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. 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. DOI: 10.3760/cma.j.cn121381-202305018-00400
Meng Yang, Ping Chen, Xinyu Wang, Hongxu Li, Qingzhu Wang. Application of 18F-FDG PET/CT metabolic parameters combined with serum CEA、CA19-9、CA72-4 in the prediction of microsatellite instability in colorectal cancer[J]. Int J Radiat Med Nucl Med. DOI: 10.3760/cma.j.cn121381-202305018-00400
Citation: Meng Yang, Ping Chen, Xinyu Wang, Hongxu Li, Qingzhu Wang. Application of 18F-FDG PET/CT metabolic parameters combined with serum CEA、CA19-9、CA72-4 in the prediction of microsatellite instability in colorectal cancer[J]. Int J Radiat Med Nucl Med. DOI: 10.3760/cma.j.cn121381-202305018-00400

18F-FDG PET/CT代谢参数联合血清CEA、CA19-9、CA72-4预测结直肠癌微卫星不稳定性的价值

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

  • 摘要:
    目的 探讨18F-FDG PET/CT联合血清CEA、CA19-9、CA72-4预测结直肠癌(CRC)微卫星不稳定性(MSI)的价值。
    方法 回顾性分析郑州大学第一附属医院2018年6月至2022年12月间行18F-FDG PET/CT检查并于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,平均年龄(60.06±13.80)岁的临床资料,根据术后肿瘤组织免疫组化结果分为MSI组及微卫星稳定(MSS)组。测量病灶ROI的最大标准化摄取值(SUVmax)、标准化摄取峰值(SUVpeak),分别以病灶ROI的标准化摄取值(SUV)=2.5及SUVmax的40%为阈值,得到病灶的平均标准化摄取值(SUVmean)、肿瘤代谢体积(MTV)、病灶糖酵解总量(TLG)。通过两独立样本t检验比较组间患者年龄差异,采用χ2检验分析比较患者性别、肿瘤位置、组织学类型、分化程度、TNM分期等临床资料的组间差异,采用Mann-Whitney U检验分析不同MSI状态患者肿瘤沿长轴最大长度、病灶代谢参数及血清CEA、CA199、CA724的差异,通过多因素Logistic回归分析预测MSI状态的独立危险因素;利用受试者工作曲线分析代谢参数及血清肿瘤标志物预测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组在肿瘤原发位置、分化程度及血清CEA、CA19-9、CA72-4水平等方面差异存在统计学意义(χ2=4.287~5.103,Z−3.467~2.412,均P<0.05)。另外,2组患者在性别、年龄、肿瘤沿肠轴长度、组织学类型、大体类型、区域淋巴结转移、TNM分期、脉管侵犯、神经侵犯及切缘侵犯中的差异均无统计学意义(t=0.626,χ2=0~3.108,均P>0.05);SUVmax、SUVpeak和以SUV=2.5为阈值的病灶SUVmean、MTV及TLG的组间差异均无统计学意义(Z=−1.685~−0.122,均P>0.05);以SUVmax的40%为阈值的病灶MTV40%Z=−2.351,P=0.019)和TLG40%值(Z=−2.104,P=0.035),MSI组明显高于MSS组,差异具有统计学意义。多因素Logistic回归分析显示血清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联合TLG40%预测MSI状态时,AUC为0.81(95%CI:0.676~0.933,P<0.001),灵敏度为67%,特异度为92%。
    结论 TLG40%、TLG40%及CA72-4具有预测结直肠癌患者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来评估结直肠癌患者的MSI状态,可以实现对MSI的无创性评估,从而更好地指导结直肠癌患者的免疫治疗。

     

    Abstract:
    Objective To investigate the value of 18F-FDG PET/CT metabolic parameters combined with serum CEA、CA19-9、CA72-4 in predicting microsatellite instability (MSI)state in patients with colorectal cancer(CRC).
    Methods The clinicl data of 96 patients 62 males,34 females, aged (60.06±13.80 years) who received PET/CT examination and pathologically confirmed as colorectal cancer in the First Affiliated Hospital of Zhengzhou University from June 2018 to August 2022 were retrospectively analyzed. The patients were divided into MSI group and microsatellite stability (MSS) group according to the results of immunohistochemistry. Maximum standardized uptake value (SUVmax) and peak standardized uptake value (SUVpeak) of region of in inrerest (ROI) were measured, and the standardized uptake value of ROI was 2.5 and 40% of SUVmax as thresholds, respectively, to obtain SUVmean, tumor metabolic volume (MTV) and total lesion glycolysis (TLG). Two independent sample Student's t, χ2test and Mann-Whitney U test were used to compare the differences of each parameter between MSI group and MSS group. Multivariate logistic regression was used to analyze the independent predictor of MSI. ROC curve was used to analyze its predictive efficacy.
    Results A tatol of 96 patients,78 (81.25%) were MSI state and 18 (18.75%) were MSS state. There were significant differences of in tumor primary location, differentiation degree and serum levels of CEA, CA19-9 and CA72-4 between MSS group and MSI group (χ2=4.287~5.103, Z=−3.467~2.412, all P<0.05). In addition, there was no significant difference in sex, age, tumor length along intestinal axis, histological type, gross type, regional lymph node metastasis, TNM stage, vascular invasion, nerve invasion and margin invasion between the two groups (t=0.626, χ2=0~3.108, all P>0.05). There was no significant difference in SUVmax, SUVpeak and SUVmean, MTV and TLG with SUV=2.5 as the threshold (Z−1.685~−0.122, all P>0.05). The MTV (Z=−2.351, P=0.019) and TLG (Z=−2.104, P=0.035) of the lesions with 40% of SUVmax as the threshold were significantly higher in MSI group than in MSS group, and the difference was statistically significant. Multivariate logistic regression analysis showed that CA72-4 (OR=1.147, 95%CI: 1.048~1.255, P=0.003), MTV40% (OR=1.092, 95%CI: 1.004~1.187, P=0.041)and TLG40% (OR=0.568, 95%CI: 0.345~0.936, P=0.026) was the independent predictor of MSI state in colorectal cancer patients. The AUC of MSI status of colorectal cancer measured by serum CA72-4 combined with MTV40% were 0.79 (95%CI: 0.643~0.926, P<0.001), sensitivity was 72%, specificity was 87%; when CA72-4 combined with TLG-40% predicted MSI status, AUC was 0.81 (95%CI: 0.676~0.933, P<0.001), sensitivity was 67%, specificity was 92%.
    Conclusions MTV40%, TLG40% and serum CA72-4 can predict MSI state in colorectal cancer. Using 18F-FDG PET/CT metabolic parameters combined with serum tumor markers to evaluate the status of MSI in patients with colorectal cancer can achieve non-invasive evaluation of MSI, so as to better guide the immunotherapy of CRC patients.

     

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