-
胃癌是常见的消化道系统恶性肿瘤之一,发病率在全球恶性肿瘤中位居第6位[1]。在我国,胃癌的发病率和病死率均位居恶性肿瘤的第2位[2],严重威胁人类的生命健康,且整体预后差。胃癌的术前诊断及其分期是制定胃癌综合治疗方案的前提,目前用于评估胃癌的影像学技术包括胃镜、超声内镜检查、X射线、CT、MRI和PET/CT等。随着影像学技术的发展,18F-FDG PET/CT在胃癌诊断中被广泛应用,其可以同时对胃癌原发灶、淋巴结及远处组织转移作出准确判断,但手术病理结果仍然是胃癌诊断的“金标准”,故本研究重点探讨胃癌18F-FDG PET/CT影像学表现与临床病理的相关性。
-
由表1可知,胃癌原发灶SUVmax在原发灶长径、原发灶部位和病理类型组间的差异有统计学意义(t=7.022,P=0.001;t=5.564,P=0.005;t=2.212,P=0.029)。
临床病理特征 例数 SUVmax ( ±s)$ \scriptstyle\bar x $ t值或F 值 P值 性别 0.580 0.565 男 73 5.553±2.663 女 28 6.050±4.216 年龄 0.468 0.640 <65岁 68 5.588±3.240 ≥65岁 33 5.903±3.011 原发灶长径(D) 7.022 0.001 <4 cm 23 3.774±1.062 4 cm≤D<8 cm 54 6.552±3.695 ≥8 cm 24 5.592±2.305 病理类型 2.212 0.029 印戒细胞癌 17 4.176±1.724 非印戒细胞癌a 84 5.998±3.295 分化程度 1.109 0.270 分化型 35 6.169±3.536 未分化型b 66 5.438±2.931 原发灶部位 5.564 0.005 胃底、贲门 23 7.157±4.425 胃体 48 4.710±2.010 胃窦 30 6.137±3.069 淋巴结 0.297 0.769 转移 80 5.630±2.814 未转移 21 5.924±4.292 T分期 0.865 0.389 T1~T2期 19 5.126±3.525 T3~T4期 82 5.822±3.072 N分期 0.265 0.851 N0期 21 5.924±4.292 N1期 15 5.227±2.067 N2期 18 6.106±3.443 N3期 47 5.577±2.788 M分期 0.525 0.601 M0期 90 5.749±3.267 M1期 11 5.218±2.075 临床分期 0.378 0.769 Ⅰ期 11 5.155±4.530 Ⅱ期 14 5.329±2.123 Ⅲ期 65 5.940±3.253 Ⅳ期 11 5.218±2.075 注:表中,a:包括中、低分化腺癌及黏液腺癌、神经内分泌癌;b:包括低分化腺癌、印戒细胞癌、黏液腺癌及神经内分泌癌。SUVmax:最大标准化摄取值 表 1 101例胃癌患者原发灶SUVmax在各项临床病理特征 间的比较
Table 1. Comparison SUVmax in primary lesions amony clinicopathological features in 101 patients with gastric cancer
-
Pearson相关性分析结果表明,原发灶SUVmax与胃癌原发灶的长径、短径、厚度呈正相关(r=0.209,P=0.036;r=0.245,P=0.013;r=0.359,P<0.001)。
-
PET/CT诊断胃癌淋巴结转移的灵敏度为71.3%(57/80)、特异度为81.0%(17/21)、阳性预测值为93.4%(57/61)、阴性预测值为42.5%(17/40)、准确率为73.3%(74/101)。PET/CT诊断胃癌N0、N1、N2、N3分期淋巴结转移的灵敏度分别为0、60.0%(9/15)、61.1%(11/18)、78.7%(37/47)。
-
单因素分析结果表明,淋巴结转
移中可将不同的分化程度及不同的T分期纳入Logistic回归分析( χ2=3.679,P=0.055;χ2=22.435,P=0.000)(表2) 。多因素Logistic回归分析结果显示,T分期是预测淋巴结转移的独立因素(OR=12.648,95%CI:3.905~40.961,P<0.001)(表3)。 临床病理
特征淋巴结转移组
(n=80)淋巴结未转移组
(n=21)t值或χ2值 P值 年龄(岁) 60.15±11.50 58.19±11.12 0.700 0.486 性别(例) 0.996 0.318 男 56 17 女 24 4 原发灶部位(例) 1.467 0.480 贲门、胃底 20 3 胃体 38 10 胃窦 22 8 病理类型(例) 1.778 0.182 印戒细胞癌 16 1 非印戒细胞癌a 64 20 分化程度(例) 3.679 0.055 分化型 24 11 未分化型b 56 10 T分期(例) 22.435 <0.001 T1~T2期 7 12 T3~T4期 73 9 M分期(例) 1.978 0.160 M0期 69 21 M1期 11 0 临床分期(例) 53.123 0.000 Ⅰ期 1 10 Ⅱ期 6 8 Ⅲ期 62 3 Ⅳ期 11 0 原发灶SUVmax 5.630±2.814 5.924±4.292 0.297 0.769 注:表中,a:包括中、低分化腺癌及黏液腺癌、神经内分泌癌;b:包括低分化腺癌、印戒细胞癌、黏液腺癌及神经内分泌癌。SUVmax:最大标准化摄取值 表 2 2组胃癌患者淋巴结是否转移与各项临床病理特征的 关系
