期、病理类型、分化程度及CEA有关,可反映病灶的增殖、侵袭能力。

Objective： To evaluate the clinical value of 18F-fluorodeoxyglucose （18F-FDG） PET/CT in preoperative TNM staging, and explore the clinical value of maximum standardized uptake value （SUVmax） in the patients with colon cancer. Methods： PET/CT preoperative images of forty-four patients diagnosed with colon cancer were retrospectively analyzed to evaluate the accuracy of PET/CT in TNM Staging before surgery. The groups were matched by sex, age, lesion position, diameter, TNM stage, American Joint Committee on Cancer （AJCC） stage, pathological type, differentiation state, carcinoembryonic antigen （CEA）, carbohydrate antigen 199 （CA199） and CA242, and SUVmax was calculated. The accuracy of SUVmax for differentiation was analyzed by receiver operating characteristic （ROC） curve. Results： There was a good consistency between PET/CT and pathologyresults in T stage and M stage （Kappa=0.776, 1.0; P〈0.05）, while a worse consistency in N stage （Kappa=0.493; P〈0.05）. There was no correlation between SUVmax and sex, age, lesion position, CA199 and CA242 （P〉0.05）. But SUVmax was correlated with lesion diameter, TNM stage, AJCC stage, pathological type, differentiation state and CEA （P〈0.05）. The area under ROC curve of SUVmax was 0.862. Taking SUVmax=14.6 as threshold value to evaluate the differentiation state of colon cancer, the sensitivity and specificity were both 77.8%. Conclusion： PET/CT should be applied in preoperative TNM staging in the patients with colon cancer. SUVmax may be related to lesion diameter, TNM stage, AJCC stage, pathological type, differentiation state and CEA. SUVmax can reflect the invasion and proliferation ability of colon cancer.