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结直肠癌(colorectal cancer, CRC)是消化道常见的恶性肿瘤之一,严重威胁人类生命健康,全球发病率居恶性肿瘤第3位,病死率排第4位,且发病率呈逐年上升的趋势[1],早期诊断和准确分期是制定个体化治疗方案和预后评估的基础,PET/CT实现了功能影像与解剖影像的同机融合,为CRC的诊断及分期提供了新方法[2]。SUVmax是PET/CT衡量18F-FDG摄取程度的半定量分析指标,了解SUVmax与临床特征、肿瘤分期的相关性可进一步指导临床治疗、评估预后。笔者对83例手术确诊为CRC患者的临床病理资料和术前18F-FDG PET/CT检查结果进行了回顾性分析,评估术前SUVmax与CRC患者临床病理资料、TNM分期、临床分期的相关性,探讨术前18F-FDG PET/CT显像在CRC分期中的价值。
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83例患者中直肠癌37例,右半结肠癌27例(升结肠癌24例、结肠肝曲癌1例、横结肠癌2例),左半结肠癌19例(乙状结肠癌17例、降结肠癌2例);中分化腺癌64例,低分化腺癌14例,黏液腺癌5例;参照2016年国际抗癌联盟(UICC)CRC术前TNM分期(第八版)标准进行分期:原发灶T2期10例,T3期19例,T4期54例;N0期32例,N1期19例,N2期32例;M0期50例,M1期33例;临床分期:Ⅰ期5例,Ⅱ期20例,Ⅲ期24例,Ⅳ期34例。
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83例CRC患者原发病灶均表现为18F-FDG高摄取,平均SUVmax为14.63±8.10(4.43~48.19);51例(N1+N2期)CRC患者共有190枚淋巴结转移病灶,平均SUVmax为3.61±1.90(0.69~12.57)。
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原发灶SUVmax与年龄、性别、肿瘤部位无关(t=0.041、0.414、F=1.098,均P>0.05),而与肿瘤长径、病理及分化程度有关:肿瘤长径≥3 cm患者的SUVmax高于肿瘤长径 < 3 cm的患者(t=2.497,P < 0.05);低分化腺癌SUVmax高于中分化腺癌和黏液腺癌(F=3.727,P < 0.05)(表 1)。
临床病理参数 例数 原发灶SUVmax(x± s) SUVmax范围 t值或F值 P值 年龄 < 65岁 44 14.67±7.720 4.43~40.11 0.041 0.967 ≥65岁 39 14.59±8.610 6.19~48.19 性别 男 53 14.36±8.940 4. 43~48.19 0.414 0.680 女 30 15.13±6.470 5.31~31.22 部位 右半结肠 27 15.55±9.480 5.31~48.19 1.098 0.339 左半结肠 19 12.24±4.020 7.08~25.52 直肠 37 15.20±8.520 4.43~40.11 肿瘤长径 ≥3 cm 61 15.67±8.730 5.31~48.19 2.497 0.015 < 3 cm 22 11.75±5.180 4.43~27.59 病理及分化程度 低分化腺癌 14 19.05±11.13 8.31~48.19 3.727 0.028 中分化腺癌 64 14.12±7.220 5.31~40.11 黏液腺癌 5 08.83±2.640 4.43~11.14 注:表中,SUVmax:最大标准化摄取值。 表 1 原发灶SUVmax与结直肠癌不同临床病理特征的关系
Table 1. The relationship between the SUVmax of colorectal cancer primary lesions and different clinic pathological features
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不同T分期CRC原发灶的SUVmax差异无统计学意义(F=2.492,P>0.05);不同N分期、M分期CRC原发灶的SUVmax差异有统计学意义:有淋巴结转移组SUVmax高于无淋巴结转移组(t=2.081,P < 0.05),有远处转移组SUVmax高于无远处转移组(t=2.168,P < 0.05);不同临床分期SUVmax组间比较差异有统计学意义(F=2.839,P < 0.05)(表 2、图 1、图 2),但组内比较仅Ⅱ期和Ⅳ期的SUVmax差异有统计学意义(t=2.579,P < 0.05),Ⅰ期和Ⅱ期、Ⅰ期和Ⅲ期、Ⅰ期和Ⅳ期、Ⅱ期和Ⅲ期、Ⅲ期和Ⅳ期组内比较SUVmax差异均无统计学意义(t=0.294、1.342、1.694、1.824、0.802,均P>0.05)。
