^(18)F-FDG PET/CT代谢参数在头颈部鳞状细胞癌预后评估中的价值

PROGNOSTIC VALUE OF METABOLIC PARAMETERS ON ^(18)F-FDG PET/CT IN PATIENTS WITH HEAD AND NECK SQUAMOUS CELL CARCINOMA

目的探讨^(18)F-氟代脱氧葡萄糖(^(18)F-FDG)PET/CT代谢参数在头颈部鳞状细胞癌(HNSCC)病人预后评估中的价值。方法 2011年11月-2016年3月于我中心行^(18)F-FDG PET/CT检查的HNSCC病人34例,随访时间为21~72个月,平均(37.5±14.2)个月。分析原发灶最大标准化摄取值(SUV_(tumor))、淋巴结转移瘤SUV_(max)(SUV_(LN))及SUV_(LN)/SUV_(tumor)对病人总生存期(OS)的预测价值。应用ROC曲线确定各代谢参数预后评估的最佳界值点和诊断效能,采用Kaplan-Meier法及Log-rank检验进行单因素生存分析。结果 34例HNSCC包括鼻咽癌16例,喉咽癌14例,口咽癌3例以及舌癌1例。存活组和死亡组SUV_(tumor)、SUV_(LN)/SUV_(tumor)比较,差异均无显著性(P>0.05);两组SUV_(LN)比较,差异有显著性(t=2.792,P<0.05)。根据ROC,SUV_(LN)预测HNSCC的OS最佳界值点为14.52(AUC=0.757,95%CI=0.583~0.931,P<0.05);SUV_(LN)/SUV_(tumor)预测OS最佳界值点为0.79(AUC=0.702,95%CI=0.526~0.878,P<0.05)。预测病人OS选用SUV_(LN)效能最佳,其最佳界值点对应诊断特异度为90.00%;诊断灵敏度最高的参数为SUV_(LN)/SUV_(tumor),其最佳界值点对应诊断灵敏度为85.70%。采用Log-rank检验对生存函数进行组间比较,淋巴结转移瘤相关代谢参数(SUV_(LN),SUV_(LN)/SUV_(tumor))可有效预测HNSCC病人OS(χ~2=16.028、4.372,P<0.05);SUV_(tumor)无法有效预测病人OS(P>0.05)。结论淋巴结转移瘤相关代谢参数对HNSCC病人的预后具有较高的评估价值,而原发灶的代谢参数则评估价值较低。

Objective To study the prognostic value of metabolic parameters on 2-Fluorine-18-Fluoro-2-deoxy-D-glucose（18F-FDG）PET/CT in patients with head and neck squamous cell carcinoma（HNSCC）. Methods This is a retrospective study including 34 patients with HNSCC who underwent baseline 18F-FDG PET/CT at our center from November 2011 to March 2016.The mean follow-up for all patients was（37.5±14.2）months（range 21-72 months）.The prognostic value of metabolic parameters such as maximum standardized uptake value（SUVmax）of the primary tumor（SUVtumor）,lymph node（SUVLN）,SUVLN/SUVtumor were assessed for overall survival（OS）.The ROC curve was plotted to estimate the optimal cut-off value and diagnostic efficacy of each parameter.Univariate survival analysis was performed by Kaplan-Meier method with Log-rank test. ResultsWe enrolled 34 cases of HNSCC in this study including 16 cases of nasopharyngeal carcinoma,14 cases of hypopharyngeal carcinoma,3 cases of oropharyngeal carcinoma and 1 case of tongue cancer.There was no significant difference in SUVtumor,SUVLN/SUVtumorbetween survival group and death grou（P〉0.05）.SUVLN was statistically significant in survival group and death group（t=2.792,P 〈0.05）.According to the Receiver Operating Characteristic curve（ROC）,the optimal cut-off value of SUVLN and SUVLN/SUVtumorwas 14.52（AUC=0.757,95%CI=0.583-0.931,P〈0.05）and 0.79（AUC=0.702,95%CI=0.526-0.878,P〈0.05）,respectively.The SUVLN was the most effective predictor for OS,which diagnostic specificity was 90.00%.The highest diagnostic sensitivity of the parameter is SUVLN/SUVtumor,which was 85.70%.From univariate survival analysis,Lymph node metastases related metabolic parameters（SUVLN,SUVLN/SUVtumor）could effectively predict the OS（χ^2=16.028,4.372;P〈0.05）,SUVtumorcould not predict the OS effectively（P〉0.05）. Conclusion The metabolic parameters related to the lymph node matastasis have a good prognostic value in patients with HNSCC,while the metabolic parameters of primary tumor itself could not predict the OS effectively.