^(18)F-氟代脱氧葡萄糖正电子发射计算机断层显像-CT代谢参数与结直肠癌患者临床特征的关系

Correlation of ^(18)F-fluorodeoxyglucose position emission tomography-CT metabolic parameters with clinical characteristic of patients with colorectal cancera

目的探讨^(18)F-氟代脱氧葡萄糖(FDG)正电子发射计算机断层显像(PET)-CT代谢参数与结直肠癌患者临床特征的关系及对Kirsten鼠肉瘤病毒癌基因同源物(KRAS)基因突变的预测价值。方法收集75例结直肠癌患者的临床资料,检测KRAS基因突变情况。分析^(18)F-FDG PET-CT代谢参数与KRAS基因突变型结直肠癌患者临床特征的关系,并分析^(18)F-FDG PET-CT代谢参数对结直肠癌KRAS基因突变的预测价值。结果75例患者中,KRAS基因突变型39例,野生型36例。肿瘤直径﹥4.5 cm KRAS基因突变型结直肠癌患者最大标准摄取值(SUV_(max))、平均标准摄取值(SUV_(mean))、肿瘤代谢体积(MTV)及病灶糖酵解总量(TLG)均高于肿瘤直径≤4.5 cm患者,差异均有统计学意义(P﹤0.05);T3~4期KRAS基因突变型结直肠癌患者MTV及TLG均高于T1~2期患者,差异均有统计学意义(P﹤0.05)。SUV_(max)、SUV_(mean)、MTV及TLG均与肿瘤直径呈正相关,MTV、TLG均与T分期呈正相关(P﹤0.05)。KRAS基因突变型结直肠癌患者SUV_(max)、SUV_(mean)及TLG均明显高于KRAS野生型患者,差异均有统计学意义(P﹤0.01)。SUV_(max)、SUV_(mean)、MTV及TLG预测结直肠癌KRAS基因突变的曲线下面积(AUC)分别为0.833、0.696、0.681、0.629,以SUV_(max)最高。SUV_(max)、SUV_(mean)、MTV及TLG预测结直肠癌KRAS基因突变的灵敏度分别为0.883、0.753、0.724、0.676,特异度分别为0.817、0.714、0.694、0.659。结论^(18)F-FDG PET-CT代谢参数可一定程度上反映KRAS基因突变型结直肠癌患者的临床特征,可作为预测KRAS基因突变的辅助指标。

Objective To explore the correlation of ^(18)F-fluorodeoxyglucose(FDG)position emission tomography(PET)-CT metabolic parameters with clinical characteristics of patients with colorectal cancer(CRC)and the predictive value for Kirsten rat sarcoma viral oncogene homolog(KRAS).Method The clinical data of 75 patients with CRC were collected.The KRAS gene mutations in CRC patients were observed.The correlation of ^(18)F-FDG PET-CT metabolic pa-rameters with clinical characteristics of KRAS gene mutant CRC was analyzed,and the predictive value of ^(18)F-FDG PET-CT metabolic parameters for KRAS gene mutation of CRC was analyzed.Result Among the 75 patients,39 were KRAS gene mutation and 36 were wild type.The maximum standard uptake value(SUV_(max)),average standard uptake value(SUV_(mean)),metabolic tumor volume(MTV)and total lesion glycolysis(TLG)of KRAS gene mutant CRC patients with tumor diameter>4.5 cm were significantly higher than those with tumor diameter≤4.5 cm(P<0.05);MTV and TLG of KRAS gene mutant CRC patients at T3-4 stage were higher than those of patients at Ti-2 stage(P<0.05).SUV_(max),SUV_(mean),MTV and TLG were positively correlated with tumor diameter,MTV and TLG were positively correlated with T staging(P<0.05).The SUV_(max),SUV_(mean) and TLG of the KRAS gene mutant CRC patients were significantly higher than those of the wild type(P<0.01).The area under the curve(AUC)of SUV_(max),SUV_(mean),MTV and TLG for predicting KRAS gene muta-tion were 0.833,0.696,0.681,0.629,respectively,and SUV_(max) was the highest.The sensitivity of SUV_(max),SUV_(mean),MTV and TLG were 0.883,0.753,0.724 and 0.676,and the specificity were 0.817,0.714,0.694 and 0.659,respectively.Conclusion ^(18)F-FDG PET-CT metabolic parameters can reflect the clinical characteristics of patients with KRAS gene mutant CRC to a certain extent,and can be used as auxiliary indicators to predict KRAS gene mutations.