分期 例数 原发灶SUVmax(x± s) SUVmax范围 t值或F值 P值 T分期 T2 10 11.86±5.42 4.43~20.97 2.492 0.089 T3 19 17.99±10.64 5.31~40.11 T4 54 13.97±7.22 5.60~48.19 N分期 N0 32 12.34±6.17 4.43~28.34 2.081 0.041 N1+N2 51 16.07±8.860 6.64~48.19 M分期 M0 50 12.98±6.34 4.43~31.22 2.168 0.035 M1 33 17.15±9.76 6.64~48.19 TNM分期 Ⅰ期 5 10.05±6.47 4.43~20.97 2.839 0.043 Ⅱ期 20 11.21±5.03 5.31~25.52 Ⅲ期 24 15.23±6.90 7.10~31.22 Ⅳ期 34 16.90±9.72 6.64~48.19 注:表中,SUVmax:最大标准化摄取值。 表 2 不同TNM分期的结直肠癌原发灶SUVmax的比较
Table 2. The SUVmax comparation of the colorectal cancer primary lesions with different TNM staging
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原发灶SUVmax与T分期无相关性(r=0.004,P>0.05),与N分期、M分期、临床分期呈正相关,相关性由大到小依次为临床分期(r=0.324,P < 0.05)、M分期(r=0.273,P < 0.05)、N分期(r=0.248,P < 0.05)。
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转移淋巴结SUVmax与原发灶SUVmax呈正相关(r=0.312,P < 0.05),转移淋巴结SUVmax与原发灶T分期呈正相关(r=0.287,P < 0.05),与M分期及临床分期无关(r=0.083、0.125,P>0.05)。
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本研究中55例CRC患者经病理证实伴随淋巴结和(或)远处转移,28例无转移,ROC曲线示原发灶SUVmax预测CRC转移的曲线下面积为0.731,Youden指数为0.443,阈值为10.13,原发灶SUVmax=10.13时诊断淋巴结和(或)远处转移的灵敏度为80%,特异度为64.3%,SUVmax>10.13时,病灶出现转移的可能性更大(图 3)。
18F-FDG PET/CT显像与结直肠癌治疗前分期的相关性研究
Correlation between 18F-FDG PET/CT and pretreatment staging of colorectal cancer
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摘要:
目的评价结直肠癌原发灶最大标准化摄取值(SUVmax)与临床病理资料、TNM分期、临床分期的相关性。 方法回顾性分析83例已确诊的结直肠癌患者资料,所有患者均于治疗前1周内行18F-FDG PET/CT检查,并测量原发灶SUVmax,采用单因素方差分析及两独立样本t检验进行组间比较。采用Spearman相关分析评价SUVmax与TNM分期及临床分期的相关性。 结果原发灶SUVmax与肿瘤长径(t=2.497,P < 0.05)、病理及分化程度有关(F=3.727,P < 0.05);不同T分期结直肠癌原发灶的SUVmax差异无统计学意义(F=2.492,P>0.05);不同N分期、M分期、临床分期结直肠癌原发灶的SUVmax差异有统计学意义(t=2.081、2.168、F=2.839,均P < 0.05);原发灶SUVmax与T分期无相关性(r=0.004,P>0.05),与N分期、M分期、临床分期呈正相关(r=0.248、0.273、0.324,均P < 0.05)。 结论结直肠癌原发灶SUVmax与肿瘤长径、病理及分化程度、N分期、M分期、临床分期有关,可反映肿瘤的增殖、侵袭能力。 -
关键词:
- 结直肠肿瘤 /
- 分期 /
- 正电子发射断层显像术 /
- 体层摄影术, X线计算机 /
- 标准化摄取值
Abstract:ObjectiveTo investigate the correlation between the maximum standardized uptake value(SUVmax) of colorectal cancer primary lesions and clinical pathological features, such as TNM staging and clinical staging. MethodsEighty-three patients diagnosed with colorectal cancer and without any previous treatment were retrospectively analyzed and underwent 18F-fluorodeoxyglucose PET/CT examinations within one week, in which the SUVmax of the primary lesions was measured. Data were compared using one-way ANOVA and two-sample