Marcus Charles, Wray Rick, Taghipour Mehdi, Marashdeh Wael, Ahn Se Jin, Mena Esther, Subramaniam Rathan M
1 Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 601 N. Caroline St, JHOC 3235, Baltimore, MD 21287.
2 Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD.
AJR Am J Roentgenol. 2016 Aug;207(2):257-65. doi: 10.2214/AJR.15.15806.
The purpose of this study was to evaluate the impact of quantitative PET parameters in the overall survival of patients with recurrent colorectal cancer.
A total of 105 patients with a biopsy-proven recurrence of colorectal cancer who underwent PET/CT were included in the study. A gradient segmentation method was used to calculate maximum and peak standardized uptake values (SUVmax, SUVpeak), total lesion glycolysis (TLGtotal), and metabolic tumor volume (MTVtotal). These parameters were measured for each recurrent lesion at the primary, locoregional, and distant sites. The median follow-up time was 31.3 months. Overall survival (OS) was the primary outcome and was calculated using Kaplan-Meier survival plots and Cox regression analyses.
The mean ± SD for SUVmax, SUVpeak, TLGtotal, and MTVtotal of the included patients was 7.3 ± 5.3, 5.3 ± 3.3, 280.8 ± 1181 g, and 79.8 ± 294 mL, respectively. The median OS for patients who were alive was 50 months in comparison with 23.4 months among patients who died. Age (p = 0.041), tumor grade (p = 0.010), median TLG (p = 0.031), and median MTV (p = 0.009) remained significantly associated with OS in the multivariate Cox regression analysis. Kaplan-Meier survival analysis performed on the basis of the median PET/CT parametric values showed that SUVmax (threshold, 5.63; hazard ratio [HR] = 1.7; 95% CI, 1-2.8; p = 0.02), MTVtotal (threshold, 13.85 mL; HR = 2.2; 95% CI, 1.3-3.9; p = 0.003), and TLGtotal (threshold, 36.14 g; HR = 1.9; 95% CI, 1.1-3.3; p = 0.01) were significant predictors of OS during follow-up. An integrated risk stratification model with SUVmax and MTVtotal into three subgroups predicted patient survival outcomes (HR = 1.8; 95% CI, 1.25-2.65; log-rank p = 0.003).
SUVmax, MTVtotal, TLGtotal, and integrated score with FDG avidity and total tumor burden provide survival information for patients with biopsy-proven recurrent colorectal cancer.
本研究旨在评估PET定量参数对复发性结直肠癌患者总生存期的影响。
本研究纳入了105例经活检证实为结直肠癌复发且接受了PET/CT检查的患者。采用梯度分割法计算最大标准化摄取值（SUVmax）、峰值标准化摄取值（SUVpeak）、总病变糖酵解（TLGtotal）和代谢肿瘤体积（MTVtotal）。对原发部位、局部区域和远处部位的每个复发病变测量这些参数。中位随访时间为31.3个月。总生存期（OS）是主要结局，采用Kaplan-Meier生存曲线和Cox回归分析进行计算。
纳入患者的SUVmax、SUVpeak、TLGtotal和MTVtotal的平均值±标准差分别为7.3±5.3、5.3±3.3、280.8±1181g和79.8±294mL。存活患者的中位OS为50个月，而死亡患者为23.4个月。在多变量Cox回归分析中，年龄（p = 0.041）、肿瘤分级（p = 0.010）、中位TLG（p = 0.031）和中位MTV（p = 0.009）与OS仍显著相关。基于PET/CT参数值中位数进行的Kaplan-Meier生存分析显示，SUVmax（阈值，5.63；风险比[HR]=1.7；95%CI，1-2.8；p = 0.02）、MTVtotal（阈值，13.85mL；HR = 2.2；95%CI，1.3-3.9；p = 0.003）和TLGtotal（阈值，36.14g；HR = 1.9；95%CI，1.1-3.3；p = 0.01）是随访期间OS的显著预测因素。将SUVmax和MTVtotal纳入的综合风险分层模型分为三个亚组，可预测患者生存结局（HR = 1.8；95%CI，1.25-2.65；log-rank p = 0.003）。
SUVmax、MTVtotal、TLGtotal以及结合FDG亲和力和肿瘤总负荷的综合评分可为经活检证实的复发性结直肠癌患者提供生存信息。
