Yang Lu, Li Mengdan, Liang Huan, Wang Xiaohui, Guan Lili, Jing Xingguo
Department of Nuclear Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Quant Imaging Med Surg. 2024 Jan 3;14(1):972-985. doi: 10.21037/qims-23-859. Epub 2024 Jan 2.
Identifying reliable prognostic indicators can aid in improving patient care. The aim of this study was to establish the association of F-fluorodeoxyglucose positron emission tomography-computed tomography (F-FDG PET/CT) whole-body metabolic parameters, serum carbohydrate antigen 125 (CA125), and human epididymis protein 4 (HE4) with overall survival (OS) in patients with epithelial ovarian cancer (EOC) after surgery combined with platinum-based chemotherapy.
From May 2014 to May 2019, a total of 79 patients with EOC who underwent posttreatment F-FDG PET/CT in the First Affiliated Hospital of Chongqing Medical University were included. Clinical data and laboratory indicators were obtained. The whole-body maximum standardized uptake value (WBSUVmax), whole-body metabolic tumor volume (WBMTV), and whole-body total lesion glycolysis (WBTLG) were measured and calculated on F-FDG PET/CT. The follow-up was conducted until February 2023, and the endpoint was death from any cause. Pearson correlation analysis, Kaplan-Meier, and Cox proportional regression were used in this study.
The PET-positive (PET-P) patients had significantly decreased OS based on either Kaplan-Meier survival analysis (P<0.001) or univariate Cox regression analysis [hazard ratio (HR) =40.177, 95% confidence interval (CI): 2.690-600.134; P=0.007]. "Ln" is a logarithmic transformation with a base of "e" (natural logarithm). LnWBMTV, lnWBTLG, and therapy after PET were independent predictors of OS in a cohort of 63 PET-P patients. The difference in OS between groups sorted by the median WBMTV (4.16; P<0.001) and WBTLG (14.71; P<0.001) was statistically significant. There were statistically significant differences in CA125 and HE4 levels between patients in the PET-P and PET-negative (PET-N) groups (P<0.001). In the PET-P patient cohort, serum HE4 levels were substantially correlated with WBMTV and WBTLG. Kaplan-Meier survival analysis suggested a reduction in OS after treatment in patients with EOC positive for CA125, HE4, and PET (P<0.001).
Post-PET/CT treatment strategy, WBMTV, and WBTLG demonstrated significant prognostic utility in predicting posttreatment OS in patients with EOC. Patients who tested positive for both tumor markers CA125 and HE4 and had a positive PET scan demonstrated a significantly poorer prognosis in terms of posttreatment OS.
识别可靠的预后指标有助于改善患者护理。本研究的目的是确定氟脱氧葡萄糖正电子发射断层扫描-计算机断层扫描（F-FDG PET/CT）全身代谢参数、血清糖类抗原125（CA125）和人附睾蛋白4（HE4）与上皮性卵巢癌（EOC）患者术后接受铂类化疗后的总生存期（OS）之间的关联。
2014年5月至2019年5月，纳入重庆医科大学附属第一医院79例接受治疗后F-FDG PET/CT检查的EOC患者。获取临床资料和实验室指标。在F-FDG PET/CT上测量并计算全身最大标准化摄取值（WBSUVmax）、全身代谢肿瘤体积（WBMTV）和全身总病灶糖酵解（WBTLG）。随访至2023年2月，终点为任何原因导致的死亡。本研究采用Pearson相关性分析、Kaplan-Meier分析和Cox比例回归分析。
基于Kaplan-Meier生存分析（P<0.001）或单因素Cox回归分析[风险比（HR）=40.177，95%置信区间（CI）：2.690-600.134；P=0.007]，PET阳性（PET-P）患者的OS显著降低。“Ln”是以“e”为底的对数变换（自然对数）。在63例PET-P患者队列中，LnWBMTV、lnWBTLG和PET后的治疗是OS的独立预测因素。按WBMTV中位数（4.16；P<0.001）和WBTLG中位数（14.71；P<0.001）分组的患者之间OS差异具有统计学意义。PET-P组和PET阴性（PET-N）组患者的CA125和HE4水平存在统计学显著差异（P<0.001）。在PET-P患者队列中，血清HE4水平与WBMTV和WBTLG显著相关。Kaplan-Meier生存分析表明，CA125、HE4和PET阳性的EOC患者治疗后的OS降低（P<0.001）。
PET/CT治疗后策略、WBMTV和WBTLG在预测EOC患者治疗后的OS方面具有显著的预后价值。肿瘤标志物CA125和HE4均呈阳性且PET扫描呈阳性的患者在治疗后OS方面预后明显较差。
