Milardovic Renata, Dzananovic Lejla, Beslija Semir, Beslic Nermina, Puhalovic Amra, Cavaljuga Semra
Clinic of Nuclear Medicine and Endocrinology, Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina.
Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
Acta Inform Med. 2023 Jun;31(2):115-120. doi: 10.5455/aim.2023.31.115-120.
Colorectal cancer (CRC) is a diverse disease with various clinical, pathological and molecular features that affect tumor biological behavior, treatment response and prognosis.
The aim of this study was to evaluate the correlation between metabolic 18F-FDG PET/CT parameters (SUVmax, MTV and TLG) and CEA in recurrent and metastatic CRC and to evaluate prognostic value of metabolic 18F-FDG PET/CT parameters in recurrent and metastatic CRC.
A descriptive study of 100 patients with previously detected and surgically treated CRC referred to PET/CT with a suspicion of recurrent or metastatic CRC. CEA was measured within three months from the imaging. A low-dose PET/CT was performed per institutional protocol. For each hypermetabolic lesion, metabolic PET/CT parameters (SUVmax, MTV, TLG) were calculated semiautomatically. Pathohistology or clinical data from the follow-up were used as the gold standard. Sensitivity, specificity, PPV and NPV for 18F-FDG PET/CT and CEA in detection of recurrent or metastatic CRC were calculated. Correlation between CEA and SUVmax, MTV and TLG was calculated, separately. To assess the prognostic values of metabolic parameters in CRC, survival analysis with 18-month progression-free survival (PFS) as an endpoint was performed. Microsoft Excel sheets, ROC and Kaplan-Meier curves were used to present the data. Logrank and Tarone-Ware test and Cox model of proportional hazards were used to compare the groups.
Study included 100 patients, 45 males and 55 females, age range 36-81 years, mean age 61,4 years. Cancer site was colon in 56% and rectum in 44%. Sensitivity, specificity, PPV and NPV of 18F-FDG PET/CT in detection of recurrent or metastatic CRC was 95%, 73%, 70% and 95%, respectively. Sensitivity, specificity, PPV and NPV of CEA in detection of recurrent or metastatic CRC was 58%, 96%, 91% and 78%, respectively. SUVmax, MTV and TLG positively correlated with CEA, but only CEA-TLG correlation was considered significant (r=0,67). The regression model analysis revealed: SUVmax (HR=0,63, 95%CI=0,28-1,41, p=0,214), MTV (0,59, 95%CI=0,28-1,22, p=0,111) and TLG (HR=0,45 95%CI=0,21-0,99, p=0,028), and the prognostic role in CRC was proven for TLG only.
Metabolic 18F-FDG PET/CT parameters may have the prognostic value in CRC, but further multicentric prospective studies are required for validation.
结直肠癌（CRC）是一种具有多种临床、病理和分子特征的复杂疾病，这些特征会影响肿瘤的生物学行为、治疗反应和预后。
本研究旨在评估复发性和转移性结直肠癌中代谢型18F-FDG PET/CT参数（SUVmax、MTV和TLG）与癌胚抗原（CEA）之间的相关性，并评估代谢型18F-FDG PET/CT参数在复发性和转移性结直肠癌中的预后价值。
一项描述性研究，对100例先前已检测并接受手术治疗的结直肠癌患者进行PET/CT检查，怀疑有复发性或转移性结直肠癌。在成像后三个月内测量CEA。按照机构方案进行低剂量PET/CT检查。对于每个高代谢病变，半自动计算代谢型PET/CT参数（SUVmax、MTV、TLG）。将随访的病理组织学或临床数据用作金标准。计算18F-FDG PET/CT和CEA检测复发性或转移性结直肠癌的敏感性、特异性、阳性预测值和阴性预测值。分别计算CEA与SUVmax、MTV和TLG之间的相关性。为评估结直肠癌中代谢参数的预后价值，以18个月无进展生存期（PFS）为终点进行生存分析。使用Microsoft Excel工作表、ROC曲线和Kaplan-Meier曲线呈现数据。使用Logrank检验、Tarone-Ware检验和比例风险Cox模型比较各组。
研究纳入100例患者，45例男性和55例女性，年龄范围36 - 81岁，平均年龄61.4岁。癌症部位在结肠的占56%，在直肠的占44%。18F-FDG PET/CT检测复发性或转移性结直肠癌的敏感性、特异性、阳性预测值和阴性预测值分别为95%、73%、70%和95%。CEA检测复发性或转移性结直肠癌的敏感性、特异性、阳性预测值和阴性预测值分别为58%、96%、91%和78%。SUVmax、MTV和TLG与CEA呈正相关，但仅CEA-TLG相关性被认为具有显著性（r = 0.67）。回归模型分析显示：SUVmax（风险比[HR]=0.63，95%置信区间[CI]=0.28 - 1.41，p = 0.214），MTV（0.59，95%CI=0.28 - 1.22，p = 0.111）和TLG（HR = 0.45，95%CI=0.21 - 0.99，p = 0.028），并且仅TLG在结直肠癌中的预后作用得到证实。
代谢型18F-FDG PET/CT参数可能在结直肠癌中具有预后价值，但需要进一步多中心前瞻性研究进行验证。
