Department of Nuclear Medicine, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey.
Department of Pathology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey.
Rev Esp Med Nucl Imagen Mol (Engl Ed). 2023 Jul-Aug;42(4):223-230. doi: 10.1016/j.remnie.2023.01.001. Epub 2023 Jan 20.
This retrospective study aimed to investigate the value of texture features of primary tumors in pretreatment F-FDG PET/CT in the prediction of response to treatment, progression, and overall survival in patients with rectal cancer who underwent surgery after neoadjuvant therapy(NAT).
Patients with rectal cancer who had pretreatment F-FDG PET/CT, and underwent surgery after NAT were included in this study. Clinicopathologic features, date of last follow-up, progression, and death were recorded. Textural and conventional PET parameters(maximum standardized uptake value-SUVmax, metabolic tumor volume-MTV, total lesion glycolysis-TLG) were obtained from PET/CT images using LifeX program. Parameters were grouped using Youden index in ROC analysis. Factors predicting the pathological response to treatment, progression, and overall survival were determined using logistic regression and Cox regression analyses.
Forty-four patients (26(59%) male, 18(41%) female; 60.1±11.4 years) with rectal cancer were included in this study. The numbers of patients with responders and non-responders to NAT were 15(34.9%) and 28(65.1%), respectively. One patient' pathology report did not contain the response status to NAT. The median of follow-up duration was 29.9 months. 9(20.5%) showed disease progression, and 8(18.2%) died during the follow-up period. Difference entropy and correlation parameters were found as independent predictors for response to NAT. The positivity of surgical margin, intensity interquartile range and AUC-CSH texture parameters were independent predictors of progression, while normalized inverse difference and LZLGE parameters were independent predictors of mortality.
The texture parameters obtained from pretreatment F-FDG PET/CT have presented a more robust predictive value than conventional parameters in patients with rectal cancer who underwent surgery after NAT.
本回顾性研究旨在探讨原发肿瘤纹理特征在新辅助治疗（NAT）后接受手术的直肠癌患者治疗反应、进展和总生存预测中的价值。
本研究纳入了接受NAT 前 F-FDG PET/CT 检查并接受手术的直肠癌患者。记录了临床病理特征、末次随访日期、进展和死亡情况。使用 LifeX 程序从 PET/CT 图像中获得纹理和常规 PET 参数（最大标准化摄取值-SUVmax、代谢肿瘤体积-MTV、总肿瘤糖酵解-TLG）。使用 ROC 分析中的 Youden 指数对参数进行分组。使用逻辑回归和 Cox 回归分析确定预测治疗病理反应、进展和总生存的因素。
本研究纳入了 44 例直肠癌患者（26 例男性，18 例女性；60.1±11.4 岁）。NAT 治疗反应的患者有 15 例（34.9%），无反应的患者有 28 例（65.1%）。1 例患者的病理报告未包含 NAT 治疗反应情况。中位随访时间为 29.9 个月。9 例（20.5%）出现疾病进展，8 例（18.2%）在随访期间死亡。差异熵和相关参数被发现是 NAT 治疗反应的独立预测因素。手术切缘阳性、强度四分位距和 AUC-CSH 纹理参数是进展的独立预测因素，而归一化倒数和 LZLGE 参数是死亡的独立预测因素。
在接受 NAT 后接受手术的直肠癌患者中，与常规参数相比，预处理 F-FDG PET/CT 获得的纹理参数具有更强的预测价值。