Table 2. The relationship between lymph node metastasis in 2 groups of gastric cancer patients and various clinicopathological features
参数 B值 标准误 Wald值 OR值 95%可变区间 P值 中分化/低分化 0.662 0.577 1.319 1.939 0.626~6.004 0.251 T1~T2期/T3~T4期 2.537 0.600 17.911 12.648 3.905~40.961 <0.001 表 3 101例胃癌患者淋巴结转移的多因素Logistic回归分析
Table 3. The multivariate Logistic regression analysis of lymph node metastasis in 101 patients with gastric cancer
胃癌18F-FDG PET/CT影像学表现与临床病理的相关性研究
Correlative studies between 18F-FDG PET/CT findings and pathology of gastric cancer
-
摘要:
目的 探讨胃癌18F-氟脱氧葡萄糖(FDG) PET/CT影像学表现与临床病理的相关性。 方法 回顾性分析2011年10月至2016年6月在福建省肿瘤医院行PET/CT检查并接受手术治疗的101例胃癌患者的临床病理资料,其中男性73例、女性28例,年龄25~81(59.74±11.39)岁。分析PET/CT原发灶的最大标准化摄取值(SUVmax)、厚度及淋巴结转移等情况,以性别、年龄、原发灶部位、原发灶长径、病理类型及分化程度、TNM(肿瘤、结节、转移)分期及临床分期为分组条件,采用独立样本t检验、单因素方差分析评价各组间SUVmax的差异,采用Pearson相关性分析评价SUVmax与原发灶大小之间的关系。筛选有统计学差异的指标纳入多因素Logistic回归分析,评价淋巴结转移与各因素之间的关系。 结果 101例胃癌患者原发灶的SUVmax在原发灶长径D(<4 cm:3.774±1.062,4 cm≤D<8 cm:6.552±3.695,≥8 cm:5.592±2.305)、原发灶部位(胃底及贲门:7.157±4.425,胃体:4.710±2.010,胃窦:6.137±3.069)和病理类型(印戒细胞癌:4.176±1.724,非印戒细胞癌:5.998±3.295)组间的差异有统计学意义(t=7.022, P=0.001;t=5.564,P=0.005;t=2.212,P=0.029)。Pearson 相关性分析结果表明,SUVmax与胃癌原发灶的长径、短径、厚度呈正相关(r=0.209,P=0.036;r=0.245,P=0.013;r=0.359,P<0.001)。PET/CT诊断胃癌淋巴结转移的灵敏度、特异度、准确率分别为71.3%(57/80)、81.0%(17/21)、73.3%(74/101)。多因素Logistic回归分析结果表明,T分期是淋巴结是否转移的独立相关因素(OR=12.648,95%CI:3.905~40.961, P<0.001)。 结论 胃癌原发灶SUVmax与肿瘤大小、部位、病理类型有关,T分期是预测淋巴结转移的独立因素。 -
关键词:
- 正电子发射断层显像术 /
- 体层摄影术,X线计算机 /
- 胃肿瘤 /
- 淋巴结转移 /
- 氟脱氧葡萄糖F18 /
- 最大标准化摄取值
Abstract:Objective To investigate the correlation between findings from 18F-fluorodeoxyglucose (FDG) PET/CT and pathology of gastric cancer. Methods A retrospective analysis was performed on data collected from 101 patients with gastric cancer, including 73 males and 28 females, aged 25−81 ( 59.74±11.39) years old, who underwent PET/CT examination and surgical treatment in Fujian Provincial Cancer Hospital from October 2011 to June 2016. Maximum standardized uptake value (SUVmax) in primary lesion, thickness of primary lesions, and lymph node metastasis in PET/CT were recorded. According to gender, age, location