PET/CT代谢参数不同测量方式及计算方法对食管癌患者总生存期的预测价值

Predictive value of different measurement methods and calculation methods of PET/CT metabolic parameters on the overall survival of patients with esophageal cancer

目的探究18F-FDG PET/CT代谢参数不同测量方式及计算方法在食管癌(EC)患者总生存期(OS)预测中的应用价值。方法回顾性分析接受PET/CT检查的34例Ⅰ~Ⅳ期EC患者的相关资料,采用Mann-Whitney U非参数检验比较各组代谢参数的差异。通过勾画的感兴趣区域系统计算出不同阈值的最大标准摄取值(SUVmax)、肿瘤代谢体积(MTV)、病变总糖酵解(TLG)、全身肿瘤代谢体积(MTVwb)、全身总病灶糖酵解(TLGwb),按最佳截断值分成高、低值两组后绘制Kaplan-Meier生存曲线,用log-rank法检验曲线差异。分析治疗前原发灶SUVmax、MTV30、MTV40、MTV50、TLG30、TLG40、TLG50、MTVwb、TLGwb及病灶厚度、年龄、体重指数(BMI)、TNM分期、临床分期、中性粒细胞/淋巴细胞比值(NLR)、碱性磷酸酶(ALP)对患者OS的预测价值。结果至随访末期,共死亡17例(50.0%),中位生存期为16.5个月,半年生存率为81.97%,1年生存率为66.5%。以中位生存时间16.5个月为界限进行分组,中位生存时间≤16.5个月和中位生存时间>16.5个月患者的SUVmax、MTVwb、TLGwb及MTV、TLG差异均有统计学意义(均P<0.05)。不同MTV30、MTV40、MTV50、TLG40、TLG50、SUVmax、年龄、BMI、病灶厚度、cT分期、cN分期、cM分期、临床分期患者的生存曲线比较,差异均无统计学意义(均P>0.05);TLG30、TLGwb、NLR、ALP低值组生存率高于TLG30、TLGwb、NLR、ALP高值组,差异均有统计学意义(均P<0.05)。结论治疗前TLG30、TLGwb对于EC患者的预后有一定预测价值,可为临床筛选预后不良的患者提供参考依据,从而制订精准化、个体化的治疗方案。

Objective To investigate the application value of different measurement methods and calculation methods of 18 F-FDG PET/CT metabolic parameters in the prediction of overall survival(OS)in patients with esophageal cancer(EC).Methods The related data of 34 patients with stage I-IV EC who underwent PET/CT examination were retrospectively analyzed.The differences of metabolic parameters among groups were compared by Mann-Whitney U non-parametric test.The maximum standard uptake value(SUVmax),metabolic tumor volume(MTV),total lesion glycolysis(TLG),whole body metabolic tumor volume(MTVwb)and whole body total lesion glycolysis(TLGwb)of different thresholds were calculated through the delineated region of interest system,and Kaplan-Meier survival curves were plotted after the patients were divided into two groups with high and low values according to the optimal cutoff values,and the differences of curves were tested by the log-rank method.The predictive value of primary lesion SUVmax,MTV30,MTV40,MTV50,TLG30,TLG40,TLG50,MTVwb,TLGwb,as well as lesion thickness,age,body mass index(BMI),TNM stage,clinical stage,neutrophil/lymphocyte ratio(NLR)and alkaline phosphatase(ALP)before treatment on OS in patients were analyzed.Results By the end of follow-up,there were 17 deaths(50.0%)with a median OS of 16.5 months,a half-year survival rate of 81.97%and a 1-year survival rate of 66.5%.Grouping by the median survival time 16.5 months,the differences of SUVmax,MTVwb,TLGwb,MTV and TLG between patients with median survival time≤16.5 months and patients with median survival time>16.5 months were statistically significant(all P<0.05).There were no statistically significant differences in the survival curves of patients with different MTV30,MTV40,MTV50,TLG40,TLG50,SUVmax,age,BMI,lesion thickness,cT stage,cN stage,cM stage,and clinical stage(all P>0.05).The survival rate of TLG30,TLGwb,NLR and ALP low value groups were higher than that of TLG30,TLGwb,NLR and ALP high value groups,with statistically significant differences(all P<0.05).Conclusion TLG30 and TLGwb have a certain predictive value for the prognosis of patients with EC before treatment,which can provide a reference basis for clinical screening of patients with poor prognosis to make a precise and individualized treatment regimen.