分期F-FDG PET/CT在预测膀胱癌患者总生存中的附加值
The Added-value of Staging F-FDG PET/CT in the Prediction of Overall Survival in the Patients with Bladder Cancer.
作者信息
Ateş Seda Gülbahar, Demirel Bedriye Büşra, Başar Halil, Uçmak Gülin
机构信息
Hitit University Çorum Erol Olçok Training and Research Hospital, Department of Nuclear Medicine, Çorum, Türkiye.
University of Health Sciences Türkiye, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Clinic of Nuclear Medicine, Ankara, Türkiye.
出版信息
Mol Imaging Radionucl Ther. 2024 Feb 22;33(1):11-18. doi: 10.4274/mirt.galenos.2023.65002.
OBJECTIVES
This retrospective study aimed to evaluate the prognostic importance of F-fluorodeoxyglucose (F-FDG)-positive pelvic lymph nodes (LNs) and extra-pelvic disease on staging F-FDG positron emission tomography/computed tomography (PET/CT) in patients with bladder cancer.
METHODS
Bladder cancer patients who underwent staging F-FDG PET/CT were included in the study. Histopathologic features of tumors, therapy histories, presence of distinguishable tumors on CT and PET images, sizes and maximum standardized uptake value (SUV) of primary tumors, total numbers, sizes, and SUV of F-FDG-positive pelvic and extra-pelvic LNs, and total numbers and SUV of distant metastases (M1a/1b) were recorded. Patients were followed up until death or the last medical visit. Factors predicting overall survival were determined using Cox regression analysis.
RESULTS
Fifty-five patients [median age: 70 (53-84), 48 (87.3%) male, 7 (12.7%) female] with bladder cancer were included in this study. Twenty-nine (52.7%) patients had F-FDG positive pelvic LNs, while 24 (43.7%) patients had F-FDG positive extra-pelvic disease. Patients with F-FDGpositive pelvic LNs had a higher rate of extra-pelvic disease (p=0.003). The median follow-up duration was 13.5 months. The median overall survival was 16.3 months [95% confidence interval (CI) 8.9-23.7]. The primary tumor distinguishability on PET (p=0.011) and CT (p=0.009) images, the presence of F-FDG-positive pelvic LNs (p<0.001) and F-FDG-positive extra-pelvic disease/distant metastases (M1a/M1b) (p<0.001), and the number of distant metastases (p=0.034) were associated with mortality. The F-FDG-positive extra-pelvic disease/distant metastases [p=0.029, odds ratio: 4.15 (95% CI 1.16-14.86)] was found to be an independent predictor of mortality in patients with bladder cancer.
CONCLUSION
The presence of F-FDG-positive extra-pelvic disease in pretreatment F-FDG PET/CT is an important prognostic factor in bladder cancer patients.
目的
本回顾性研究旨在评估¹⁸F-氟脱氧葡萄糖（¹⁸F-FDG）阳性盆腔淋巴结（LNs）及盆腔外病变对膀胱癌患者¹⁸F-FDG正电子发射断层扫描/计算机断层扫描（PET/CT）分期的预后重要性。
方法
纳入接受¹⁸F-FDG PET/CT分期的膀胱癌患者。记录肿瘤的组织病理学特征、治疗史、CT和PET图像上可辨别的肿瘤情况、原发肿瘤大小及最大标准化摄取值（SUV）、¹⁸F-FDG阳性盆腔和盆腔外LNs的总数、大小及SUV，以及远处转移（M1a/1b）的总数及SUV。对患者进行随访直至死亡或最后一次就诊。采用Cox回归分析确定预测总生存的因素。
结果
本研究纳入55例膀胱癌患者[中位年龄：70（53 - 84）岁，48例（87.3%）男性，7例（12.7%）女性]。29例（52.7%）患者¹⁸F-FDG阳性盆腔LNs，24例（43.7%）患者¹⁸F-FDG阳性盆腔外病变。¹⁸F-FDG阳性盆腔LNs患者盆腔外病变发生率更高（p = 0.003）。中位随访时间为13.5个月。中位总生存时间为16.3个月[95%置信区间（CI）8.9 - 23.7]。PET（p = 0.011）和CT（p = 0.009）图像上原发肿瘤的可辨别性、¹⁸F-FDG阳性盆腔LNs（p < 0.001）及¹⁸F-FDG阳性盆腔外病变/远处转移（M1a/M1b）（p < 0.001），以及远处转移数量（p = 0.034）与死亡率相关。¹⁸F-FDG阳性盆腔外病变/远处转移[p = 0.029，比值比：4.15（95%CI 1.16 - 14.86）]被发现是膀胱癌患者死亡率的独立预测因素。
结论
治疗前¹⁸F-FDG PET/CT检查中¹⁸F-FDG阳性盆腔外病变的存在是膀胱癌患者重要的预后因素。
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