^(18)F-FDG PET/CT体积代谢参数对口腔癌预后价值的研究

The Prognostic Value of Preoperative Metabolic Parameters Measured by^(18)F-FDG PET/CT in Oral Cavity Cancer

目的探讨术前测定^(18)F-FDG PET/CT肿瘤代谢体积(metabolic tumor volume,MTV)和糖酵解总量(total lesion glycolysis,TLG)对口腔癌患者的预后价值。方法对83例经手术病理证实的口腔癌患者进行术前^(18)F-FDG PET/CT检查。测量原发肿瘤的最大标准摄取值(maximum standardized uptake values,SUVmax)、MTV和TLG。分析临床病理特征、影像学指标与无进展生存期(progression-free survival,PFS)、总生存期(overall survival,OS)的相关性,并对OS和PFS进行单因素Cox回归和Kaplan-Meier生存分析。通过受试者操作特征曲线(receiver operating characteristic,ROC)和决策曲线分析(decision curve analysis,CA)评价PET/CT代谢参数对口腔癌患者的预后价值。结果PFS和OS与解剖部位、病理类型、病理分级及临床TNM分期有显著相关性(P<0.05)。单因素Cox回归分析显示MTV和TLG是PFS和OS的重要预后因子(P<0.01)。SUVmax与PFS和OS无显著相关性(P>0.05)。MTV和TLG的中位数分别为6.1(1.0~47.3)mL和47.2(6.6~813.3)g,口腔癌患者的单变量生存分析表明大于中位数的MTV(P<0.01)和TLG(P=0.018)是PFS和OS不良的显著预测因子。在临床病理学特征中加入MTV和TLG代谢参数可使PFS率的曲线下面积(area under curve,AUC)从0.887提高到0.908(P<0.05),OS率的AUC从0.837提高到0.873(P<0.05),同时DCA也显示出联合MTV和TLG对提高预后预测的临床价值。结论术前测定^(18)F-FDG PET/CT基于体积的代谢参数MTV和TLG对口腔癌判断预后有重要意义。此外,与临床病理特征相比,联合MTV和TLG可提高对口腔癌患者的预后价值。

Objective To investigate the prognostic value of metabolic tumor volume(MTV)and total lesion glycolysis(TLG)measured by pretreatment^(18)F-FGD PET/CT in patients with oral cavity cancer.Methods 83 patients with oral cavity cancer(OCC)confirmed by pathology underwent definitive surgery with or without radiotherapy or chemoradiotherapy were evaluated preoperatively by^(18)F-FDG PET/CT.Maximum standardized uptake values(SUVmax),MTV,and TLG were measured for each patient.The correlation between clinicopathologic features,imaging indexes and progression-free survival(PFS),overall survival(OS)were analyzed and the univariate Cox regression and Kaplan-Meier analysis with respect to OS and PFS were also performed.We drew a receiver-operating characteristic curve(ROC)and conducted decision-curve analysis(DCA)to investigate whether metabolic parameters could improve the prognostic value in patients with OCC.Results PFS and OS were significantly correlated with anatomical sites,pathological type,pathological grading and clinical TNM stages(all P<0.05).Univariate Cox regression results revealed MTV and TLG as significant prognostic factors for PFS and OS(P<0.01).However,SUVmax was not related to PFS and OS(P>0.05).The medianof MTV and TLG were 6.1(1.0-47.3)mL and 47.2(6.6-813.3)g,respectively,and univariate survival analysis of OCC identified high MTV(P<0.01)and high TLG(P=0.018)as significant predictors of poor PFS and OS.The addition of combined metabolic parameters to clinicopathologic features improved the area under the curve(AUC)from 0.887 to 0.908(P<0.05)in PFS and 0.837 to 0.873(P<0.05)in OS.Combining DCA also demonstrated a clinical benefit to prognostic predication.Conclusion Assessment of MTV and TLG by^(18)F-FDG PET/CT in OCC patients can provide useful information regarding prognosis.Furthermore,combining metabolic parameters shows a clearly improved prognostic value compared to clinicopathologic features.