of primary lesion, length of primary lesion, pathological type and differentiation degree of primary lesion, TNM (tumor, node, metastasis) stage and clinical stage. Independent sample t test and one-way ANOVA were used to evaluate the difference in SUVmax between each group. Pearson correlation analysis was employed to examine the relationship between SUVmax and the size of primary lesion. Indices with statistical differences were included in multivariate Logistic regression analysis to evaluate the relationship between lymph node metastasis and each factor. Results Difference of SUVmax in length (<4 cm: 3.774±1.062, 4 cm≤D<8 cm: 6.552±3.695, ≥8 cm: 5.592±2.305), location (gastric fundus and cardia: 7.157±4.425, gastric body: 4.710±2.010, gastric antrum: 6.137±3.069), and pathological type of gastric cancer (signet ring cell carcinoma: 4.176±1.724, non-signet ring cell carcinoma: 5.998±3.295) were statistically significant (t=7.022, P=0.001; t=5.564, P=0.005; t=2.212, P=0.029). The results of Pearson correlation analysis showed that SUVmax was positively correlated with the length, width and thickness of gastric cancer (r=0.209, P=0.036; r=0.245, P=0.013; r=0.359, P<0.001). The sensitivity, specificity and accuracy of PET/CT in the diagnosis of lymph node metastasis of gastric cancer were 71.3% (57/80), 81.0% (17/21) and 73.3% (74/101), respectively. The result of multivariate Logistic regression analysis showed that T stage is an independent correlation factor for lymph node metastasis (OR=12.648, 95%CI=3.905−40.961, P<0.001). Conclusions The SUVmax of primary gastric cancer lesion is related to size, location, and pathological type. T stage is an independent predictor of lymph node metastasis. -
表 1 101例胃癌患者原发灶SUVmax在各项临床病理特征 间的比较
Table 1. Comparison SUVmax in primary lesions amony clinicopathological features in 101 patients with gastric cancer
临床病理特征 例数 SUVmax ( ±s)$ \scriptstyle\bar x $ t值或F 值 P值 性别 0.580 0.565 男 73 5.553±2.663 女 28 6.050±4.216 年龄 0.468 0.640 <65岁 68 5.588±3.240 ≥65岁 33 5.903±3.011 原发灶长径(D) 7.022 0.001 <4 cm 23 3.774±1.062 4 cm≤D<8 cm 54 6.552±3.695 ≥8 cm 24 5.592±2.305 病理类型 2.212 0.029 印戒细胞癌 17 4.176±1.724 非印戒细胞癌a 84 5.998±3.295 分化程度 1.109 0.270 分化型 35 6.169±3.536 未分化型b 66 5.438±2.931 原发灶部位 5.564 