王冉, 张涵玥, 韩星敏. 18F-FDG PET/CT肿瘤内代谢异质性指数预测胃腺癌隐匿性淋巴结转移的价值[J]. 国际放射医学核医学杂志. DOI: 10.3760/cma.j.cn121381-202303006-00378
引用本文: 王冉, 张涵玥, 韩星敏. 18F-FDG PET/CT肿瘤内代谢异质性指数预测胃腺癌隐匿性淋巴结转移的价值[J]. 国际放射医学核医学杂志. DOI: 10.3760/cma.j.cn121381-202303006-00378
Ran Wang, Hanyue Zhang, Xingmin Han. Value of 18F-FDG PET/CT intra-tumor metabolic heterogeneity index for predicting occult lymph node metastasis in gastric adenocarcinoma[J]. Int J Radiat Med Nucl Med. DOI: 10.3760/cma.j.cn121381-202303006-00378
Citation: Ran Wang, Hanyue Zhang, Xingmin Han. Value of 18F-FDG PET/CT intra-tumor metabolic heterogeneity index for predicting occult lymph node metastasis in gastric adenocarcinoma[J]. Int J Radiat Med Nucl Med. DOI: 10.3760/cma.j.cn121381-202303006-00378

18F-FDG PET/CT肿瘤内代谢异质性指数预测胃腺癌隐匿性淋巴结转移的价值

Value of 18F-FDG PET/CT intra-tumor metabolic heterogeneity index for predicting occult lymph node metastasis in gastric adenocarcinoma

  • 摘要:
    目的 评估术前18F-氟脱氧葡萄糖(FDG) PET/CT原发灶肿瘤内代谢异质性指数(HI)对胃腺癌隐匿性淋巴结转移(OLM)的预测价值。
    方法 回顾性分析2016年1月至2022年12月于郑州大学第一附属医院术前行18F-FDG PET/CT检查的79例胃腺癌患者的临床资料,其中男性62例、女性17例,年龄(63.8±9.0)岁。所有患者均于18F-FDG PET/CT显像后1个月内行胃腺癌根治术,根据术后组织病理学检查结果分为OLM阳性组(n=39)和OLM阴性组(n=40)。采用卡方检验、两独立样本t检验(方差齐)和Mann-Whitney U检验对胃腺癌患者的临床特征、18F-FDG PET/CT代谢参数进行组间比较。采用单因素及多因素logistic回归模型分析预测OLM的独立危险因素。采用受试者工作特征(ROC)曲线分析HI对OLM的诊断效能。
    结果 OLM阳性组与OLM阴性组间性别、分化程度及病理T分期差异均有统计学意义(x2=3.903~6.361,均P<0.05)。OLM阳性组原发灶HI-2明显高于OLM阴性组4.98(2.68,8.44)对2.61(1.84,4.23),且差异有统计学意义(z=−3.178,P<0.05);而OLM阴性组原发灶SUVmax、SUVmean、HI-1 5.59(4.46,7.51)对6.91(5.11,10.64)=、3.33(3.06,3.85)对3.65(3.25,4.64)=、(0.23±0.12) 对(0.29±0.14)均明显高于OLM阳性组,且差异均有统计学意义(z=−2.000、-2.001,t=2.096;均P<0.05)。单因素Logistic回归模型分析结果显示,分化程度(OR=4.037,95%CI:1.295~12.585,P<0.05)、病理T分期(OR=4.080,95%CI:1.310~12.709,P<0.05)、HI-1(OR=0.025,95%CI:0.001~0.992,P<0.05)和HI-2(OR=7.368,95%CI:2.385~22.764,P<0.001)是OLM的危险因素;多因素logistic回归模型分析结果显示,病理T分期(OR=4.780,95%CI:1.238~18.458,P<0.05)和HI-2(OR=6.893,95%CI:1.922~24.718,P<0.05)是胃腺癌患者OLM的独立危险因素。ROC曲线分析结果显示,HI-2预测OLM的ROC曲线下面积(AUC)为0.708(95%CI :0.237~0.483,P=0.001),当以其最佳临界值4.962进行预测时,其诊断OLM的灵敏度和特异度分别为51.3%(20/39)和87.5%(35/40)。
    结论 胃腺癌术前18F-FDG PET/CT原发灶肿瘤内代谢HI对胃腺癌OLM具有预测价值,且HI-2是OLM的独立危险因素。

     

    Abstract:
    Objective To investigate the predictive value of 18F-fluorodeoxyglucose(FDG) PET/CT primary lesions metabolic heterogeneity index for occult lymph node metastasis(OLM) in gastric cancer.
    Methods A retrospective analysis was performed on 79 patients 62 males, 17 females, age (63.8±9.0) years with gastric cancer who underwent 18F-FDG PET/CT imaging and were diagnosed as clinical (c)N0 stage before surgery from January 2016 to December 2022 in the First Affiliated Hospital of Zhengzhou University. All patients underwent radical gastrectomy in our hospital within 1 month after imaging, and were divided into OLM-positive group and OLM-negative group according to postoperative pathology to determine whether there was lymph node metastasis. The following PET/CT parameters were measured: The maximum, mean and peak normalized uptake values (SUVmax, SUVmean, SUVpeak) , tumor metabolic volume (MTV) and total focal glycolysis (TLG)of the primary lesions.And TLR (tumor - liver ratio), heterogeneity index -1 (HI-1) and heterogeneity index -2 (HI-2) were calculated. The t test and Mann-Whitney U test of two independent samples were used to compare the parameters between groups. The independent risk factors of OLM were analyzed by logistic regression. The diagnostic efficacy of heterogeneity index on OLM was analyzed by receiver operating characteristic (ROC) curve.
    Results A total of 39 (49.4%, 39/79) of the 79 patients were pathologically confirmed to have OLM. HI-2 in OLM positive group was higher than that in OLM negative group 4.98 (2.68, 8.44) vs 2.61 (1.84, 4.23), z=−3.178, P < 0.05, while SUVmax in OLM negative group was higher than that in OLM negative group 5.59 (4.46, 7.51) vs 6.91 (5.11, 10.64). z=−2.000, P < 0.05, SUVmean3.33 (3.06, 3.85) vs 3.65 (3.25, 4.64), z=−2.001, P < 0.05, HI-10.23±0.12 vs 0.29±0.14, t=2.096, P < 0.05 were significantly higher than those in OLM positive group. Multivariate logistic regression analysis showed that HI-2 was an independent risk factor for OLM odds ratio (OR) =6.893, 95%CI: 1.922-24.718, P < 0.05. The area under ROC curve (AUC) of HI-2 for OLM prediction was 0.708 (95%CI: 0.237-0.483, P=0.001), and the sensitivity and specificity for OLM diagnosis were 51.3% (20/39) and 87.5% (35/40), respectively, when the threshold was 4.962.
    Conclusion 18F-FDG PET/CT tumor metabolic heterogeneity index has predictive value for OLM in gastric cancer, and heterogeneity index -2 is an independent risk factor for OLM.

     

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