18F-FDG PET/CT代谢参数、炎症指标、SCC-Ag与局部进展期宫颈鳞癌临床分期和病理特征相关性的研究

Correlation of 18F-FDG PET/CT metabolic parameter, inflammatory indexes and SCC-Ag with clinical staging and pathological features of locally progressive cervical squamous carcinoma

    摘要
  • 摘要:
    目的  探讨18F-氟脱氧葡萄糖（FDG） PET/CT代谢参数、炎症指标、鳞状细胞癌抗原（SCC-Ag）与局部进展期宫颈鳞癌国际妇产科联合会（FIGO）临床分期和病理特征之间的相关性，为宫颈鳞癌的病理特征评价和准确临床分期提供参考。
    方法  回顾性分析2015年8月至2023年10月在青岛市中心医院诊治的56例宫颈鳞癌患者的临床资料，患者年龄为（56.0±9.3）岁。所有患者均经组织病理学检查结果确诊为宫颈鳞癌（ⅡB~ⅣA期），于治疗前行18F-FDG PET/CT及血清学检测，获得最大标准摄取值（SUVmax）、平均标准摄取值（SUVmean）、肿瘤代谢体积（MTV）、糖酵解总量（TLG）、淋巴结SUVmax（nSUVmax）、SCC-Ag及炎症指标等参数。采用Spearman秩相关分析18F-FDG PET/CT代谢参数、血清肿瘤标志物、炎症指标水平与ⅡB~ⅣA宫颈鳞癌临床病理特征之间的相关性。
    结果  56例患者中，13例（23.21%） FIGO分期为ⅡB期，34例（60.71%）为Ⅲ期，9例（16.07%）为ⅣA期。其中，38例（67.86%）患者在初始分期时即出现淋巴结转移。18F-FDG PET/CT代谢参数中，nSUVmax、MTV、TLG、原发病灶/肝脏SUVmax、淋巴结/肝脏SUVmax与FIGO分期均呈正相关（r=0.317~0.571，均P<0.05）；炎症指标中，中性粒细胞/淋巴细胞比值、血小板/淋巴细胞比值与FIGO分期均呈正相关（r=0.311、0.285，均P<0.05）；淋巴细胞/单核细胞比值、白蛋白（ALB）与FIGO分期均呈负相关（r=−0.481、−0.547，均P<0.001）。上述18F-FDG PET/CT代谢参数均与淋巴结转移呈正相关（r=0.300~0.823，均P<0.05），而ALB与淋巴结转移呈负相关（r=−0.303，P<0.05）。SCC-Ag与宫颈鳞癌FIGO分期及淋巴结转移均呈正相关（r=0.515、0.433，均P<0.001）。18F-FDG PET/CT代谢参数、炎症指标及SCC-Ag与病理分级相关性均无统计学意义（r=−0.083~0.141，均P>0.05）。
    结论  宫颈鳞癌原发灶18F-FDG PET/CT代谢参数、炎症指标及血清肿瘤标志物与临床病理特征、FIGO 分期间存在不同程度的相关性，均可反映宫颈鳞癌患者的肿瘤生物学特征和病理学特性，有利于宫颈鳞癌的病理特征评价和准确临床分期。

     

    Abstract:
    Objective To investigate the correlation of 18F-fluorodeoxyglucose (FDG) PET/CT metabolic parameters, inflammatory indexes, and squamous cell carcinoma antigen (SCC-Ag) with the International Federation of Obstetrics and Gynecology (FIGO) clinical stage and pathological characteristics in locally advanced cervical squamous carcinoma and provide a reference for the evaluation of pathological features and accurate clinical staging of cervical squamous carcinoma.
    Methods The clinical data of 56 patients with cervical squamous carcinoma who were aged (56.0±9.3) years and treated in Qingdao Central Hospital from August 2015 to October 2023 were retrospectively analyzed. All patients were diagnosed as having cervical squamous carcinoma (Stage ⅡB−ⅣA) on the basis of histopathological findings and underwent 18F-FDG PET/CT and serological examination before treatment to obtain the maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), metabolic tumor volume (MTV), total lesion glycolysis (TLG), lymph node SUVmax (nSUVmax), SCC-Ag, and inflammatory indexes. Spearman rank correlation analysis was used to analyze the correlation among 18F-FDG PET/CT metabolic parameters, serum tumor markers, inflammatory indexes, and clinicopathological features of ⅡB−ⅣA cervical squamous carcinoma.
    Results Of the 56 patients, 13(23.21%) were at stage ⅡB, 34(60.71%) were at stage Ⅲ, and 9(16.07%) were at stage ⅣA. Thirty-eight (67.86%) of the patients had lymph node metastasis at the initial stage. Some 18F-FDG PET/CT metabolic parameters, such as nSUVmax, MTV, TLG, tumor-to-liver ratio SUVmax, and node-to-liver ratio SUVmax, were positively correlated with FIGO staging (r=0.317–0.571, all P<0.05), and inflammation indicators neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were positively correlated with FIGO staging (r=0.311, 0.285; both P<0.05). Meanwhile, lymphocyte-to-monocyte ratio and albumin (ALB) were negatively correlated with FIGO staging (r=−0.481, −0.547; both P<0.05). All of the 18F-FDG PET/CT metabolic parameters were positively correlated with lymph node metastasis (r=0.300–0.823, all P<0.05), and ALB was negatively correlated with lymph node metastasis (r=−0.303, P<0.05). SCC-Ag was positively correlated with FIGO stage and lymph node metastasis in cervical squamous carcinoma (r=0.515, 0.433; both P<0.05). 18F-FDG PET/CT metabolic parameters, inflammatory indexes, and SCC-Ag were not statistically significant correlated with pathologic grade (r: from –0.083 to 0.141, all P>0.05).
    Conclusions The 18F-FDG PET/CT metabolic parameters of the primary foci of cervical squamous carcinoma, inflammatory indexes, and serum tumor markers have different degrees of correlation with clinicopathological features and FIGO grading and can reflect the biological and pathological characteristics of tumors in patients with cervical squamous carcinoma. They are conducive to the evaluation of pathological features and accurate clinical staging of cervical squamous carcinoma.

     

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