同步放化疗治疗局部晚期宫颈癌患者的治疗后 F-FDG PET/CT 预后价值及代谢反应的预测因素：基于强度和体积的 PET 参数分析。
Prognostic value of posttreatment F-FDG PET/CT and predictors of metabolic response to therapy in patients with locally advanced cervical cancer treated with concomitant chemoradiation therapy: an analysis of intensity- and volume-based PET parameters.
机构信息
Nuclear Medicine Department, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
Oncologic Gynecology Unit, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
出版信息
Eur J Nucl Med Mol Imaging. 2018 Nov;45(12):2139-2146. doi: 10.1007/s00259-018-4077-1. Epub 2018 Aug 2.
PURPOSE
To investigate the prognostic value of posttreatment F-FDG PET/CT in patients with locally advanced cervical cancer (LACC) treated with concomitant chemoradiation therapy (CCRT). The secondary aim was to assess the possible role of intensity-based and volume-based PET parameters including SUVmax, SUVmean, MTV and TLG, and clinical parameters including age, pathology, FIGO stage and nodal involvement as factors predicting response to treatment.
METHODS
This retrospective study included 82 patients affected by LACC treated with CCRT. All patients underwent F-FDG PET/CT both before and after treatment. The posttreatment PET/CT scans were used to classify patients as complete metabolic responders (CMR) or non-complete metabolic responders (N-CMR) according to the EORTC criteria. Kaplan-Meier analysis was used to evaluate differences in overall survival (OS) between the CMR and N-CMR groups. Student's t test, Pearson's chi-squared test and logistic regression were used to investigate the possible value of PET and clinical parameters as predictors of metabolic response to therapy.
RESULTS
Kaplan-Meier analysis showed a highly significant difference in OS between the CMR and N-CMR groups (log-rank test p < 0.0001). Significant independent predictors of response to therapy were MTV (p = 0.019, odds ratio = 1.015, 95% CI = 1.002-1.028, Nagelkerke R = 0.110), TLG (p = 0.045, odds ratio = 1.001, 95% CI = 1.000-1.002, Nagelkerke R = 0.081) and nodal involvement (p = 0.088, odds ratio = 2.361, 95% CI = 0.879-6.343, Nagelkerke R = 0.051).
CONCLUSION
F-FDG PET/CT-based response assessment using the EORTC criteria reliably predicts OS in LACC patients treated with CCRT. In our cohort of patients, pretreatment MTV and TLG and nodal involvement were predictors of response to therapy. MTV was the best predictor of response. However, its additional risk value seems to be low (MTV odds ratio = 1.015).
目的
探讨氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（18F-FDG PET/CT）在接受同期放化疗（CCRT）治疗的局部晚期宫颈癌（LACC）患者中的预后价值。次要目的是评估 SUVmax、SUVmean、MTV 和 TLG 等基于强度和基于体积的 PET 参数以及年龄、病理、FIGO 分期和淋巴结受累等临床参数作为预测治疗反应的因素的可能作用。
方法
本回顾性研究纳入了 82 例接受 CCRT 治疗的 LACC 患者。所有患者在治疗前后均进行了 18F-FDG PET/CT 检查。根据 EORTC 标准，将治疗后 PET/CT 扫描结果用于将患者分为完全代谢缓解（CMR）或非完全代谢缓解（N-CMR）。Kaplan-Meier 分析用于评估 CMR 和 N-CMR 组之间总生存（OS）的差异。Student's t 检验、Pearson's chi-squared 检验和逻辑回归用于研究 PET 和临床参数作为预测治疗代谢反应的可能性。
结果
Kaplan-Meier 分析显示 CMR 和 N-CMR 组之间 OS 存在显著差异（对数秩检验，p<0.0001）。治疗反应的显著独立预测因素为 MTV（p=0.019，优势比=1.015，95%置信区间=1.002-1.028，Nagelkerke R=0.110）、TLG（p=0.045，优势比=1.001，95%置信区间=1.000-1.002，Nagelkerke R=0.081）和淋巴结受累（p=0.088，优势比=2.361，95%置信区间=0.879-6.343，Nagelkerke R=0.051）。
结论
基于 18F-FDG PET/CT 的 EORTC 标准的反应评估可靠地预测了接受 CCRT 治疗的 LACC 患者的 OS。在我们的患者队列中，治疗前 MTV 和 TLG 以及淋巴结受累是治疗反应的预测因素。MTV 是反应的最佳预测因子。然而，其额外的风险值似乎较低（MTV 优势比=1.015）。
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