18F-FDG PET/CT相关参数预测结直肠癌切除术预后口价值

18F-FDG PET/CT related parameters can predict postoperative prognosis of colorectal cancer

目的探究18F-FDG PET/CT相关参数对结直肠癌(CRC)根治术后患者的无病生存时间(DFS)和总生存时间(OS)的预后预测价值。方法回顾性分析2011年11月至2016年10月行18F-FDG PET/CT检查的132例CRC患者临床资料,其中男性93例、女性39例,中位年龄63岁。使用18F-FDG PET/CT的最大标准化摄取值(SUVmax)=2.5及SUVmax的20%、30%、40%、50%等作为不同阈值,计算不同阈值的平均标准化摄取值(SUVmean)、肿瘤代谢体积(MTV)和病灶糖酵解总量(TLG),并预测CRC患者根治术后的DFS和OS。通过受试者工作特征(ROC)曲线获得18F-FDG PET/CT相关参数的曲线下面积,并获得DFS的最佳阈值。生存分析采用Kaplan-Meier法进行,单因素分析采用Log-rank检验,多因素分析采用COX比例风险模型。结果ROC曲线分析预测DFS最佳阈值分别为SUVmax=19.36、MTV=22.64cm3、TLG= 117.78 g、TLG20%=129.74 g、TLG30%=107.05 g、TLG40%=73.22 g和TLG50%=56.13 g. DFS预后的单因素分析结果显示,癌胚抗原(CEA)、糖类抗原(CA)19-9、淋巴结转移、临床分期、化疗、SUVmax、MTV、TLG、TLG20%、TLG30%、TLG40%、TLG50%是CRC患者DFS的影响因素;多因素分析结果显示,SUVmax(95%CI:1.882~5.815,OR=3.308,P=0.000)、临床分期(95%CI:1.226~3.819,OR=2.164,P=0.008)和CA19-9(95%CI:1.182~3.724,OR=2.098,P=0.011)是影响CRC患者术后DFS的独立危险因素。OS预后的单因素分析结果显示,CEA、CA19-9、组织学类型、SUVmax、MTV、TLG、TLG20%、TLG30%、TLG40%、TLG50%是CRC患者OS的影响因素;多因素分析结果显示,SUVmax(95%CI:1.129~6.624,OR=2.735,P=0.026)、TLG50%(95%CI:1.640~19.801,OR=5.699,P=0.006)和CA19-9(95%CI:1.868~ 11.084,OR=4.550,P=0.001)是影响CRC患者术后OS的独立危险因素。结论18F-FDG PET/CT相关参数SUVmax、TLG50%可以用于评估CRC患者的预后,参数值越大,预后越差。

Objective To explore the clinical value of 18F-FDG PET/CT-related parameters for the prediction of tumor disease-free survival time (DFS) and overall survival time (OS) after the radical resection of colorectal cancer (CRC). Methods Retrospective analysis was conducted on 132 patients (93 males and 39 females;median age, 63 years) with CRC who underwent 18F-FDG PET/CT examination between November 2011 and October 2016. The 18F-FDG PET/CT-related parameters were as follows: SUVmax=2.5 (20%, 30%, 40%, and 50% of SUVmax were used as different thresholds);SUVmean, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of different thresholds;and DFS and OS of CRC patients after radical resection. The receiver-operating characteristic (ROC) curve was used in the measurement of the area under curve of 18F-FDG PET/CT-related parameters and the optimal DFS cutoff value. Survival analysis was performed with the Kaplan-Meier method. Univariate and multivariate analyses were performed with Log-rank test and the COX proportional hazards model, respectively. Results The ROC curve predicted the DFS cut off value, and SUVmax=19.36, MTV= 22.64 cm3, TLG= 117.78 g, TLG20%= 129.74 g, TLG30%= 107.05 g, TLG40%= 73.22 g, and TLG50%= 56.13 g. DFS univariate analysis showed that CEA, CA19-9, lymph node metastasis, clinical stage, chemotherapy, SUVmax, MTV, TLG, TLG20%, TLG30%, TLG40%, and TLG50% were the factors influencing postoperative DFS. Multivariate analysis showed that SUVmax (95%CI: 1.882–5.815, OR= 3.308, P<0.000), clinical stage (95%CI: 1.226–3.819, OR = 2.164, P=0.008), and CA19-9 (95%CI: 1.182–3.724, OR=2.098, P= 0.011) were independent risk factors for postoperative DFS. The survival analysis of OS univariate analysis showed that CEA, CA19-9, histological type, SUVmax, MTV, TLG, TLG20%, TLG30%, TLG40%, and TLG50% were the factors influencing postoperative OS. Furthermore, SUVmax (95%CI: 1.129–6.624, OR=2.735, P=0.026), TLG50%(95%CI: 1.640–19.801, OR=5.699, P=0.006), and CA19-9 ( 95%CI: 1.868–11.084, OR=4.550, P=0.001) were the independent risk factors for postoperative OS. Conclusion 18F-FDG PET/CT-related parameters SUVmax and TLG50% can predict the prognosis of patients with CRC;the higher the parameter values are, the worse the prognoses are.