用于评估胃癌无进展生存期的治疗前F-18氟代脱氧葡萄糖正电子发射断层显像/X线计算机体层摄影（F-18 FDG PET/CT）参数
Pretreatment F-18 FDG PET/CT Parameters to Evaluate Progression-Free Survival in Gastric Cancer.
作者信息
Kim Jeonghun, Lim Seok Tae, Na Chang Ju, Han Yeon-Hee, Kim Chan-Young, Jeong Hwan-Jeong, Sohn Myung-Hee
机构信息
Department of Nuclear Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea.
Department of Nuclear Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea ; Department of Nuclear Medicine, Research Institute of Clinical Medicine, Cyclotron Research Center, Molecular Imaging & Therapeutic Medicine Research Center, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea.
出版信息
Nucl Med Mol Imaging. 2014 Mar;48(1):33-40. doi: 10.1007/s13139-013-0243-3. Epub 2013 Nov 28.
PURPOSE
We performed this study to evaluate the predictive value of pretreatment F-18 FDG PET/CT for progression-free survival (PFS) in patients with gastric cancer.
METHODS
Of 321 patients with a diagnosis of gastric cancer, we retrospectively enrolled 97 patients (men:women = 61:36, age 59.8 ± 13.2 years), who underwent pretreatment F-18 fluoro-2-deoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) from January 2009 to December 2009. Maximum standardized uptake value (SUVmax) was measured for each case with detectable primary lesions. In the remaining non-detectable cases, SUVmax was measured from the corresponding site seen on gastroduodenoscopy for analysis. In subgroup analysis, metabolic tumor volume (MTV) was measured in 50 patients with clearly distinguishable primary lesions. SUVmax, stage, depth of tumor invasion and presence of lymph node metastasis were analyzed in terms of PFS. Receiver operating characteristic (ROC) curves were used to find optimal cutoff values of SUVmax and MTV for disease progression. The relationship between SUVmax, MTV and PFS was analyzed using the Kaplan-Meier with log-rank test and Cox's proportional hazard regression methods.
RESULTS
Of 97 patients, 15 (15.5 %) had disease progression. The mean follow-up duration was 29.6 ± 10.2 months. The mean PFS of low SUVmax group (≤5.74) was significantly longer than that of the high SUVmax group (>5.74) (30.9 ± 8.0 vs 24.3 ± 13.6 months, p = 0.008). In univariate analysis, stage (I vs II, III, IV), depth of tumor invasion (T1 vs T2, T3, T4), presence of lymph node metastasis and SUVmax (>5.74 vs ≤5.74) were significantly associated with recurrence. In multivariate analysis, high SUVmax (>5.74) was the only poor prognostic factor for PFS (p = 0.002, HR 11.03, 95 % CI 2.48-49.05). Subgroup multivariate analysis revealed that high MTV (>16.42) was the only poor prognostic factor for PFS (p = 0.034, HR 3.59, 95 % CI 1.10-11.71).
CONCLUSION
In gastric cancer, SUVmax measured by pretreatment F-18 FDG PET/CT has a significant predictive value for PFS. In addition, if MTV is measurable, high MTV is an independent factor for disease progression.
目的
我们开展这项研究以评估术前F-18氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（F-18 FDG PET/CT）对胃癌患者无进展生存期（PFS）的预测价值。
方法
在321例确诊为胃癌的患者中，我们回顾性纳入了97例患者（男:女 = 61:36，年龄59.8±13.2岁），这些患者于2009年1月至2009年12月期间接受了术前F-18氟-2-脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（F-18 FDG PET/CT）。对每例有可检测到的原发性病变的患者测量最大标准化摄取值（SUVmax）。在其余未检测到病变的病例中，从胃十二指肠镜检查所见的相应部位测量SUVmax进行分析。在亚组分析中，对50例原发性病变清晰可辨的患者测量代谢肿瘤体积（MTV）。分析SUVmax、分期、肿瘤浸润深度和淋巴结转移情况与PFS的关系。采用受试者工作特征（ROC）曲线来确定SUVmax和MTV对疾病进展的最佳临界值。使用Kaplan-Meier法和对数秩检验以及Cox比例风险回归方法分析SUVmax、MTV与PFS之间的关系。
结果
97例患者中，15例（15.5%）出现疾病进展。平均随访时间为29.6±10.2个月。低SUVmax组（≤5.74）的平均PFS显著长于高SUVmax组（>5.74）（30.9±8.0 vs 24.3±13.6个月，p = 0.008）。单因素分析中，分期（I期vs II期、III期、IV期）、肿瘤浸润深度（T1期vs T2期、T3期、T4期）、淋巴结转移情况以及SUVmax（>5.74 vs ≤5.74）与复发显著相关。多因素分析中，高SUVmax（>5.74）是PFS唯一的不良预后因素（p = 0.002，HR 11.03，95%CI 2.48 - 49.05）。亚组多因素分析显示，高MTV（>16.42）是PFS唯一的不良预后因素（p = 0.034，HR 3.59，95%CI 1.10 - 11.71）。
结论
在胃癌中，术前F-18 FDG PET/CT测量的SUVmax对PFS具有显著的预测价值。此外，如果MTV可测量，高MTV是疾病进展的独立因素。
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