Du Siyao, Sun Hongzan, Gao Si, Xin Jun, Lu Zaiming
1Department of Radiology, 2Liaoning Provincial Key Laboratory of Medical Imaging, Shengjing Hospital of China Medical University, Shenyang 110004, China.
Quant Imaging Med Surg. 2019 Mar;9(3):440-452. doi: 10.21037/qims.2019.02.09.
Positron emission tomography (PET) parameters for a combination of the primary tumor and suspicious metastatic lymph nodes (SMLNs) appear to be more potential than those for the primary tumor alone for evaluating tumor recurrence in locally advanced cervical carcinoma (LACC), while the optimal threshold has not been determined. This study investigated the optimal PET parameters and percentage of SUV (%SUV) thresholds for tumor recurrence evaluation, and the relationship with hematological parameters in patients with LACC treated with concurrent chemoradiotherapy (CCRT).
Eighty-nine patients with advanced squamous cell cervical carcinoma (SCCC) scheduled for CCRT underwent pretreatment whole body PET/CT scans. We analyzed PET parameters including maximum standardized uptake value (SUV), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary tumor (SUV-P, MTV-P, TLG-P) and the combination of the primary tumor and SMLNs (SUV-C, MTV-C, TLG-C). The association between PET parameters with different %SUV threshold and recurrence-free survival (RFS), and the correlations between PET parameters and hematological parameters including squamous cell carcinoma antigen (SCC-ag), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and hemoglobin (Hb) were evaluated.
The optimal threshold for evaluating tumor recurrence was 50%SUV, and the optimal PET parameter was MTV-C with the 50%SUV threshold (MTV-C) (c-index =0.752). Multivariate analysis indicated that MTV-C [hazard ratio (HR), 1.065; P<0.001], NLR (HR, 1.195; P=0.045) and SMLNs (HR, 2.225; P=0.003) were independent risk factors for RFS. MTV and TLG with most of %SUV thresholds had slight-to-moderate correlations with SCC-ag, NLR and PLR. For SCC-ag, MTV-C55% (r=0.500; P<0.001) had the highest correlation coefficient among all parameters. For NLR and PLR, MTV-C (r=0.637 and r=0.515, respectively; P<0.001 for both correlations) received the highest correlation coefficient.
The MTV-C estimated by using a 50%SUV threshold, which is related to systemic inflammatory response biomarker (NLR and PLR), can be used as an optimal PET parameter associated with tumor recurrence of LACC.
对于局部晚期宫颈癌（LACC），原发性肿瘤与可疑转移性淋巴结（SMLN）联合的正电子发射断层扫描（PET）参数在评估肿瘤复发方面似乎比单独的原发性肿瘤参数更具潜力，而最佳阈值尚未确定。本研究调查了用于肿瘤复发评估的最佳PET参数和SUV百分比（%SUV）阈值，以及同步放化疗（CCRT）治疗的LACC患者中这些参数与血液学参数的关系。
89例计划接受CCRT的晚期宫颈鳞状细胞癌（SCCC）患者在治疗前进行了全身PET/CT扫描。我们分析了PET参数，包括原发性肿瘤的最大标准化摄取值（SUV）、代谢肿瘤体积（MTV）和总病灶糖酵解（TLG）（SUV-P、MTV-P、TLG-P）以及原发性肿瘤与SMLN联合的参数（SUV-C、MTV-C、TLG-C）。评估了不同%SUV阈值的PET参数与无复发生存期（RFS）之间的关联，以及PET参数与血液学参数之间的相关性，血液学参数包括鳞状细胞癌抗原（SCC-ag）、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）和血红蛋白（Hb）。
评估肿瘤复发的最佳阈值为50%SUV，最佳PET参数是50%SUV阈值下的MTV-C（MTV-C）（c指数=0.752）。多因素分析表明，MTV-C[风险比（HR），1.065；P<0.001]、NLR（HR，1.195；P=0.045）和SMLN（HR，2.225；P=0.003）是RFS的独立危险因素。大多数%SUV阈值下的MTV和TLG与SCC-ag、NLR和PLR有轻度至中度的相关性。对于SCC-ag，MTV-C55%（r=0.500；P<0.001）在所有参数中具有最高的相关系数。对于NLR和PLR，MTV-C（分别为r=0.637和r=0.515；两者相关性P<0.001）具有最高的相关系数。
使用50%SUV阈值估算的MTV-C与全身炎症反应生物标志物（NLR和PLR）相关，可作为与LACC肿瘤复发相关的最佳PET参数。