0.005 胃底、贲门 23 7.157±4.425 胃体 48 4.710±2.010 胃窦 30 6.137±3.069 淋巴结 0.297 0.769 转移 80 5.630±2.814 未转移 21 5.924±4.292 T分期 0.865 0.389 T1~T2期 19 5.126±3.525 T3~T4期 82 5.822±3.072 N分期 0.265 0.851 N0期 21 5.924±4.292 N1期 15 5.227±2.067 N2期 18 6.106±3.443 N3期 47 5.577±2.788 M分期 0.525 0.601 M0期 90 5.749±3.267 M1期 11 5.218±2.075 临床分期 0.378 0.769 Ⅰ期 11 5.155±4.530 Ⅱ期 14 5.329±2.123 Ⅲ期 65 5.940±3.253 Ⅳ期 11 5.218±2.075 注:表中,a:包括中、低分化腺癌及黏液腺癌、神经内分泌癌;b:包括低分化腺癌、印戒细胞癌、黏液腺癌及神经内分泌癌。SUVmax:最大标准化摄取值 表 2 2组胃癌患者淋巴结是否转移与各项临床病理特征的 关系
Table 2. The relationship between lymph node metastasis in 2 groups of gastric cancer patients and various clinicopathological features
临床病理
特征淋巴结转移组
(n=80)淋巴结未转移组
(n=21)t值或χ2值 P值 年龄(岁) 60.15±11.50 58.19±11.12 0.700 0.486 性别(例) 0.996 0.318 男 56 17 女 24 4 原发灶部位(例) 1.467 0.480 贲门、胃底 20 3 胃体 38 10 胃窦 22 8 病理类型(例) 1.778 0.182 印戒细胞癌 16 1 非印戒细胞癌a 64 20 分化程度(例) 3.679 0.055 分化型 24 11 未分化型b 56 10 T分期(例) 22.435 <0.001 T1~T2期 7 12 T3~T4期 73 9 M分期(例) 1.978 0.160 M0期 69 21 M1期 11 0 临床分期(例) 53.123 0.000 Ⅰ期 1 10 Ⅱ期 6 8 Ⅲ期 62 3 Ⅳ期 11 0 原发灶SUVmax 5.630±2.814 5.924±4.292 0.297 0.769 注:表中,a:包括中、低分化腺癌及黏液腺癌、神经内分泌癌;b:包括低分化腺癌、印戒细胞癌、黏液腺癌及神经内分泌癌。SUVmax:最大标准化摄取值 表 3 101例胃癌患者淋巴结转移的多因素Logistic回归分析
Table 3. The multivariate Logistic regression analysis of lymph node metastasis in 101 patients with gastric cancer
参数 B值 标准误 Wald值 OR值 95%可变区间 P值 中分化/低分化 0.662 0.577 1.319 1.939 0.626~6.004 0.251 T1~T2期/T3~T4期 2.537 0.600 17.911 12.648 3.905~40.961 <0.001 -
[1] Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012[J]. Int J Cancer, 2015, 136(5): E359−E386. DOI: 10.1002/ijc.29210. [2] Chen WQ, Zheng RS, Baade PD, et a1. Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016, 66(2): 115−132. DOI: 10.3322/caac.21338. [3] Washington K. 7th edition of the AJCC cancer staging manual: stomach[J]. Ann Surg Oncol, 2010, 17(12): 3077−3079. DOI: 10.1245/s10434-010-1362-z. [4] 谢静, 方军, 金木兰, 等. 胃癌病理分型研究进展[J]. 中国实用内科杂志, 2014, 34(6): 626−630. DOI: 10.7504/nk2014050803.
Xie J, Fang J, Jin ML, et al. Progress in pathological classification of gastric cancer[J]. Chin J Pract Intern Med, 2014, 34(6): 626−630. DOI: 10.7504/nk2014050803.[5] 徐鑫, 邓胜明, 李继会, 等. 18F-FDG PET/CT在胃癌分期、复发检测及预后评估中的应用价值[J]. 国际放射医学核医学杂志, 2018, 42(6): 541−546. DOI: 10.3760/j.issn.1673-4114.2018.06.012.
