Ho Kung-Chu, Fang Yu-Hua Dean, Chung Hsiao-Wen, Yen Tzu-Chen, Ho Tsung-Ying, Chou Hung-Hsueh, Hong Ji-Hong, Huang Yi-Ting, Wang Chun-Chieh, Lai Chyong-Huey
Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan UniversityTaipei, Taiwan; Department of Nuclear Medicine and Center for Advanced Molecular Imaging and Translation, Chang Gung Memorial Hospital and Chang Gung UniversityTaoyuan, Taiwan.
Department of Biomedical Engineering, National Cheng Kung University Tainan, Taiwan.
Am J Nucl Med Mol Imaging. 2016 Jul 6;6(3):166-75. eCollection 2016.
We examined the role of intratumoral metabolic heterogeneity on (18)F-FDG PET during concurrent chemoradiotherapy (CCRT) in predicting survival outcomes for patients with cervical cancer. This prospective study consisted of 44 patients with bulky (≥ 4 cm) cervical cancer treated with CCRT. All patients underwent serial (18)F-FDG PET studies. Primary cervical tumor standardized uptake values, metabolic tumor volume, and total lesion glycolysis (TLG) were measured in pretreatment and intra-treatment (2 weeks) PET scans. Regional textural features were analyzed using the grey level run length encoding method (GLRLM) and grey-level size zone matrix. Associations between PET parameters and overall survival (OS) were tested by Kaplan-Meier analysis and Cox regression model. In univariate analysis, pretreatment grey-level nonuniformity (GLNU) > 48 by GLRLM textural analysis and intra-treatment decline of run length nonuniformity < 55% and the decline of TLG (∆TLG) < 60% were associated with significantly worse OS. In multivariate analysis, only ∆TLG was significant (P = 0.009). Combining pretreatment with intra-treatment factors, we defined the patients with a initial GLNU > 48 and a ∆TLG ≤ 60% as the high-risk group and the other patients as the low-risk. The 5-year OS rate for the high-risk group was significantly worse than that for the low-risk group (42% vs. 81%, respectively, P = 0.001). The heterogeneity of intratumoral FDG distribution and the early temporal change in TLG may be an important predictor for OS in patients with bulky cervical cancer. This gives the opportunity to adjust individualized regimens early in the treatment course.
我们研究了同步放化疗（CCRT）期间瘤内代谢异质性对宫颈癌患者（18）F-FDG PET预测生存结局的作用。这项前瞻性研究纳入了44例接受CCRT治疗的体积较大（≥4 cm）的宫颈癌患者。所有患者均接受了系列（18）F-FDG PET检查。在治疗前和治疗中（2周）的PET扫描中测量原发性宫颈肿瘤的标准化摄取值、代谢肿瘤体积和总病变糖酵解（TLG）。使用灰度游程长度编码方法（GLRLM）和灰度大小区域矩阵分析区域纹理特征。通过Kaplan-Meier分析和Cox回归模型检验PET参数与总生存（OS）之间的关联。在单变量分析中，通过GLRLM纹理分析得出治疗前灰度非均匀性（GLNU）>48、治疗中运行长度非均匀性下降<55%以及TLG下降（∆TLG）<60%与OS显著较差相关。在多变量分析中，只有∆TLG具有显著性（P = 0.009）。结合治疗前和治疗中的因素，我们将初始GLNU>48且∆TLG≤60%的患者定义为高危组，其他患者定义为低危组。高危组的5年OS率显著低于低危组（分别为42%和81%，P = 0.001）。瘤内FDG分布的异质性和TLG的早期时间变化可能是体积较大的宫颈癌患者OS的重要预测指标。这为在治疗过程早期调整个体化治疗方案提供了机会。
