应用 18F-氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描的代谢反应和癌胚抗原水平的变化预测直肠癌患者术前放化疗反应。

The metabolic response using 18F-fluorodeoxyglucose-positron emission tomography/computed tomography and the change in the carcinoembryonic antigen level for predicting response to pre-operative chemoradiotherapy in patients with rectal cancer.

机构信息

Department of Radiation Oncology, Chonnam National University Medical School, Gwangju, Republic of Korea.

出版信息

Radiother Oncol. 2011 Jan;98(1):134-8. doi: 10.1016/j.radonc.2010.10.012. Epub 2010 Oct 30.

DOI:10.1016/j.radonc.2010.10.012

PMID:21040991

Abstract

BACKGROUND AND PURPOSE

To predict tumor regression in pre-operative chemoradiotherapy (CRT) using (18)F-fluorodeoxyglucose-positron emission tomography/computed tomography (PET/CT) and serum carcinoembryonic antigen (CEA) in patients with rectal cancer.

MATERIALS AND METHODS

The metabolic response of the tumor was assessed by determining the maximal standardized uptake value (SUV(max)), absolute difference (ΔSUV(max)), and SUV reduction ratio (SRR) on pre- and post-CRT PET/CT scans. The serum CEA, absolute difference (ΔCEA), and the CEA reduction ratio (CRR) were also determined. A receiver-operating characteristic (ROC) curve was generated.

RESULTS

Of all seventy two patients, mean pre- and post-CRT SUV(max) was 14.9 and 5.8, respectively. The mean pre- and post-CRT CEA level was 15.5 ng/ml and 5.4 ng/ml, respectively. Forty-three patients (59.8%) were classified as responders (Dworak's tumor regression grade 3-4) and 36 patients (50%) achieved tumor down-staging. ROC analysis showed that both post-CRT SUV(max) and SRR were predictive factors for responders (p=0.03 and p=0.02, respectively). A threshold of post-CRT SUV(max) was 5.4 and that of SRR was 53.1%. Pre-CRT SUV(max), ΔSUV(max), and all parameters in regard to CEA were not significant in ROC analysis.

CONCLUSIONS

The post-CRT SUV(max) and SRR are potential factors for predicting tumor response in pre-operative CRT. The patients with lower post-CRT SUV(max) and higher SRR could be expected to achieve maximum tumor regression after pre-operative CRT in this study.

摘要

背景与目的

本研究旨在通过检测直肠癌患者术前放化疗（CRT）前后（18）F-氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（PET/CT）的最大标准化摄取值（SUV(max)）和血清癌胚抗原（CEA），预测肿瘤的退缩情况。

材料与方法

通过术前和 CRT 后 PET/CT 扫描确定肿瘤代谢反应，评估 SUV(max)的最大标准化摄取值（SUV(max)）、绝对差异（ΔSUV(max)）和 SUV 下降率（SRR）。还测定了血清 CEA、绝对差异（ΔCEA）和 CEA 下降率（CRR）。生成了受试者工作特征（ROC）曲线。

结果

在所有 72 例患者中，术前和 CRT 后 SUV(max)的平均值分别为 14.9 和 5.8。术前和 CRT 后 CEA 水平的平均值分别为 15.5ng/ml 和 5.4ng/ml。43 例（59.8%）患者被分类为应答者（Dworak 肿瘤消退分级 3-4），36 例（50%）患者实现了肿瘤降期。ROC 分析显示，CRT 后 SUV(max)和 SRR 均为应答者的预测因素（p=0.03 和 p=0.02）。CRT 后 SUV(max)的阈值为 5.4，SRR 的阈值为 53.1%。ROC 分析中，术前 SUV(max)、ΔSUV(max)和 CEA 的所有参数均无显著意义。