杨萌, 陈平, 王心宇, 李宏旭, 王庆祝. 18F-FDG PET/CT代谢参数联合血清CEA、CA19-9、CA72-4水平预测结直肠癌微卫星不稳定性的价值[J]. 国际放射医学核医学杂志, 2024, 48(6): 335-342. DOI: 10.3760/cma.j.cn121381-202305018-00400
引用本文: 杨萌, 陈平, 王心宇, 李宏旭, 王庆祝. 18F-FDG PET/CT代谢参数联合血清CEA、CA19-9、CA72-4水平预测结直肠癌微卫星不稳定性的价值[J]. 国际放射医学核医学杂志, 2024, 48(6): 335-342. DOI: 10.3760/cma.j.cn121381-202305018-00400
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Yang Meng, Chen Ping, Wang Xinyu, Li Hongxu, Wang Qingzhu. Value of 18F-FDG PET/CT metabolic parameters combined with serum CEA, CA19-9, and CA72-4 level in the prediction of microsatellite instability in colorectal cancer[J]. Int J Radiat Med Nucl Med, 2024, 48(6): 335-342. DOI: 10.3760/cma.j.cn121381-202305018-00400
Citation: Yang Meng, Chen Ping, Wang Xinyu, Li Hongxu, Wang Qingzhu. Value of 18F-FDG PET/CT metabolic parameters combined with serum CEA, CA19-9, and CA72-4 level in the prediction of microsatellite instability in colorectal cancer[J]. Int J Radiat Med Nucl Med, 2024, 48(6): 335-342. DOI: 10.3760/cma.j.cn121381-202305018-00400
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18F-FDG PET/CT代谢参数联合血清CEA、CA19-9、CA72-4水平预测结直肠癌微卫星不稳定性的价值

Value of 18F-FDG PET/CT metabolic parameters combined with serum CEA, CA19-9, and CA72-4 level in the prediction of microsatellite instability in colorectal cancer

    摘要
  • 摘要:
    目的  探讨18F-FDG PET/CT联合血清癌胚抗原（CEA）、糖类蛋白（CA）19-9、CA72-4水平预测结直肠癌（CRC）微卫星不稳定性（MSI）的价值。
    方法 回顾性分析2018年6月至2022年12月于郑州大学第一附属医院行18F-FDG PET/CT检查并经术后组织病理学证实为结直肠癌的96例患者男性62例、女性34例，年龄（60.1±13.8）岁的临床资料，根据术后肿瘤组织免疫组织化学检查结果分为MSI组和微卫星稳定性（MSS）组。测量病灶感兴趣区（ROI）的最大标准化摄取值（SUVmax）、标准化摄取峰值，分别以病灶ROI的标准化摄取值（SUV）=2.5及SUVmax的40%为临界值，得到病灶的平均标准化摄取值（SUVmean）和SUVmean40%、肿瘤代谢体积（MTV）和MTV40%、病灶糖酵解总量（TLG）和TLG40%。组间计量资料的比较采用两独立样本t检验和Mann-Whitney U检验；计数资料的比较采用χ2检验。采用多因素Logistic回归分析预测MSI状态的独立危险因素；采用受试者工作特征曲线分析代谢参数及血清肿瘤标志物水平预测MSI状态的价值。
    结果 MSS组患者78例（81.25%，78/96），MSI组患者18例（18.75%，18/96）。MSS组和MSI组患者在原发肿瘤位置、分化程度及血清CEA、CA19-9、CA72-4水平中的差异均有统计学意义（χ2=4.287、5.103，Z=−3.467~−2.412，均P<0.05）。另外，MSI组病灶MTV40%和TLG40%显著高于MSS组27.03（12.07, 53.15）对13.39（8.35, 21.46），294.19（140.79, 679.66）对141.36（81.11，276.12），且差异均有统计学意义（Z=−2.351、−2.104，均P<0.05）。多因素Logistic回归分析结果显示，血清CA72-4水平（OR=1.147，95%CI：1.048~1.255，P=0.003）、TLG40%（OR=1.092，95%CI：1.004~1.187，P=0.041）及MTV40%（OR=0.568，95%CI：0.345~0.936，P=0.026）是预测MSI状态的独立危险因素。当CA72-4水平联合MTV40%预测MSI状态时，AUC为0.79（95%CI：0.643~0.926，P<0.001），灵敏度为72%、特异度为87%；当CA72-4水平联合TLG40%预测MSI状态时，曲线下面积（AUC）为0.81（95%CI：0.676~0.933，P<0.001），灵敏度为67%、特异度为92%；当CA72-4水平联合MTV40%及TLG40%预测MSI状态时，AUC为0.98（95%CI：0.931~0.999，P<0.001），灵敏度为94%、特异度为98%。
    结论 TLG40%、TLG40%及CA72-4水平具有预测CRC患者MSI状态的价值，使用18F-FDG PET/CT代谢参数联合血清肿瘤标志物水平可以实现对CRC患者的MSI状态的无创性评估，从而更好地指导CRC患者的免疫治疗。

