氟脱氧葡萄糖正电子发射断层扫描（FDG PET）作为不可切除肝细胞癌治疗后早期预后预测指标。
FDG PET as a prognostic predictor in the early post-therapeutic evaluation for unresectable hepatocellular carcinoma.
机构信息
Shiga Medical Center Research Institute, 5-4-30, Moriyama, Moriyama City, Shiga, 524-8524, Japan.
出版信息
Eur J Nucl Med Mol Imaging. 2010 Mar;37(3):468-82. doi: 10.1007/s00259-009-1284-9. Epub 2009 Oct 17.
PURPOSE
To elucidate the prognostic role of post-therapeutic (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET), we conducted a retrospective cohort study analysing the clinical factors that affect overall survival after non-operative therapy for unresectable hepatocellular carcinoma (HCC).
METHODS
Sixty-seven cases with unresectable HCC who received non-operative therapy (transcatheter arterial chemoembolization: n = 24, transcatheter arterial infusion chemotherapy: n = 31, radiofrequency ablation: n = 5 or systemic chemotherapy: n = 7) and had received FDG PET for the evaluation of the therapeutic effect within 1 month after the end of the therapy were evaluated. Overall survival rate was evaluated using the univariate and multivariate analyses of relevant clinical and laboratory parameters before and after therapy, including visual PET analysis and quantitative analysis using maximum standardized uptake value (SUV).
RESULTS
Visual PET diagnosis of post-therapeutic lesions was a good predictor of overall survival of unresectable HCC patients. The low FDG group showed significantly longer survival (average: 608 days) than that (average: 328 days) of the high FDG group (p < 0.0001). Multivariate analysis showed four significant prognostic factors for the survival: post-therapeutic alpha-fetoprotein (alphaFP) level (=400 ng/ml, p = 0.004), post-therapeutic visual PET diagnosis (p = 0.006), post-therapeutic clinical stage (UICC stage IV, p = 0.04) and post-therapeutic Milan criteria (p = 0.03), while pre-therapeutic clinical factors, SUV by post-therapeutic FDG PET (5.0 or more) or others did not show significance.
CONCLUSION
The present study suggests that post-therapeutic PET performed within 1 month after non-operative therapy can be a good predictor of overall survival in unresectable HCC patients, while pre-therapeutic evaluation including PET, tumour markers and clinical staging may not be useful.
目的
通过回顾性队列研究分析影响不可切除肝细胞癌（HCC）非手术治疗后总生存率的临床因素，阐明治疗后（18）F-氟代脱氧葡萄糖（18F-FDG）正电子发射断层扫描（PET）的预后作用。
方法
对 67 例接受非手术治疗（经导管动脉化疗栓塞术：n=24，经导管动脉内化疗：n=31，射频消融术：n=5 或全身化疗：n=7）并在治疗结束后 1 个月内接受 FDG PET 评估治疗效果的不可切除 HCC 患者进行评估。采用单因素和多因素分析治疗前后相关临床和实验室参数，包括视觉 PET 分析和最大标准化摄取值（SUV）的定量分析，评估总生存率。
结果
治疗后病变的视觉 PET 诊断是不可切除 HCC 患者总生存率的良好预测指标。低 FDG 组的生存时间明显长于高 FDG 组（平均：608 天）（平均：328 天）（p<0.0001）。多因素分析显示，4 个因素对生存有显著影响：治疗后甲胎蛋白（alphaFP）水平（=400ng/ml，p=0.004）、治疗后视觉 PET 诊断（p=0.006）、治疗后临床分期（UICC 分期 IV 期，p=0.04）和治疗后米兰标准（p=0.03），而治疗前临床因素、治疗后 FDG PET 的 SUV（5.0 或更高）或其他因素无显著意义。
结论
本研究表明，非手术治疗后 1 个月内进行的治疗后 PET 可作为不可切除 HCC 患者总生存率的良好预测指标，而包括 PET、肿瘤标志物和临床分期在内的治疗前评估可能没有意义。
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