食管鳞癌胃壁内转移患者PET/CT代谢参数与病理特征及预后的关系
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摘要
目的:探究食管鳞癌胃壁内转移(IGM)患者正电子发射计算机体层显像仪(PET/CT)代谢参数与病理特征及预后的关系。方法:收集安徽医科大学附属省立医院2008年1月至2014年12月收治的食管鳞癌IGM患者86例,外科手术前采用PET/CT对患者进行影像学检查,检测患者IGM最大标准摄取值(SUVmax)、代谢体积(MTV)、PET长度(PTL)和平均标准摄取值(SUVmean),计算得出病灶糖酵解总量(TLG)等代谢参数。记录患者5年随访期间生存情况,分析代谢参数与患者临床病理特征及预后的关系。结果:食管鳞癌IGM SUVmax和SUVmean与肿瘤原发灶肉眼直径有关(均P<0.05);MTV与原发灶肉眼直径、淋巴结转移情况和TNM分期有关(均P<0.05);TLG与原发灶肉眼直径、淋巴结转移情况、TNM分期和组织分化程度有关(均P<0.05)。5年随访期间,共有6例患者失访,36例患者死亡,44例患者5年随访结束仍存活;SUVmax、MTV、TLG、PTL、SUVmean和TNM分期是患者预后的预测因子(均P<0.05);MTV、TLG、PTL、SUVmean、TNM分期是患者预后的危险因素(均P<0.05)。结论:食管鳞癌IGM患者PET/CT检查中的SUVmax、MTV、TLG、PTL、SUVmean等代谢参数与患者病理特征有关,MTV、TLG、PTL、SUVmean、TNM分期是患者预后的危险因素,食管鳞癌IGM患者行PET/CT检查对患者预后评估有一定价值。
Objective: To investigate the relationship between PET/CT metabolic parameters and pathological features and prognosis in esophageal squamous cell carcinoma(ESCC) patients with intramural gastric metastasis(IGM). Methods: Totally 86 cases of ESCC IGM patients treated in Anhui Provincial Hospital Affiliated to Anhui Medical University from January 2008 to December 2014 were selected for this study. The patients received the imaging examination by positron emission tomography and computed tomography(PET/CT). The metabolic parameters including maximum standard uptake value(SUVmax), metabolic tumor volume(MTV), PET tumor length(PTL) and mean standard uptake value(SUVmean) were examined to calculate the total lesion glycolysis(TLG). The survival of the patients during 5-year follow-up was recorded, and the relationship between metabolic parameters and clinical pathological features and prognosis was analyzed. Results: SUVmax and SUVmean of IGM patients were related to the diameter of the primary tumor(all P<0.05); MTV was associated with the tumor diameter, lymph node metastasis, and TNM staging(all P<0.05); TLG was associated with the tumor diameter, lymph node metastasis, TNM stage, and tissue differentiation(all P<0.05). During the 5-year follow-up, 6 patients were lost to follow-up, 36 patients died and 44 patients survived; SUVmax, MTV, TLG, PTL, SUVmean, and TNM staging were predictors for patients' prognosis(all P<0.05); MTV, TLG, PTL, SUVmean, and TNM staging were risk factors for prognosis(all P<0.05). Conclusion: The metabolic parameters including SUVmax, MTV, TLG, PTL and SUVmean in ESCC patients with IGM are related to the pathological characteristics of patients; moreover, MTV, TLG, PTL, SUVmean and TNM staging are risk factors for prognosis; so, PET/CT examination has certain clinical value for the prognosis assessment in ESCC patients with IGM.