     

    Abstract:
    Objective  To investigate the importance of 18F-fluorodeoxyglucose (18F-FDG) PET/CT metabolic parameters combined with serum carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 19-9, and CA72-4 levels in the prediction of microsatellite instability (MSI) status in patients with colorectal cancer (CRC).
    Methods  A retrospective analysis of 96 patients (62 males and 34 females, aged (60.1±13.8) years) who underwent 18F-FDG PET/CT examination and were confirmed as colorectal cancer (CRC) via postoperative histopathology at the First Affiliated Hospital of Zhengzhou University from June 2018 to December 2022 were conducted. The patients were divided into the MSI and microsatellite stability (MSS) groups based on the results of immunohistochemistry. The maximum standardized uptake value (SUVmax) and peak standardized uptake value of region of interest (ROI) were measured, and the SUV of ROI set at 2.5 and 40% of the SUVmax as thresholds, respectively, to obtain mean standardized uptake value (SUVmean) and SUVmean40%, tumor metabolic volume (MTV) and MTV40%, and total lesion glycolysis (TLG) and TLG40%. Two independent sample student's t and Mann-Whitney U tests were conducted for the comparison of differences in the measurement data between groups. Statistical data were compared using χ2 test. The independent predictor of MSI status was analyzed via multivariate Logistic regression. The metabolic parameters and serum tumor markers in the prediction of MSI status were analyzed using the receiver operating characteristic curve.
    Results   Of 96 patients, 78 (81.25%) and 18 (18.75%) were in the MSI and MSS groups, respectively. Significant differences were observed in tumor primary location, differentiation degree and serum levels of CEA, CA19-9, and CA72-4 between the MSS and MSI groups (χ2=4.287, 5.103, Z=−3.467 to –2.412; all P<0.05). In addition, the MSI group exhibited significantly higher MTV40% and TLG40% values than the MSS group (27.03(12.07, 53.15) vs.13.39 (8.35, 21.46), 294.19(140.79, 679.66) vs. 141.36(81.11, 276.12)), and the differences were statistically significant (Z=−2.351, −2.104; both P<0.05). Multivariate Logistic regression analysis revealed that CA72-4 level (OR=1.147, 95%CI: 1.048–1.255, P=0.003), TLG40% (OR=1.092, 95%CI: 1.004–1.187, P=0.041) and MTV40% (OR=0.568, 95%CI: 0.345–0.936, P=0.026) was an independent predictor of MSI status in CRC patients. When CA72-4 level combined with MTV40% predicted MSI status, the area under the curve (AUC) was 0.79(95%CI: 0.643–0.926, P<0.001), sensitivity was 72%, specificity was 87%. When CA72-4 level combined with TLG40% were used to predict MSI status, the AUC was 0.81(95%CI: 0.676–0.933, P<0.001), and the sensitivity and specificity were 67% and 92%, respectively. When CA72-4 level combined with MTV40% and TLG40% were used to predict MSI status, the AUC was 0.98(95%CI: 0.931–0.999, P<0.001), and the sensitivity and specificity respectively reached 94% and 98%.
    Conclusions   MTV40%, TLG40%, and serum CA72-4 level can be applied in the prediction of the MSI status in CRC. The use of 18F-FDG PET/CT metabolic parameters combined with serum tumor markers can achieve the noninvasive assessment of MSI status in patients with CRC for improved guidance on the immunotherapy .

     

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