¹⁸F-FDG PET/CT联合临床特征对食管鳞癌患者治疗后的预后研究

Prognostic study of ¹⁸F-FDG PET/CT combined with clinical characteristics in treated patients with esophageal squamous cell carcinoma

摘要

目的 评估氟代脱氧葡萄糖（¹⁸F-fluoro-2-deoxy-2-D-glucose，¹⁸F-FDG）正电子发射型计算机断层显像/计算机断层扫描显像（positron emission tomography/computed tomography PET/CT）代谢参数联合临床特征在治疗食管鳞癌患者治疗后的预后价值。 方法 回顾性分析重庆医科大学附属第一医院2015年1月至2021年11月经病理学确诊为食管鳞癌的75例患者［男65例、女10例，平均年龄（63.41±7.75）岁］的临床资料，所有患者在治疗后完成¹⁸F-FDG PET/CT检查。测定¹⁸F-FDG PET/CT相关参数：全身SUVmax（whole body SUVmax，SUVmaxwb）；以40%SUVmax为临界值测得SUVmean及代谢肿瘤体积（metabolic tumor volume，MTV），并计算全身代谢肿瘤体积（whole body MTV，MTVwb）和全身病灶糖酵解总量（whole body total lesion glycolysis，TLGwb）。采用Kaplan-Meier生存曲线和Cox比例风险模型分析PET参数与总生存期（overall survival，OS）的关系。 结果 52例（69.3%）患者死亡。PET阳性患者的死亡风险是PET阴性患者的6.029倍（P<0.001），中位生存时间分别22.3个月和43.2个月。以PET参数的中位数SUVmaxwb=11.09、MTVwb=27.07 cm³、TLGwb=162.34 g将PET阳性患者分组，Kaplan-Meier生存曲线及log-rank检验表明，病理分级、M分期、PET检查抗肿瘤治疗情况、MTVwb、TLGwb与OS相关，其中，M分期是OS的独立预测因素（HR=5.698，95%CI=1.791~18.123，P=0.003）。PET显像及血清学双阳性患者的死亡风险是PET显像阴性患者的6.112倍（P<0.001）。 结论 ¹⁸F-FDG PET/CT体积代谢参数是治疗后食管鳞癌患者的重要预后预测因素，PET显像阳性及肿瘤标志物阳性的患者预后明显较差。

Abstract

Objective To evaluate the prognostic value of ¹⁸F-fluorodeoxyglucose（FDG） positron emission tomography（PET）/computed tomography（CT） （¹⁸F-FDG PET/CT） metabolic parameters combined with clinical characteristics in treated patients with esophageal squamous cell carcinoma（ESCC）. Methods The clinical data of 75 patients （65 males and 10 females，age of 63.41±7.75 years） with pathologically confirmed ESCC in * Hospital from January 2015 to November 2021 were retrospectively analyzed. All patients underwent ¹⁸F-FDG PET/CT examination after treatment. The relevant parameters of ¹⁸F-FDG PET/CT were determined：whole body SUVmax（SUVmaxwb）； SUVmean and metabolic tumor volume（MTV） were measured with 40% SUVmax as the critical value，and whole body MTV（MTVwb） and whole body total lesion glycolysis（TLGwb） were calculated. Kaplan-Meier survival curves and Cox proportional hazards model were used to evaluate the relationship between PET parameters and overall survival（OS）. Results Fifty-two（69.3%） patients died. PET-positive patients exhibited a 6.029-fold increased risk of death compared with PET-negative patients（P<0.001），with the median survival time of 22.3 months and 43.2 months，respectively. PET-positive patients were categorized based on median parameters of PET：SUVmaxwb=11.09，MTVwb=27.07 cm³，and TLGwb=162.34 g. Kaplan-Meier survival curves and log-rank tests revealed the correlations of pathological classification，M stage，post-PET anti-tumor treatment，MTVwb，and TLGwb with OS. M stage emerged as an independent predictor for OS（hazard ratio=5.698，95%CI=1.791-18.123，P=0.003）. Patients positive for both PET imaging and serology had a 6.112-fold higher death risk compared with those negative for PET imaging（P<0.001）. Conclusion ¹⁸F-FDG PET/CT volume metabolism parameters are significant prognostic predictors for treated patients with ESCC，and patients positive for PET imaging and tumor markers are associated with a poor prognosis.

关键词

食管鳞癌 / 预后 / 氟代脱氧葡萄糖 / 正电子发射型计算机断层显像

Key words

esophageal squamous cell carcinoma / prognosis / fluorodeoxyglucose / positron emission tomography

基金资助

四川省国际创新合作资助项目(2022YFH0014)