PET/CT纹理分析预测胰腺导管腺癌新辅助放化疗疗效及预后的价值

Value of PET/CT texture analysis in predicting the efficacy and prognosis of neoadjuvant radiochemotherapy for pancreatic ductal adenocarcinoma

目的探讨正电子发射断层扫描(PET)/电子计算机断层扫描(CT)纹理分析预测胰腺导管腺癌(PDAC)新辅助放化疗疗效及预后的价值。方法选取2020年10月至2022年10月河南科技大学第一附属医院收治的78例PDAC患者为研究对象。所有患者术前均接受新辅助放化疗,以10 d为一周期,共放化疗3个周期,放化疗手术治疗后根据病理肿瘤退缩程度(TRG)分为有反应组与无反应组,根据放化疗后患者病灶情况分为预后良好组与预后不良组。所有患者在新辅助放化疗前和结束后分别进行1次PET/CT纹理分析,获得肿瘤区域中超过40%的最大摄入值(SUVmax)、肿瘤代谢容积(MTV)、能量、熵、对比度、相关性等纹理参数,分析各参数对预测PDAC患者新辅助放化疗疗效及预后的价值。结果78例PDAC患者经过新辅助放化疗后,分为无反应组(0~2级)46例(58.98%)与有反应组(3~4级)32例(41.02%),分为预后良好组52例(66.67%),预后不良组26例(33.33%)。术后PET/CT显像显示,有反应组SUVmax和MTV均高于无反应组,差异有统计学意义(P<0.05),而能量、熵、对比度、相关性参数比较,差异未见统计学意义(P>0.05)。ROC曲线图结果表明,SUVmax、MTV参数及二者联合预测PDAC患者新辅助放化疗疗效的AUC分别为0.698、0.778、0.903,具有一定的预测价值,且联合预测价值最高。新辅助放化疗后PET/CT表明预后良好组能量高于预后不良组,预后不良组熵高于预后良好组,差异有统计学意义(P<0.05)。而两组对比度、相关度、SUVmax、MTV比较,差异未见统计学意义(P>0.05)。ROC曲线图结果表明,熵、能量参数及联合预测PDAC患者新辅助放化疗预后的AUC分别为0.721、0.707、0.862,具有一定的预测价值,且联合预测价值最高。讨论PET/CT纹理分析可以预测PDAC患者新辅助放化疗后的疗效和预后。

Objective To investigate the value of positron emission tomography/computed tomography(PET/CT)texture analysis in predicting the efficacy and prognosis of neoadjuvant radiochemotherapy for pancreatic ductal adenocarcinoma(PDAC).Methods Seventy-eight patients with PDAC in the First Affiliated Hospital of Henan University of Science and Technology from October 2020 to October 2022 were enrolled.Preoperative neoadjuvant radiochemotherapy was administered in 10-day cycles for a total of 3 cycles.After the radiochemotherapy,the pathological responses were evaluated using the tumor regression grade(TRG),and patients were classified into response group and non-response group;the patients were re-divided into good prognosis group and poor-prognosis group according to the lesion status.All patients underwent PET/CT scanning before and at the end of neoadjuvant radiochemotherapy,and the parameters including maximum standardized uptake value(SUVmax),metabolic tumor volume(MTV),energy,entropy,contrast,and correlation were obtained,then the value of those parameters in predicting the efficacy and prognosis of neoadjuvant radiochemotherapy for PDAC was assessed.Results After neoadjuvant radiochemotherapy in 78 PDAC patients,TRG evaluations showed that 46 cases(58.98%)were classified as pathological nonresponders(TRG 0-2),whereas 32 cases(41.03%)were classified as pathological responders(TRG 3-4).The prognostic assessment yielded 52 cases(66.67%)with good prognosis and 26 cases(33.33%)with poor prognosis.PET/CT after surgery showed that the response group had higher SUVmax and MTV that those of the non-response group,with significant differences(P<0.05).While the energy,entropy,contrast and correlation demonstrated no significant difference(all P>0.05).Receiver operating characteristic(ROC)curve suggested that the AUCs of separate and combined test of SUVmax and MTV in predicting the effect of neoadjuvant radiochemotherapy in PDAC patients were 0.698,0.778 and 0.903,and the combined test had better predictive efficacy than the separate test.PET/CT after neoadjuvant radiochemotherapy showed that good prognosis group had larger energy and lower entropy than those of poor prognosis group,with significant differences(P<0.05),while no significant difference was found in contrast,correlation,SUVmax,and MTV between good prognosis group and poor prognosis group(P>0.05).ROC curve suggested that the AUCs of separate and combined test of entropy and energy in predicting the prognosis of patients with PDAC after neoadjuvant radiochemotherapy were 0.721,0.707 and 0.862,and the predictive value was the highest under combined test.Conclusions PET/CT texture analysis is of great value in predicting the efficacy and prognosis of neoadjuvant radiochemotherapy for PDAC patients.