正电子发射断层显像/磁共振成像在宫颈癌中的应用：影像生物标志物与肿瘤分期、疾病进展及总生存期的相关性
PET/MRI in Cervical Cancer: Associations Between Imaging Biomarkers and Tumor Stage, Disease Progression, and Overall Survival.
作者信息
Shih I-Lun, Yen Rouh-Fang, Chen Chi-An, Cheng Wen-Fang, Chen Bang-Bin, Chang Yu-Hsuan, Cheng Mei-Fang, Shih Tiffany Ting-Fang
机构信息
Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan.
Department of Radiology, College of Medicine, National Taiwan University, Taipei, Taiwan.
出版信息
J Magn Reson Imaging. 2021 Jan;53(1):305-318. doi: 10.1002/jmri.27311. Epub 2020 Aug 14.
BACKGROUND
Positron emission tomography (PET)/MRI biomarkers have been shown to have prognostic significance in patients with cervical cancer. Their associations with progression-free survival (PFS) and overall survival (OS) merit further investigation.
PURPOSE
To evaluate the association between PET/MRI biomarkers and tumor stage, PFS, and OS in patients with cervical cancer.
STUDY TYPE
Prospective cohort study.
POPULATION
In all, 54 patients with newly diagnosed cervical cancer and measurable tumors (>1 cm) were included in the image analysis.
FIELD STRENGTH/SEQUENCE: 3.0T integrated PET/MRI including diffusion-weighted echo-planar imaging (b = 50 and 1000 s/mm ) and [18F]fluorodeoxyglucose PET.
ASSESSMENT
Two radiologists measured the minimum and mean apparent diffusion coefficient (ADC and ADC ), maximum standardized uptake value (SUV ), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary tumors.
STATISTICAL TESTS
A Mann-Whitney U-test was used to evaluate the association between the imaging biomarkers and tumor stage. A Cox proportional hazards model was used to assess the relationships between the imaging biomarkers and survival.
RESULTS
In advanced tumors (T ≥ 1b2, M1, stage ≥ IB3), ADC was significantly lower and MTV, TLG, MTV/ADC , and TLG/ADC were significantly higher (P values between <0.001 and 0.036). In N1 tumors, ADC was significantly lower and MTV and MTV/ADC were significantly higher (P values between 0.005 and 0.016). In survival analysis, SUV was an independent predictor of PFS (hazard ratio [HR] = 4.57, P < 0.05), and ADC was an independent predictor of OS (HR = 0.02, P < 0.05). In subgroup analysis of patients with different stages, MTV/ADC was a predictor of PFS in stage I disease (P = 0.003), ADC (P = 0.038), and MTV (P = 0.020) in stage II, SUV (P = 0.006), and TLG (P = 0.006) in stage IV; and ADC was a predictor of OS in stage III disease (P = 0.008).
DATA CONCLUSION
PET/MRI biomarkers of cervical cancer are associated with tumor stage and survival. SUV and ADC are independent predictors of PFS and OS, respectively.
LEVEL OF EVIDENCE
1 TECHNICAL EFFICACY: 3.
背景
正电子发射断层扫描（PET）/磁共振成像（MRI）生物标志物已被证明在宫颈癌患者中具有预后意义。它们与无进展生存期（PFS）和总生存期（OS）的关联值得进一步研究。
目的
评估PET/MRI生物标志物与宫颈癌患者肿瘤分期、PFS和OS之间的关联。
研究类型
前瞻性队列研究。
研究对象
共有54例新诊断的宫颈癌且肿瘤可测量（>1 cm）的患者纳入图像分析。
场强/序列：3.0T一体化PET/MRI，包括扩散加权回波平面成像（b = 50和1000 s/mm²）以及[¹⁸F]氟代脱氧葡萄糖PET。
评估
两名放射科医生测量了原发性肿瘤的最小和平均表观扩散系数（ADCmin和ADCmean）、最大标准化摄取值（SUVmax）、代谢肿瘤体积（MTV）和总病灶糖酵解（TLG）。
统计检验
采用曼-惠特尼U检验评估成像生物标志物与肿瘤分期之间的关联。采用Cox比例风险模型评估成像生物标志物与生存之间的关系。
结果
在晚期肿瘤（T≥1b2、M1、分期≥IB3）中，ADCmin显著降低，MTV、TLG、MTV/ADCmin和TLG/ADCmin显著升高（P值在<0.001至0.036之间）。在N1期肿瘤中，ADCmin显著降低，MTV和MTV/ADCmin显著升高（P值在0.005至0.016之间）。在生存分析中，SUVmax是PFS的独立预测因子（风险比[HR]=4.57，P<0.05），ADCmin是OS的独立预测因子（HR = 0.02，P<0.05）。在不同分期患者的亚组分析中，MTV/ADCmin是I期疾病PFS的预测因子（P = 0.003），II期的ADCmin（P = 0.038）和MTV（P = 0.020），IV期的SUVmax（P = 0.006）和TLG（P = 0.006）；ADCmin是III期疾病OS的预测因子（P = 0.008）。
数据结论
宫颈癌的PET/MRI生物标志物与肿瘤分期和生存相关。SUVmax和ADCmin分别是PFS和OS的独立预测因子。
证据级别
1 技术效能：3。
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