t test. Spearman correlation analysis was used to evaluate the correlation of the SUVmax of colorectal cancer primary lesions with TNM staging and clinical staging. ResultsThe SUVmax of colorectal cancer primary lesions correlated with the tumor diameter(t=2.497, P < 0.05), pathological type and differentiation degree(F=3.727, P < 0.05). Statistically significant differences were found in the SUVmax of different N stages, M stages, and clinical stages(t=2.081, t=2.168, F=2.839, all P < 0.05) but not in the SUVmax of different T stages. The SUVmax of colorectal cancer primary lesions positively correlated with N, M, and clinical stages(r=0.248, 0.273, 0.324, all P < 0.05) but not with T stages (r=0.004, P>0.05). ConclusionsThe SUVmax of colorectal cancer primary lesions correlated with the tumor diameter, pathological type, differentiation degree, N stages, M stages, and clinical stages. Hence, SUVmax can reflect the invasion and proliferation abilities of colorectal cancer. -
表 1 原发灶SUVmax与结直肠癌不同临床病理特征的关系
Table 1. The relationship between the SUVmax of colorectal cancer primary lesions and different clinic pathological features
临床病理参数 例数 原发灶SUVmax(x± s) SUVmax范围 t值或F值 P值 年龄 < 65岁 44 14.67±7.720 4.43~40.11 0.041 0.967 ≥65岁 39 14.59±8.610 6.19~48.19 性别 男 53 14.36±8.940 4. 43~48.19 0.414 0.680 女 30 15.13±6.470 5.31~31.22 部位 右半结肠 27 15.55±9.480 5.31~48.19 1.098 0.339 左半结肠 19 12.24±4.020 7.08~25.52 直肠 37 15.20±8.520 4.43~40.11 肿瘤长径 ≥3 cm 61 15.67±8.730 5.31~48.19 2.497 0.015 < 3 cm 22 11.75±5.180 4.43~27.59 病理及分化程度 低分化腺癌 14 19.05±11.13 8.31~48.19 3.727 0.028 中分化腺癌 64 14.12±7.220 5.31~40.11 黏液腺癌 5 08.83±2.640 4.43~11.14 注:表中,SUVmax:最大标准化摄取值。 表 2 不同TNM分期的结直肠癌原发灶SUVmax的比较
Table 2. The SUVmax comparation of the colorectal cancer primary lesions with different TNM staging
分期 例数 原发灶SUVmax(x± s) SUVmax范围 t值或F值 P值 T分期 T2 10 11.86±5.42 4.43~20.97 2.492 0.089 T3 19 17.99±10.64 5.31~40.11 T4 54 13.97±7.22 5.60~48.19 N分期 N0 32 12.34±6.17 4.43~28.34 2.081 0.041 N1+N2 51 16.07±8.860 6.64~48.19 M分期 M0 50 12.98±6.34 4.43~31.22 2.168 0.035 M1 33 17.15±9.76 6.64~48.19 TNM分期 Ⅰ期 5 10.05±6.47 4.43~20.97 2.839 0.043 Ⅱ期 20 11.21±5.03 5.31~25.52 Ⅲ期 24 15.23±6.90 7.10~31.22 Ⅳ期 34 16.90±9.72 6.64~48.19 注:表中,SUVmax:最大标准化摄取值。 -
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