18F-FDG PET/CT显像预测肝外胆管癌转移的临床研究

Analysis of Risk Factors for Metastases in Extrahepatic Cholangiocarcinoma Patients with 18F-FDG PET/CT

目的探讨18F-FDG PET/CT显像预测肝外胆管癌转移的重要的危险因素。方法回顾性分析57例肝外胆管癌患者的18F-FDG PET/CT影像资料及相关的临床特征,其中有转移者28例,无转移者29例,应用单因素及多因素分析肝外胆管癌发生转移的危险因素,并绘制ROC曲线分析原发灶TSUVmax及T/B在鉴别诊断肝外胆管癌有无转移的最佳临界值。结果单因素分析患者有黄疸、T/B和CA199水平是肝外胆管癌转移的危险因素;多因素分析T/B是肝外胆管癌转移的独立的危险因素。TSUVmax预测胆管癌转移的曲线下面积为0.601,当TSUVmax=4.1时,灵敏度、特异度、准确性分别是73.9%、64.7%、68.4%;T/B预测胆管癌转移的曲线下面积为0.662,当T/B=1.8时,灵敏度、特异度、准确度分别是82.3%、62.5%、68.4%。结论T/B为肿瘤发生转移的独立的危险因素,为突破形态学因素。

Objective To observe the relationship between metastases and various clinical indexes based on the 18F-FDG PET/CT imaging in order to explore the risk factors for metastases in extrahepatic cholangiocarcinoma.Methods 57 patients with extrahepatic cholangiocarcinoma diagnosed in the first visit and underwent 18F-FDG PET/CT were retrospectively reviewed.The relationship between metastasis and various clinical indexes were analyzed.And risk factors for metastasis in extrahepatic cholangiocarcinoma were assessed by Multivariate Logistic regression analysis.Receiver operating characteristic(ROC)curve was used for analyzing the best critical value of TSUVmax,T/B to differentiate between extrahepatic cholangiocarcinoma with metastases and without metastases.Results Monofactorial analysis showed that patients had jaundice,level of CA199 and T/B ratio were vital risk elements for tumor metastasis.Further adopting Multivariate Logistic regression analysis showed that only T/B was an independent factor for metastasis.The ROC curve analysis the best critical value of TSUVmax and T/B in differential between extrahepatic cholangiocarcinoma with metastases and without metastases were 4.1 and 1.8 respectively.The best critical value of TSUVmax was 73.9%sensitive,64.7%specific,and 68.4%accurate for diagnosing extrahepatic cholangiocarcinoma with metastases.The best critical value of T/B was 82.3%sensitive,62.5%specific and 68.4%accurate for diagnosing extrahepatic cholangiocarcinoma with metastases.Conclusion T/B was an independent predictor of metastasis in extrahepatic cholangiocarcinoma patients.