Liu Guobing, Yin Hongyan, Cheng Xi, Wang Yan, Hu Yan, Liu Tianshu, Shi Hongcheng
Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, No. 180 in Fenglin Road, Shanghai, 200032, People's Republic of China.
Department of Medical Oncology, Center of Evidence-based Medicine, Zhongshan Hospital, Fudan University, No. 180 in Fenglin Road, Shanghai, 200032, People's Republic of China.
Clin Exp Med. 2021 Feb;21(1):129-138. doi: 10.1007/s10238-020-00659-8. Epub 2020 Sep 3.
The present study aimed to investigate the prognostic value of intra-tumor metabolic heterogeneity on 2-[18F] Fluoro-2-deoxy-D-glucose (F-FDG) positron emission tomography/computed tomography (PET/CT) for patients with gastric cancer. Fifty-five patients with advanced gastric cancer that had received neoadjuvant chemotherapy and radical surgery were included. Clinicopathological information, F-FDG PET/CT before chemotherapy, pathological response, recurrence or metastasis, progression-free survival (PFS), and overall survival (OS) of the patients were collected. The maximum, peak, and mean standardized uptake values (SUV, SUV, and SUV), tumor-to-liver ratio (TLR), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) on PET/CT were measured. Heterogeneity index-1 (HI-1) was calculated as SUV divided by the standard deviation, and heterogeneity index-2 (HI-2) was evaluated through linear regressions of MTVs according to different SUV thresholds. Associations between these parameters and patient survival outcomes were analyzed. None of the parameters on PET were associated with tumor recurrence. Pathological responders had significantly smaller TLR, MTV and HI-2 values than non-responders (P = 0.017, 0.017 and 0.013, respectively). In multivariate analysis of PFS, only HI-2 was an independent factor (hazard ratio [HR] = 2.693, P = 0.005) after adjusting for clinical tumor-node-metastasis (TNM) stage. In multivariate analysis of OS, HI-2 was also an independent predictive factor (HR = 2.281, P = 0.009) after adjusting for tumor recurrence. Thus, HI-2 generated from baseline F-FDG PET/CT is significantly associated with survival of patients with gastric cancer. Preoperative assessment of HI-2 by F-FDG PET/CT might be promising to identify patients with poor prognosis.
本研究旨在探讨2-[18F]氟-2-脱氧-D-葡萄糖（F-FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）上肿瘤内代谢异质性对胃癌患者的预后价值。纳入了55例接受新辅助化疗和根治性手术的晚期胃癌患者。收集患者的临床病理信息、化疗前F-FDG PET/CT、病理反应、复发或转移、无进展生存期（PFS）和总生存期（OS）。测量PET/CT上的最大、峰值和平均标准化摄取值（SUVmax、SUVpeak和SUVmean）、肿瘤与肝脏比值（TLR）、代谢肿瘤体积（MTV）和总病变糖酵解（TLG）。异质性指数-1（HI-1）计算为SUV除以标准差，异质性指数-2（HI-2）通过根据不同SUV阈值对MTV进行线性回归来评估。分析这些参数与患者生存结果之间的关联。PET上的这些参数均与肿瘤复发无关。病理反应者的TLR、MTV和HI-2值明显小于无反应者（分别为P = 0.017、0.017和0.013）。在PFS的多因素分析中，调整临床肿瘤-淋巴结-转移（TNM）分期后，只有HI-2是独立因素（风险比[HR]=2.693，P = 0.005）。在OS的多因素分析中，调整肿瘤复发后，HI-2也是独立预测因素（HR = 2.281，P = 0.009）。因此，基线F-FDG PET/CT产生的HI-2与胃癌患者的生存显著相关。通过F-FDG PET/CT术前评估HI-2可能有助于识别预后不良的患者。