Objective: To investigate the relationship between PET/CT metabolic parameters and pathological features and prognosis in esophageal squamous cell carcinoma(ESCC) patients with intramural gastric metastasis(IGM). Methods: Totally 86 cases of ESCC IGM patients treated in Anhui Provincial Hospital Affiliated to Anhui Medical University from January 2008 to December 2014 were selected for this study. The patients received the imaging examination by positron emission tomography and computed tomography(PET/CT). The metabolic parameters including maximum standard uptake value(SUVmax), metabolic tumor volume(MTV), PET tumor length(PTL) and mean standard uptake value(SUVmean) were examined to calculate the total lesion glycolysis(TLG). The survival of the patients during 5-year follow-up was recorded, and the relationship between metabolic parameters and clinical pathological features and prognosis was analyzed. Results: SUVmax and SUVmean of IGM patients were related to the diameter of the primary tumor(all P<0.05); MTV was associated with the tumor diameter, lymph node metastasis, and TNM staging(all P<0.05); TLG was associated with the tumor diameter, lymph node metastasis, TNM stage, and tissue differentiation(all P<0.05). During the 5-year follow-up, 6 patients were lost to follow-up, 36 patients died and 44 patients survived; SUVmax, MTV, TLG, PTL, SUVmean, and TNM staging were predictors for patients' prognosis(all P<0.05); MTV, TLG, PTL, SUVmean, and TNM staging were risk factors for prognosis(all P<0.05). Conclusion: The metabolic parameters including SUVmax, MTV, TLG, PTL and SUVmean in ESCC patients with IGM are related to the pathological characteristics of patients; moreover, MTV, TLG, PTL, SUVmean and TNM staging are risk factors for prognosis; so, PET/CT examination has certain clinical value for the prognosis assessment in ESCC patients with IGM.
引文
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[18]LIM Y,BANG J I,HAN S W,et al.Total lesion glycolysis(TLG)as an imaging biomarker in metastatic colorectal cancer patients treated with regorafenib[J].Eur J Nucl Med Mol Imaging,2017,44(5):757-764.DOI:10.1007/s00259-016-3577-0.
[19]KITAJIMA K,SUENAGA Y,UENO Y,et al.Preoperative risk stratification using metabolic parameters of(18)F-FDG PET/CT in patients with endometrial cancer[J].Eur J Nucl Med Mol Imaging,2015,42(8):1268-1275.DOI:10.1007/s00259-015-3037-2.
[20]HERRERA F G,BREUNEVAL T,PRIOR J O,et al.[(18)F]FDG-PET/CT metabolic parameters as useful prognostic factors in cervical cancer patients treated with chemo-radiotherapy[J/OL].Radiat Oncol,2016,11:43[2018-10-20].https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4793502/.DOI:10.1186/s13014-016-0614-x.
[2]周超,杨海华,周丽珍,等.局部晚期食管鳞癌新辅助同期放化疗患者生活质量与手术可行性研究[J].实用肿瘤杂志,2018,33(2):139-145.DOI:10.13267/j.cnki.syzlzz.2018.02.009.
[3]刘海伦,程忠平.CA125不同计算方法在卵巢癌筛查、评估及预后方面的作用[J].现代妇产科进展,2016,25(8):636-639.DOI:10.13283/j.cnki.xdfckjz.2016.08.023.
[4]KANTER P,ZEIDMAN A,STREIFLER J,et al.PET-CT imaging of combined brachial and lumbosacral neurolymphomatosis[J].Eur J Haematol,2005,74(1):66-69.DOI:10.1111/j.1600-0609.2004.00369.x.
[5]张倩,辛军,李红.18F-FDG PET/CT显像半定量参数MTV、TLG联合SUV在乳腺癌诊断中的应用价值[J].中国临床医学影像杂志,2016,27(9):620-624.
[6]LE PRISE E A,MEUNIER B C,ETIENNE P L,et al.Sequential chemotherapy and radiotherapy for patients with squamous cell carcinoma of the esophagus[J].Cancer,1995,75(2):430-434.
[7]HAMBRAEUS G M,MERCKE C E,WILLE?R,et al.Prognostic factors influencing survival in combined radiotherapy and surgery of squamous cell carcinoma of the esophagus with special reference to a histopathologic grading system[J].Cancer,1988,62(5):895-904.
[8]王莹,杨鹏飞,李艳梅,等.肿瘤/对侧肌肉比值与肿瘤/肝脏比值在18F-FDG PET/CT肿瘤代谢显像诊断肺癌中的价值[J].中国医学影像学杂志,2016,24(12):934-936.DOI:10.3969/j.issn.1005-5185.2016.12.015.
