基线18F-FDG PET/CT代谢参数对伴有转移的食管鳞状细胞癌放化疗患者预后的预测价值

Prognostic value of baseline 18F-FDG PET/CT metabolic parameters in the prognosis of patients with metastasis esophageal squamous cell carcinoma with chemoradiotherapy

    摘要
  • 摘要:
    目的 探究治疗前18F-氟脱氧葡萄糖（FDG） PET/CT显像原发灶与转移灶代谢参数对接受放化疗的食管鳞状细胞癌（ESCC）患者预后的预测价值。
    方法 回顾性分析2013年11月至2021年4月于青岛大学附属医院行18F-FDG PET/CT检查的106例接受放化疗的ESCC患者的临床资料，其中男性98例、女性8例，年龄（63.9±8.8）岁。临床因素包括年龄、性别、原发灶位置、临床分期、分化程度和治疗方式。以40%最大标准化摄取值（SUVmax）作为阈值，勾画治疗前食管癌原发病灶及转移灶的感兴趣区（ROI），获得相应的食管癌原发灶的SUVmax，原发灶的肿瘤代谢体积（MTVp），原发灶的病灶糖酵解总量（TLGp）和全身病灶的MTV（MTVwb），全身病灶的TLG（TLGwb），转移灶与原发灶SUVmax，MTV，TLG的比值（R-SUVmax、R-MTV、R-TLG）。采用Kaplan-Meier法及Log-Rank检验进行单因素分析，采用Cox比例风险模型进行多因素分析，预测影响患者无进展生存（PFS）期及总生存（OS）期的预后因素。
    结果 单因素分析结果显示，T分期、MTVp、TLGp、MTVwb、TLGwb及R-TLG是影响接受放化疗ESCC患者PFS期和OS期的危险因素（χ2=4.105~27.992，均P<0.05）；多因素分析结果显示，T分期及R-TLG为ESCC患者PFS期（HR=2.210，95%CI：1.307~3.737，P=0.003；HR=3.118，95%CI：1.414~6.875，P=0.005）及OS期（HR=1.885，95%CI：1.072~3.317，P=0.028；HR=2.584，95%CI：1.186~5.629；P=0.017）的独立预后因素。联合T分期及R-TLG将患者分为低、中、高危3组，结果显示，各组患者间PFS期及OS期的差异均有统计学意义（χ2=38.392、19.857，均P<0.001）。
    结论 ESCC患者放化疗前T分期和18F-FDG PET/CT代谢参数R-TLG为PFS期及OS期的独立预后因素。

     

    Abstract:
    Objective To investigate the prognostic value of primary and metastatic metabolic parameters of 18F-fluorodeoxyglucose(FDG) PET/CT imaging before chemoradiotherapy in patients with esophageal squamous cell carcinoma (ESCC).
    Methods A retrospective analysis was performed on 106 patients 98 males, 8 females, aged (63.9±8.8) years with metastatic ESCC who received radiochemotherapy and underwent 18F-FDG PET/CT from November 2013 to April 2021 in the Affiliated Hospital of Qingdao University. Clinical factors included age, sex, primary location, clinical stage, degree of differentiation, and treatment. Using 40% maximum standardized uptake value (SUVmax) as the threshold, delineate the region of interest (ROI) of the primary and metastatic lesions of esophageal cancer before treatment. Metabolic parameters included SUVmax of primary lesion, metabolic tumor volume (MTV) of primary lesion (MTVp), total lesion glycolysis (TLG) of primary lesion (TLGp), MTV of whole body (MTVwb), TLG of whole body (TLGwb), and SUVmax, MTV, TLG ratio of metastatic lesion to primary lesion (R-SUVmax, R-MTV, R-TLG). Kaplan-Meier method and Log-Rank test were used for univariate analysis and multivariate analysis was conducted by Cox proportional hazards model to predict the prognostic factors affecting progression-free survival (PFS) and overall survival (OS) of patients.
    Results Univariate analysis showed that T stage, MTVp, TLGp, MTVwb, TLGwb and R-TLG were prognostic factors for PFS and OS in ESCC patients receiving chemoradiotherapy (χ2=4.105−27.992, all P<0.05). Multivariate analysis showed that T stage and R-TLG were independent prognostic factors for PFS (HR=2.210, 95%CI: 1.307−3.737, P=0.003; HR=3.118, 95%CI: 1.414−6.875, P=0.005) and OS (HR=1.885, 95%CI: 1.072−3.317, P=0.028; HR=2.584, 95%CI: 1.186−5.629, P=0.017) in ESCC patients. Combined with T stage and R-TLG, the patients were divided into low-risk, medium-risk and high-risk groups. The results showed that there were statistically significant differences in PFS and OS among the groups (χ2=38.392, 19.857; both P<0.001).
    Conclusion T stage and 18F-FDG PET/CT metabolic parameter R-TLG were independent prognostic factors for PFS and OS in ESCC patients before chemoradiotherapy.

     

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