基线^(18)F-FDG PET/CT代谢参数在局部晚期宫颈癌同步放化疗中的预后预测价值

Prognostic value of baseline ^(18)F-FDG PET/CT metabolic parameters in locally advanced cervical cancer after concurrent chemoradiotherapy

目的探讨基线^(18)F-FDG PET/CT肿瘤代谢参数在局部晚期宫颈癌(LACC)同步放化疗(CCRT)中的预后预测价值。方法回顾性分析2015年9月至2021年10月山东第一医科大学附属肿瘤医院接受CCRT的LACC患者180例(年龄:22~76岁)。患者治疗前均接受基线^(18)F-FDG PET/CT检查,利用42%SUVmax作为固定阈值自动勾画病灶边界,提取肿瘤代谢参数,包括肿瘤代谢体积(MTV)、病灶糖酵解总量(TLG)、SUVmax和SUVmean。采用ROC曲线分析获得预测无进展生存(PFS)的最佳界值,采用Kaplan-Meier法进行生存分析并行log-rank检验,采用多因素Cox比例风险回归模型对PFS进行预后分析。结果中位随访19.1个月,54例(30.0%,54/180)患者肿瘤进展。ROC曲线分析示,MTV预测PFS的最佳界值为31.145 ml,AUC为0.641;临床因素中腹主动脉旁淋巴结(PALN)转移AUC最高(0.589),其次为国际妇产科联盟(FIGO)分期(AUC为0.581)。MTV<31.145 ml(n=88)和MTV≥31.145 ml(n=92)患者的1年PFS率分别为80.68%和59.78%(χ^(2)=13.72,P<0.001)。多因素Cox分析示病理类型[风险比(HR)=3.075,95%CI:1.370~6.901,P=0.006]、FIGO分期(HR=1.955,95%CI:1.031~3.707,P=0.040)、PALN转移(HR=2.136,95%CI:1.202~3.796,P=0.010)、MTV(HR=2.449,95%CI:1.341~4.471,P=0.004)是影响PFS的因素。结论病理类型、FIGO分期、PALN转移、MTV是LACC患者CCRT后PFS的独立预测因素;MTV作为基线^(18)F-FDG PET/CT代谢参数,可实现患者预后再分层。

Objective To explore the prognostic value of baseline ^(18)F-FDG PET/CT metabolic parameters in locally advanced cervical cancer(LACC)after concurrent chemoradiotherapy(CCRT).Methods From September 2015 to October 2021,the clinical data of 180 LACC patients(age:22-76 years)who underwent ^(18)F-FDG PET/CT before CCRT at Affiliated Cancer Hospital of Shandong First Medical University were analyzed retrospectively.The metabolic tumor volume(MTV),total lesion glycolysis(TLG),SUVmax,and SUVmean were computed by using the margin threshold of 42%SUVmax.The optimal threshold for predicting progression-free survival(PFS)was obtained by ROC curve analysis.The Kaplan-Meier method was applied for survival analysis,and the log-rank test was applied to compare the survival rate between groups.Multivariate Cox proportional hazard regression was used to analyze progression for PFS.Results The median follow-up was 19.1 months,and 54 patients(30.0%,54/180)suffered from disease progression.ROC curve analysis showed that the optimal cut-off value of MTV was 31.145 ml,with the AUC of 0.641.Para-aortic lymph node(PALN)metastasis had the highest AUC value(0.589)among the clinical factors,followed by International Federation of Gynecology and Obstetrics(FIGO)stage(0.581).The 1-year PFS rates of patients with MTV<31.145 ml(n=88)and MTV≥31.145 ml(n=92)were 80.68%and 59.78%,respectively(χ^(2)=13.72,P<0.001).Multivariate Cox analysis demonstrated that pathological type(hazard ratio(HR)=3.075,95%CI:1.370-6.901,P=0.006),FIGO stage(HR=1.955,95%CI:1.031-3.707,P=0.040),PALN metastasis(HR=2.136,95%CI:1.202-3.796,P=0.010)and MTV(HR=2.449,95%CI:1.341-4.471,P=0.004)were the significant predictors for PFS.Conclusions Pathological type,FIGO stage,PALN metastasis and MTV are independent prognostic risk factors for PFS.MTV as the baseline ^(18)F-FDG PET/CT metabolic parameter,can realize prognostic stratification analysis.