Xu X, Deng SM, Li JH, et al. Progress in research on the use of 18F-FDG PET/CT in the staging, recurrence detection, and prognosis evaluation of patients with gastric carcinoma[J]. Int J Radiat Med Nucl Med, 2018, 42(6): 541−546. DOI: 10.3760/j.issn.1673-4114.2018.06.012.[6] Kitajima K, Nakajo M, Kaida H, et al. Present and future roles of FDG-PET/CT imaging in the management of gastrointestinal cancer: an update[J]. Nagoya J Med Sci, 2017, 79(4): 527−543. DOI: 10.18999/nagjms.79.4.527. [7] Oh HH, Lee SE, Choi IS, et al. The peak-standardized uptake value (P-SUV) by preoperative positron emission tomography-computed tomography (PET-CT) is a useful indicator of lymph node metastasis in Gastric Cancer[J]. J Surg Oncol, 2011, 104(5): 530−533. DOI: 10.1002/jso.21985. [8] Mocellin S, Pasquali S. Diagnostic accuracy of endoscopic ultrasonography (EUS) for the preoperative locoregional staging of primary gastric cancer[J/OL]. Cochrane Database Syst Rev, 2015, 6(2): CD009944[2019-05-30]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6465120. DOI: 10.1002/14651858.CD009944.pub2. [9] Kamimura K, Nagamachi S, Wakamatsu H, et al. Role of gastric distention with additional water in differentiating locally advanced gastric carcinomas from physiological uptake in the stomach on 18F-fluoro-2-deoxy-D-glucose PET[J]. Nucl Med Commun, 2009, 30(6): 431−439. DOI:10.1097/MNM.0b013e3283299a2f. [10] Chon HJ, Kim C, Cho A, et al. The clinical implications of FDG-PET/CT differ according to histology in advanced gastric cancer[J]. Gastric Cancer, 2019, 22(1): 113−122. DOI: 10.1007/s10120-018-0847-5. [11] Berlth F, Mönig S, Pinther B, et al. Both glut-1 and glut-14 are independent prognostic factors in gastric adenocarcinoma[J]. Ann Surg Oncol, 2015, 31 Spuppl 3: S822−831. DOI: 10.1245/s10434-015-4730-x. [12] Pak KH, Yun M, Cheong JH, et al. Clinical implication of FDG-PET in advanced gastric cancer with signet ring cell histology[J]. J Surg Oncol, 2011, 104(6): 566−570. DOI: 10.1002/jso.21997. [13] Malibari N, Hickeson M, Lisbona R, et al. PET/computed tomography in the diagnosis and staging of gastric cancers[J]. PET Clin, 2015, 10(3): 311−326. DOI: 10.1016/j.cpet.2015.03.008. [14] 崔建新, 李婷, 郗洪庆, 等. 18氟-脱氧葡萄糖正电子发射计算机断层成像术在胃癌术前分期中应用价值的Meta分析[J]. 中华胃肠外科杂志, 2013, 16(5): 418−424. DOI: 10.3760/cma.j.issn.1671-0274.2013.05.005.
Cui JX, Li T, Xi HQ, et al. Evaluation of 18F-FDG PET/CT in preoperative staging of gastric cancer:a meta-analysis[J]. Chin J Gastrointest Surg, 2013, 16(5): 418−424. DOI: 10.3760/cma.j.issn.1671-0274.2013.05.005.[15] 黄世明, 罗燕薇, 尹亮, 等. 18F-FDG PET/CT与CT诊断胃癌淋巴结转移直接比较的系统评价[J]. 标记免疫分析与临床, 2017, 24(4): 384−389. DOI: 10.11748/bjmy.issn.1006-1703.2017.04.006.
Huang SM, Luo YW, Yin L, et al. Direct comparison of 18F-FDG PET/CT and CT in the diagnosis of lymph node metastasis of gastric cancer: a systematic review[J]. Labeled Immunoassay Clin Med, 2017, 24(4): 384−389. DOI: 10.11748/bjmy.issn.1006-1703.2017.04.006.[16] Chae S, Lee A, Lee JH, et al. The effectiveness of the new (7th) UICC N classification in the prognosis evaluation of gastric cancer patients: a comparative study between the 5th/6th and 7th UICC N classification[J]. Gastric Cancer, 2011, 14(2): 166−171. DOI: 10.1007/s10120-011-0024-6. [17] Kudou M, Kosuga T, Kubota T, et al. Value of preoperative PET-CT in the prediction of pathological stage of gastric cancer[J]. Ann Surg Oncol, 2018, 25(6): 1633−1639. DOI: 10.1245/s10434-018-6455-0. [18] 宋林杰, 那兴邦, 张红亮, 等. 术前PET-CT p-SUV值与胃癌淋巴结转移相关性研究[J]. 腹部外科, 2018, 31(4): 235−237. DOI: 10.3969/j.issn.1003-5591.2018.04.003.
Song LJ, Na XB, Zhang HL, et al. Correlation between preoperational PET-CT p-SUV values and lymph node metastasis in patients with gastric cancer[J]. J Abd Surg, 2018, 31(4): 235−237. DOI: 10.3969/j.issn.1003-5591.2018.04.003.