18F-FDG PET/CT代谢参数预测局部复发鼻咽癌放化疗预后的价值及与外周血炎性反应指标的相关性

Prognostic value of 18F-FDG PET/CT metabolic parameters in locally recurrent nasopharyngeal carcinoma receiving chemoradiotherapy and their relationships with peripheral blood inflammation markers

目的探讨18F-FDG PET/CT预测局部复发鼻咽癌(NPC)放化疗的预后价值,以及不同代谢参数与外周血炎性反应指标的相关性。方法回顾性分析佛山市第一人民医院2013年1月至2017年6月间56例出现局部NPC复发并采用放化疗治疗的患者资料(男40例、女16例,年龄27~81岁),测量治疗前病灶18F-FDG PET/CT SUVmax、肿瘤代谢体积(MTV)、病灶糖酵解总量(TLG)以及治疗前1周内的外周血炎性反应指标,采用Spearman秩相关分析显像参数与炎性反应指标间的相关性。根据ROC曲线获取SUVmax、MTV、TLG的最佳临界值并进行分组,利用Kaplan-Meier法及Cox回归对患者3年无区域复发生存(LRFFS)以及总生存(OS)进行单因素分析及多因素分析;比较不同复发T(rT)分期患者代谢参数对3年OS的影响。结果局部复发NPC患者治疗前MTV与中性粒细胞、中性粒-淋巴细胞比值(NLR)、血小板-淋巴细胞比值(PLR)、超敏C-反应蛋白(hs-CRP)呈正相关(rs值:0.30、0.30、0.28、0.27,均P<0.05),TLG与中性粒细胞、单核细胞、NLR、PLR呈正相关(rs值:0.30、0.28、0.32、0.30,均P<0.05),而SUVmax与外周血炎性反应标志物均没有相关性(rs值:-0.18~0.24,均P>0.05)。SUVmax是患者3年LRFFS的影响因素[风险比(HR)=3.815(95%CI:1.278~11.388),P=0.016],rT分期及MTV则是3年OS的影响因素[HR值:4.492(95%CI:1.474~13.688)、7.238(95%CI:1.653~31.688),P值:0.008、0.009]。对于局部复发晚期(rT3~4期)的患者,若MTV≥6.84 cm3,3年OS明显降低(χ2=6.99,P=0.008)。结论治疗前病灶SUVmax与MTV对局部复发NPC患者放化疗预后有重要预测价值,但两者的预测作用并不一致,局部炎性反应对代谢参数的影响可能是造成两者差异的重要因素之一。

Objective To investigate the prognostic value of 18F-FDG PET/CT in patients with locally recurrent nasopharyngeal carcinoma(NPC)receiving chemoradiotherapy,and relationships between different metabolic parameters and peripheral blood inflammation markers.Methods From January 2013 to June 2016,the data of 56 patients(40 males,16 females,age 27-81 years)with locally recurrent NPC receiving chemoradiotherapy in the First People′s Hospital of Foshan were retrospectively analyzed.The SUVmax,metabolic tumor volume(MTV),and total lesion glycolysis(TLG)were determined by 18F-FDG PET/CT and peripheral blood inflammation markers within 1 week before treatment were measured.Spearman rank correlation analysis was used to estimate the correlations between metabolic parameters and inflammation markers.According to the ROC curve,the best cut-off values of the SUVmax,MTV and TLG were obtained and used to group patients.The Kaplan-Meier method and Cox regression were used to conduct univariate analysis and multivariate analysis of 3-year locoregional failure-free survival(LRFFS)and 3-year overall survival(OS)in patients with locally recurrent NPC.The prognostic value of metabolic parameters in patients with early and advanced recurrent T(rT)stages were compared.Results MTV was positively correlated with neutrophils,neutrophil-lymphocyte ratio(NLR),platelet-lymphocyte ratio(PLR)and high-sensitivity C-reactive protein(hs-CRP)before treatment in patients with locally recurrent NPC(rs values:0.30,0.30,0.28,0.27,all P<0.05);TLG was positively correlated with neutrophils,monocytes,NLR and PLR(rs values:0.30,0.28,0.32,0.30,all P<0.05).But there were no correlations between SUVmax and peripheral blood inflammation markers(rs values:from-0.18 to 0.24,all P>0.05).SUVmax was an factor affecting 3-year LRFFS of patients undergoing radiotherapy and chemotherapy(hazard ratio(HR)=3.815(95%CI:1.278-11.388),P=0.016),while rT stage and MTV were prognostic factors for 3-year OS(HR values:4.492(95%CI:1.474-13.688),7.238(95%CI:1.653-31.688),P values:0.008,0.009).For patients with advanced rT(rT3-4),the 3-year OS of the MTV≥6.84 cm3 group was significantly lower than that of MTV<6.84 cm3 group(χ2=6.99,P=0.008).Conclusions SUVmax of tumor and MTV before treatment have important prognostic values in patients with locally recurrent NPC receiving chemoradiotherapy,but their predictive effects on prognosis are not the same.The varying effects of local inflammation on metabolic parameters may be one of the important reasons lead to that difference.