18F-FDG PET/CT代谢参数在Ⅳ期子宫内膜癌患者中的预后价值

Prognostic value of 18F-FDG PET/CT metabolic parameters in patients with stage Ⅳ endometrial carcinoma

    摘要
  • 摘要:
    目的 研究18F-氟脱氧葡萄糖（FDG）PET/CT代谢参数在Ⅳ期子宫内膜癌患者中的预后价值。
    方法 回顾性分析2013年12月至2023年3月于南京大学医学院附属鼓楼医院确诊为Ⅳ期子宫内膜癌的40例患者的临床资料，患者中位年龄58岁，年龄范围36~80岁。所有患者均行18F-FDG PET/CT检查，通过LIFEx7.2.0软件自动勾画感兴趣区（ROI）并测量每例患者转移病灶的最大标准化摄取值（SUVmax），肿瘤总代谢体积（TMTV）和病灶糖酵解总量（TLG）。采用受试者工作特征（ROC）曲线获得PET参数的最佳临界值，并根据最佳临界值将患者分为高危组和低危组。采用单因素、多因素Cox比例风险模型分析临床特征及PET代谢参数对患者总生存期（OS）和无进展生存期（PFS）的预后价值；采用Log-rank检验比较高危组与低危组患者OS和PFS的差异。
    结果 ROC曲线分析结果显示，SUVmax、TMTV和TLG预测Ⅳ期子宫内膜癌患者PFS的最佳临界值分别为13.65、51.50 cm3和319.50 g。SUVmax、MTV、TLG高危组与低危组患者PFS的差异均有统计学意义（χ2=5.64、9.75、9.75，均P<0.05）。SUVmax、TMTV和TLG预测OS的最佳临界值分别为10.85、71.00 cm3和431.50 g。TMTV、TLG高危组与低危组患者OS的差异均有统计学意义（χ2=8.72、7.89，均P<0.01）。单因素Cox比例风险模型分析结果显示，SUVmax、TMTV和TLG是Ⅳ期子宫内膜癌患者PFS的预后因素， TMTV和TLG是OS的预后因素。多因素Cox比例风险模型分析结果表明，TMTV>51.50 cm3是Ⅳ期子宫内膜癌患者PFS的独立预后因素，TMTV>71.00 cm3和TLG>431.50 g是OS的预测因素。
    结论 18F-FDG PET/CT代谢参数TMTV是Ⅳ期子宫内膜癌患者PFS的最佳预后因素。

     

    Abstract:
    Objective  To investigate the prognostic value of 18F-fluorodeoxyglucose (FDG) PET/CT metabolic parameters in patients with stage Ⅳ endometrial carcinoma.
    Methods  The clinical data of 40 patients with stage Ⅳ endometrial carcinoma who were diagnosed in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from December 2013 to March 2023, with a median age of 58, ranged from 36 to 80 years old, were retrospectively analyzed. All patients underwent 18F-FDG PET/CT examination, and LIFEx7.2.0 software was used to automatically map the region of interst (ROI) and measure the maximum standardized uptake value (SUVmax), total metabolic tumor volume (TMTV), and total lesion glycolysis (TLG) of all metastatic lesions in each patient. The optimal cut-off values of PET parameters were obtained using the receiver operating characteristic (ROC) curve. The patients were divided into the high-risk and low-risk groups in accordance with the optimal cut-off values. Univariate and multivariate Cox proportional hazard model was conducted to assess the prognostic value of clinical features and PET metabolic parameters for overall survival (OS) and progression-free survival (PFS). The Log-rank test was used to compare the differences in OS and PFS between the high-risk group and low-risk group.
    Results  ROC curves analysis revealed that the optimal cut-off values for SUVmax, TMTV, and TLG in predicting PFS in patients with stage Ⅳ endometrial carcinoma were 13.65, 51.50 cm3, and 319.50 g, respectively. The differences in PFS between the high-risk and low-risk group based on SUVmax, MTV, and TLG were statistically significant (χ2=5.64, 9.75, 9.75; all P<0.05). The optimal cut-off values for SUVmax, TMTV, and TLG in predicting OS were 10.85, 71.00 cm3, and 431.50 g, respectively. The differences in OS between the high-risk group and low-risk group based on TMTV and TLG were statistically significant (χ2=8.72, 7.89; both P<0.01). Univariate Cox proportional hazard model analysis showed that SUVmax, TMTV, and TLG were the independent prognostic factors for PFS in patients with stage Ⅳ endometrial carcinoma, whereas TMTV and TLG were the independent prognostic factors for OS. Multivariate Cox proportional hazard model analysis indicated that TMTV>51.50 cm3 was an independent prognostic factor for PFS, and TMTV>71.00 cm3 and TLG>431.50 g were the prognostic factor for OS.
    Conclusion  The 18F-FDG PET/CT metabolic parameter TMTV is the best prognostic factor for PFS in patients with stage Ⅳ endometrial carcinoma.

     

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