^(18)F-脱氧葡萄糖PET/CT代谢参数在预测交界可切除及局部晚期胰腺癌患者接受新辅助化疗后病理反应及预后价值分析

^(18)F-fluordeoxyglucose PET/CT metabolic parameters in predicting the pathological response and prognosis of patients with borderline resectable and locally advanced pancreatic cancer after receiving neoadjuvant chemotherapy

目的探讨^(18)F-脱氧葡萄糖(^(18)F-FDG)PET/CT代谢参数在预测交界可切除及局部晚期胰腺癌患者接受新辅助化疗(NACT)后的病理反应及预后的价值。方法回顾性分析自2021年11月至2023年12月在解放军总医院接受^(18)F-FDG PET/CT检查和NACT的39例胰腺癌患者的临床资料。根据接受NACT后的病理反应将患者分为治疗反应组(n=12)与治疗无反应组(n=27)。比较两组患者的^(18)F-FDG PET/CT代谢参数,包括最大标准摄取值(SUVmax)、平均标准摄取值(SUVmean),并以病变SUVmax的40%作为阈值计算肿瘤代谢体积(MTV)和总葡萄糖酵解(TLG);比较两组治疗前、后的^(18)F-FDG PET/CT代谢参数差值(ΔSUVmax、ΔSUVmean、ΔTLG、ΔMTV),以及代谢参数差值百分比(ΔSUVmax%、ΔSUVmean%、ΔTLG%、ΔMTV%)。收集患者的预后情况并进行Kaplan-Meier分析。结果两组^(18)F-FDG PET/CT代谢参数中的治疗后SUVmax、SUVmean及ΔSUVmax%比较,差异均有统计学意义(P<0.05)。治疗后SUVmax和ΔSUVmax%显示出较好的曲线下面积(AUC),其中,治疗后SUVmax的AUC为0.790(95%可信区间:0.641~0.939),最佳诊断阈值为3.09,敏感性和特异性分别为0.917(0.598~0.996)、0.667(0.460~0.828);ΔSUVmax%的AUC为0.753(95%可信区间:0.593~0.913),最佳诊断阈值为51.5%,敏感性和特异性分别为0.917(0.598~0.996)、0.703(0.497~0.855)。当治疗后TLG=17.94作为阈值时,与治疗后TLG>17.94的患者比较,治疗后TLG<17.94的患者具有更好的总生存期(log-rankχ^(2)=7.793,P=0.005),但无进展生存期比较,差异无统计学意义(χ^(2)=3.450,P=0.063)。结论^(18)F-FDG PET/CT代谢参数对预测接受NACT的交界可切除及局部晚期胰腺癌患者病理反应和预后中具有较高的临床价值,在一定程度上能够为接受NACT的交界可切除及局部晚期胰腺癌患者的治疗提供更多核医学层面的帮助。

Objective To explore the value of ^(18)F-fluorodeoxyglucose(^(18)F-FDG)PET/CT metabolic parameters in predicting the pathological response and prognosis of patients with borderline resectable and locally advanced pancreatic cancer after receiving neoadjuvant chemotherapy(NACT).Methods Clinical data of 39 patients with pancreatic cancer who underwent ^(18)F-FDG PET/CT examination and NACT at Chinese PLA General Hospital from November 2021 to December 2023 were retrospectively analyzed.The patients were divided into treatment response group(n=12)and treatment non-response group(n=27)according to their pathological reactions after receiving NACT.The ^(18)F-FDG PET/CT metabolic parameters of the two groups were compared,including the maximum standard uptake value(SUVmax)and the average standard uptake value(SUVmean),and the metabolic tumor volume(MTV)and total glucose glycolysis(TLG)were calculated using 40%of the pathological SUVmax as the threshold value.The difference of^(18)F-FDG PET/CT metabolic parameters before and after treatment(ΔSUVmax,ΔSUVmean,ΔTLG,ΔMTV)and the percentage difference of metabolic parameters(ΔSUVmax%,ΔSUVmean%,ΔTLG%,ΔMTV%)were compared between the two groups before and after treatment.The prognosis of the patients was collected and Kaplan-Meier analysis was performed.Results There were significant differences in SUVmax,SUVmean andΔSUVmax%of^(18)F-FDG PET/CT metabolic parameters between the two groups after treatment(P<0.05).SUVmax andΔSUVmax%showed good area under the curve(AUC)after treatment,where the AUC of SUVmax after treatment was 0.790(95%confidence interval:0.641-0.939),the optimal diagnostic threshold was 3.09,the sensitivity and specificity were 0.917(0.598-0.996)and 0.667(0.460-0.828),respectively.The AUC ofΔSUVmax%was 0.753(95%confidence interval:0.593-0.913),the optimal diagnostic threshold was 51.5%,and the sensitivity and specificity were 0.917(0.598-0.996)and 0.703(0.497-0.855),respectively.When TLG=17.94 after treatment was taken as the threshold,patients with TLG<17.94 after treatment had better overall survival(log-rank χ^(2)=7.793,P=0.005)compared with patients with TLG>17.94 after treatment,but the difference in progression-free survival was not statistically significant(χ^(2)=3.450,P=0.063).Conclusion^(18)F-FDG PET/CT metabolic parameters have high clinical value in predicting the pathological response and prognosis of borderline resectable and lacally alvanced pancreatic cancer patients receiving NACT,and can provide more nuclear medicine help for the treatment of borderline resectable and locally advanced pancreatic cancer patients receiving NACT to a certain extent.