[9]ABGRAL R,VALETTE G,ROBIN P,et al.Prognostic evaluation of percentage variation of metabolic tumor burden calculated by dualphase(18)FDG PET-CT imaging in patients with head and neck cancer[J].Head Neck,2016,38(Suppl 1):E600-E606.DOI:10.1002/hed.24048.
[10]BRENDLE C,KUPFERSCHL?GER J,NIKOLAOU K,et al.Is the standard uptake value(SUV)appropriate for quantification in clinical PET imaging?-Variability induced by different SUV measurements and varying reconstruction methods[J].Eur J Radiol,2015,84(1):158-162.DOI:10.1016/j.ejrad.2014.10.018.
[11]汤泊,张银,周锦,等.18F-FDG PET-CT代谢参数与乳腺癌临床病理特征的关系[J].中华肿瘤杂志,2017,39(4):280-285.DOI:10.3760/cma.j.issn.0253-3766.2017.04.008.
[12]HUANG W,LIU B,FAN M,et al.The early predictive value of a decrease of metabolic tumor volume in repeated(18)F-FDG PET/CT for recurrence of locally advanced non-small cell lung cancer with concurrent radiochemotherapy[J].Eur J Radiol,2015,84(3):482-488.DOI:10.1016/j.ejrad.2014.11.020.
[13]吴增杰,边甜甜,王艳丽,等.18F-FDG PET/CT显像SUVmax>2.5的病灶数及肿瘤代谢体积对多发性骨髓瘤预后评估的价值[J].中华核医学与分子影像杂志,2016,36(1):44-47.DOI:10.3760/cma.j.issn.2095-2848.2016.01.011.
[14]丁重阳,李天女,郭喆,等.18氟-氟代脱氧葡萄糖PET/CT检查判断结直肠癌术后预后的临床价值[J].中华消化外科杂志,2016,15(10):1018-1025.DOI:10.3760/cma.j.issn.1673-9752.2016.10.015.
[15]LOVINFOSSE P,JANVARY Z L,COUCKE P,et al.FDG PET/CTtexture analysis for predicting the outcome of lung cancer treated by stereotactic body radiation therapy[J].Eur J Nucl Med Mol Imaging,2016,43(8):1453-1460.DOI:10.1007/s00259-016-3314-8.
[16]吴忠仕,简志祥,余敏,等.术前18F-2-脱氧葡萄糖PET/CT测定肿瘤负荷在胰腺癌预后判断中的价值[J].中国老年学杂志,2016,36(12):2948-2951.DOI:10.3969/j.issn.1005-9202.2016.12.059.
[17]LIM Y,BANG J I,HAN S W,et al.Total lesion glycolysis(TLG)as an imaging biomarker in metastatic colorectal cancer patients treated with regorafenib[J].Eur J Nucl Med Mol Imaging,2017,44(5):757-764.DOI:10.1007/s00259-016-3577-0.
[18]LIM Y,BANG J I,HAN S W,et al.Total lesion glycolysis(TLG)as an imaging biomarker in metastatic colorectal cancer patients treated with regorafenib[J].Eur J Nucl Med Mol Imaging,2017,44(5):757-764.DOI:10.1007/s00259-016-3577-0.
[19]KITAJIMA K,SUENAGA Y,UENO Y,et al.Preoperative risk stratification using metabolic parameters of(18)F-FDG PET/CT in patients with endometrial cancer[J].Eur J Nucl Med Mol Imaging,2015,42(8):1268-1275.DOI:10.1007/s00259-015-3037-2.
[20]HERRERA F G,BREUNEVAL T,PRIOR J O,et al.[(18)F]FDG-PET/CT metabolic parameters as useful prognostic factors in cervical cancer patients treated with chemo-radiotherapy[J/OL].Radiat Oncol,2016,11:43[2018-10-20].https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4793502/.DOI:10.1186/s13014-016-0614-x.