^(18)F-FDG PET/CT代谢参数联合肿瘤标志物预测胃腺癌PD-L1表达状态的初步探索

Preliminary Exploration of^(18)F-FDG PET/CT Metabolic Parameters Combined with Tumor Markers to Predict the Expression of PD-L1 in Gastric Adenocarcinoma

目的探索氟代脱氧葡萄糖(^(18)F-FDG)正电子发射断层成像/X线计算机体层成像(PET/CT)代谢参数及临床病理特征与胃腺癌患者程序性死亡受体配体-1(PD-L1)表达状态的价值。方法回顾性分析2016年12月至2023年8月经组织活检或手术病理证实的100例胃腺癌患者临床资料,所有患者在治疗前均行PET/CT检查及免疫组织化学,测量胃原发灶的最大标准摄取值(SUV_(max))、肿瘤代谢体积(MTV)及总病变糖酵解量(TLG),以PD-L1组合阳性评分(CPS)≥5为分界值,分为高表达组及低表达组。所有连续定量数据以Mann-Whitney U检验进行组间比较,所有分类变量以皮尔逊χ^(2)检验进行组间比较,Logistic回归分析进行单因素和多因素分析筛选独立预测因素并构建模型。通过受试者工作特性(ROC)曲线判断模型的诊断性能。结果PD-L1高表达的SUV_(max)、MTV、TLG均高于低表达组(SUV_(max):11.80 vs.10.50;MTV:10.30 vs.6.30;TLG:81.10 vs.43.30),仅SUV_(max)在组间具有统计学意义(P<0.05),患者的临床病理特征及肿瘤标志物显示仅糖类抗原125(CA125)在组间具有统计学意义,SUV_(max)及CA125均为PD-L1表达状态的独立预测因子。当以SUV_(max)=11.10作为截断值时,预测胃癌患者PD-L1表达状态的敏感度为60.8%,特异度为63.3%,曲线下面积(AUC)为0.620(95%CI:0.510~0.730),SUV_(max)联合CA125后,AUC可达0.710(95%CI:0.610~0.811)。结论SUV_(max)能够预测胃腺癌患者PD-L1的表达状态,联合肿瘤标志物CA125后预测效能提升。

Objective To explore the value of^(18)F-FDG PET/CT metabolic parameters and clinicopathological features in the expression of Programmed Death Receptor Ligand-1 in patients with gastric adenocarcinoma.Methods Retrospective analysis of clinical data of 100 patients with gastric adenocarcinoma confirmed by tissue biopsy or surgical pathology from December 2016 to August 2023,PET/CT and immunohistochemistry before treatment for all patients,the maximum standard uptake value(SUV_(max)),tumor metabolic volume(MTV)and total lesion glycolysis(TLG)of primary gastric cancer were measured.PD-L1 CPS≥5 was used as the cut-off value and divided into high expression group and low expression group.All continuous quantitative data were compared between groups by Mann-Whitney U test,all categorical variables were compared between groups by Pearson's χ^(2)test,and Logistic regression models were used to screen for independent predictors by univariate and multivariate analyses and to construct models.The diagnostic performance of the model was judged by Receiver operating characteristic(ROC)curve.Results The SUV_(max),MTV and TLG of PD-L1 high expression group were higher than those of low expression group(SUV_(max):10.50 vs.11.80;MTV:6.30 vs.10.30;TLG:43.30 vs.81.10).Only SUV_(max)was statistically significant between the groups(P<0.05).The clinicopathological features of the patients showed that only carbohydrate antigen 125(CA125)was statistically significant between the groups.SUV_(max)and CA125 were independent predictors.When SUV_(max)was 11.10 as the cut-off value,the sensitivity of predicting PD-L1 expression in gastric cancer patients was 60.8%,the specificity was 63.3%,and the AUC was 0.620(95%CI:0.510,0.730).After SUV_(max)combined with CA125,the AUC reached 0.710(95%CI:0.610,0.811).Conclusion SUV_(max)can predict the expression of PD-L1 in patients with gastric adenocarcinoma,and the predictive efficacy is improved after combined with tumor marker CA125.