^(18)F-氟脱氧葡萄糖的最大标准摄取值评估宫颈癌伴淋巴结转移患者预后的价值

Prognostic Value of ^(18)F-FDG SUVmax in Pelvic Lymph Nodes Metastases of Patients with Cervical Cancer

背景淋巴结转移是影响宫颈癌预后的主要因素,早期诊断可以有效提高患者的生存率。目的探讨^(18)F-氟脱氧葡萄糖(^(18)F-FDG)的最大标准摄取值(SUVmax)评估宫颈癌伴淋巴结转移患者预后的价值,并分析患者生存率的影响因素。方法收集2004年12月—2011年8月天津市第四中心医院妇产科经活组织检查证实的伴盆腔淋巴结转移和/或腹主动脉旁淋巴结转移宫颈癌患者70例为研究对象。患者均行正电子发射断层联合计算机断层扫描术(PET/CT)检查,记录^(18)F-FDG的SUVmax,患者均接受放、化疗,从患者接受治疗开始随访,随访至患者复发或死亡,随访截止日期为2015-06-30。结果 SUVmax预测患者复发的受试者工作特征(ROC)曲线下面积(AUC)为0.703,95%CI(0.542,0.838),临界值为7.5,灵敏度为85.7%,特异度为98.2%,阳性预测值为92.3%,阴性预测值为96.5%,约登指数为0.8。SUVmax<7.5 13例,SUVmax≥7.5 57例。SUVmax<7.5患者与SUVmax≥7.5患者总生存率(OS)比较,差异无统计学意义(χ~2=2.934,P=0.087)。SUVmax<7.5患者无病生存率(DFS)高于SUVmax≥7.5患者(χ~2=4.791,P=0.035)。多元Cox比例风险回归分析结果显示,SUVmax、淋巴结转移部位、疗效反应是OS的影响因素(P<0.05);SUVmax、淋巴结转移部位、疗效反应是DFS的影响因素(P<0.05)。结论^(18)F-FDG的SUVmax可以较好地评估宫颈癌伴淋巴结转移患者预后;^(18)F-FDG的SUVmax较大、伴盆腔淋巴结转移、完全反应宫颈癌患者生存率较差。

Background Lymph nodes metastasis is the main factor that affects the prognosis of cervical cancer. Early diagnosis can effectively improve the survival rate of patients with cervical cancer. Objective To evaluate the prognostic value of the 18 F-FDG maximum standardized uptake value（SUVmax）in pelvic lymph nodes metastases of patients with cervical cancer and analyze the impact factors of survival. Methods A total of 70 cervical carcinoma patients with pelvic and/ or paraaortic lymph nodes metastases confirmed by biopsy in Department of Obstetrics and Gynecology of Tianjin Forth Center Hospital were enrolled in this study from December 2004 to August 2011. All patients accepted PET/ CT examination and 18 F-FDG SUVmax was recorded. All patients received radiotherapy and chemotherapy. Patients were followed up when the treatment began. The follow -up ended when patients relapsed or died. The deadline of follow - up was 2015 - 06 - 30. Results The AUC of SUVmax for＆amp;nbsp;predicting patients＆#39; recurrence was 0. 703,95% CI（0. 542,0. 838）,the cut - off value was 7. 5,the sensitivity was 85. 7% , the specificity was 98. 2% ,the positive predictive value was 92. 3% and the negative predictive value was 96. 5% ,the Youden index was 0. 8. There were 13 cases with SUVmax ﹤ 7. 5 and 57 cases with SUVmax≥7. 5. There was no statistically significant differences in overall survival（OS）between patients with SUVmax ﹤ 7. 5 and SUVmax≥7. 5（χ2 = 2. 934,P = 0. 087）. The disease - free survival（DFS）of patients with SUVmax ﹤ 7. 5 was higher than that of patients with SUVmax≥7. 5（χ2 = 4. 791, P = 0. 035）. Multivariate Cox proportional hazards regression analysis showed that SUVmax,sites of lymph nodes metastases and therapeutic response were the impact factors of OS（ P ﹤ 0. 05）;SUVmax,sites of lymph nodes metastases and therapeutic response were the impact factors of DFS（ P ﹤ 0. 05）. Conclusion SUVmax of 18 F-FDG can be used to well evaluate the prognosis of cervical cancer patients with lymph nodes metastases. The survival rate of patients with cervical cancer is poor when they have higher SUVmax of 18 F-FDG,pelvic lymph nodes metastases and complete therapeutic response.