FDGPET—CT显像代谢参数与食管癌放疗预后相关性研究

Prognostic value of FDG PET-CT metabolic parameters before radiotherapy in patients with esophageal cancer receiving radiotherapy

目的 研究放疗前FDG PET-CT显像代谢参数作为食管癌患者预后评估指标的价值。方法 回顾性分析2010—2015年安徽省立医院治疗的37例Ⅱ—Ⅲ期食管鳞癌患者,均于放疗前4周内完善PET-CT扫描,整理患者年龄、性别、原发灶部位、临床分期、治疗方案等信息,获得原发灶SUVmax、SUVmean、MTV、PTL并计算TLG,利用ROC曲线找出最优界值。采用Kaplan-Meier法生存分析,Logrank法检验及单因素分析,Cox模型对有意义临床变量进行多因素分析。结果 ROC曲线下面积提示MTV〉TLG〉PTL=0.713〉0.679〉0.670,生存分析显示当MTV〈27.44 cm3、TLG〈166.2 g、PTL〈36.74 mm时患者有更好的生存期（P〈0.05）。多因素分析显示MTV是放疗预后影响因素（P=0.000）。结论 放疗前PET-CT代谢参数MTV、TLG及PTL对食管癌患者预后评估具有参考价值,对患者临床治疗方案的选择及调整、提高患者生存率及改善预后具有一定意义。

Objective To investigate the prognostic value of metabolic parameters of 18F-fluorodeoxyglucose positron emission tomography/computed tomography （FDG PET-CT） before radiotherapy in patients with esophageal cancer receiving radiotherapy. Methods We retrospectively analyzed the clinical data of 37 patients with stage Ⅱ-Ⅲ esophageal squamous cell carcinoma admitted to Anhui Provincial Hospital from 2010 to 2015, who underwent PET-CT scans within 4 weeks before radiotherapy. The following information was collected：age, sex, the location of primary lesion, clinical stage, and treatment regimen. The maximum standard uptake value （SUVmax）, mean standard uptake value （SUVmean）, metabolic tumor volume （MTV）, PET tumor length （PTL）, and total lesion glycolysis （TLG） were calculated. The optimal cut-off values of SUVmax, SUVmean, MTV, PTL, and TLG were determined by the receiver operating characteristic （ROC） curve. The Kaplan-Meier method was used to calculate survival rates, and the log-rank test was used for survival comparison and univariate prognostic analysis;the Cox model was used for multivariate prognostic analysis of significant variables. Results The area under the ROC curve suggested that MTV〉TLG〉PTL=0.713〉0.679〉0.670. The Kaplan-Meier survival analysis showed that patients had better survival time when MTV was less than 27.44 cm3, TLG was less than 166.2 g, and PTL was less than 36.74 mm （P〈0.05）. The Cox multivariate regression analysis showed that only MTV was an independent prognostic factor for radiotherapy in patients with esophageal cancer （P=0.000）. Conclusions MTV, TLG and PTL have certain values in predicting the prognosis of patients with esophageal cancer before radiotherapy, and are helpful for selecting and adjust the clinical treatment regimen and improving the survival rate and prognosis.