^(18)F-FDG PET/CT预测肾细胞癌伴下腔静脉癌栓侵及下腔静脉壁

^(18)F-FDG PET/CT for predicting renal cell carcinoma complicated with inferior vena cava tumor thrombi involving inferior vena cava wall

目的观察术前^(18)F-FDG PET/CT预测肾细胞癌(RCC)伴下腔静脉(IVC)癌栓侵及IVC壁的价值。方法回顾性分析42例接受根治性肾切除术+IVC癌栓取出术的RCC患者,根据病理所见癌栓是否侵及IVC壁将其分为侵犯组(n=26)及无侵犯组(n=16),比较2组PET/CT及临床资料,观察各指标预测癌栓侵及IVC壁的效能。结果PET/CT检出42例癌栓,检出率100%(42/42);检出10例血栓,检出率90.91%(10/11);正确分级39例癌栓,低估3例。侵犯组癌栓比显著高于无侵犯组(P<0.05);以1.34为最佳截断值,根据癌栓比预测癌栓侵及IVC壁的敏感度为50.00%,特异度为93.70%,曲线下面积为0.68[95%CI(0.52,0.85),P=0.049],标准误为0.083。结论术前^(18)F-FDG PET/CT有助于预测RCC伴IVC癌栓侵及IVC壁;癌栓比达1.34提示IVC壁受侵。

Objective To observe the value of preoperative ^(18)F-FDG PET/CT for predicting inferior vena cava(IVC)wall invasion of renal cell carcinoma(RCC)complicated with IVC tumor thrombi.Methods Data of 42 RCC complicated with IVC tumor thrombi patients who underwent radical nephrectomy and IVC thrombectomy were retrospectively analyzed.According to the pathological results,the patients were divided into invasion group(n=26)and non-invasion group(n=16).PET/CT and clinical data were compared between groups to observe the efficacy of each index for predicting IVC wall invasion.Results PET/CT detected tumor thrombi of IVC in all 42 cases,with the detection rate of 100%(42/42),also 10 cases with thrombi,with the detection rate of 90.91%(10/11).PET/CT correctly graded tumor thrombi in 39 cases,but underestimated tumor thrombi in 3 cases.The tumor thrombi ratio of invasive group was significantly higher than that of non-invasive group(P<0.05).Taken 1.34 as the best cutoff value,the sensitivity of tumor thrombi ratio for predicting IVC wall invasion was 50.00%,the specificity was 93.70%,and the area under the curve was 0.68(95%CI[0.52,0.85],P=0.049),and the standard error was 0.083.Conclusion Preoperative PET/CT was helpful to predicting IVC wall invasion of RCC complicated with IVC tumor thrombi.Tumor thrombi ratio reached 1.34 indicating IVC wall invasion.