序贯18F-FDG PET/CT显像在非手术治疗食管癌同步放化疗疗效预测中的价值  

Predictive value of sequential 18F-FDG PET/CT scan in concurrent chemoradiotherapy of non-surgical esophageal carcinoma

作　　者：李夷民[1] 林勤[1] 王丽琛[1] 孙龙[2] 戴明明[1] 罗作明[2] 郑华[1] 赵龙[2] 吴华[2] 

机构地区：[1]361003,厦门大学附属第一医院肿瘤放射治疗科 [2]361003,厦门大学附属第一医院核医学科

出　　处：《中华核医学与分子影像杂志》2013年第6期-,共7页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：厦门市科技计划指导性项目，福建省科技项目

摘　　要：目的 利用序贯18F-FDG PET/CT显像观察非手术食管癌同步放化疗(CCRT)中肿瘤代谢变化规律,探讨其预测价值.方法 2009年5月至2011年10月前瞻性入组并经病理证实、拟行CCRT的28例食管鳞状细胞癌(简称鳞癌)患者,在CCRT前、放疗总剂量(DT)达50 Gy时、DT达60 Gy时、CCRT后1个月进行18F-FDG PET/CT显像;记录4次显像的食管放射性异常浓聚区SUVmax,分别记为SUVmax1～4.采用软件自动勾画放疗前的大于40％ SUVmax的原发灶及邻近淋巴结,计算两者体积和,命名为MTV.CCRT后对患者进行定期随访,中位随访时间为18.5个月,记录无进展生存期(PFS)、无复发生存期(RFS)及总生存期(OS).将患者按有无疾病进展、有无复发及有无死亡各自进行分组,采用Mann-Whitney u检验比较组间SUVmax和SUVmax变化率的差异.用ROC曲线计算MTV等参数预测生存的最优阈值,并采用Kaplan-Meier及Cox回归分析进行生存分析.结果 截至随访结束,28例患者中,进展19例,无进展9例;复发17例,无复发11例;死亡15例,生存13例.有无复发组间SUVmax2(7.4±3.3与4.8±2.5)及SUVmax3(5.5±2.1与3.8±2.1)差异均有统计学意义(u=46、47,均P＜0.05).SUVmax4在有无进展组间(5.3±3.9与2.4±1.7)、有无复发组间(5.6±4.0与2.4±1.5)和有无死亡组间(5.8±4.2与2.6±1.5)差异均有统计学意义(u=31、26、29,均P＜0.05);△R14[(SUVmax1-SUVmax4)/SUVmax1]的差异也如此(0.49±0.57与0.76±0.22、0.48±0.60与0.73±0.22、0.44±0.64与0.73±0.19;u=39、50、53,均P＜0.05).28例患者治疗前MTV均值为19.3 ml,ROC曲线计算的最优预测阈值为12.4 ml(P＜0.01),治疗前MTV≥12.4 ml者PFS较＜12.4 ml者短,中位值分别为13.1个月及31.4个月(x2=9.0,P＜0.05).△R14预测PFS及OS的最佳阈值为0.75.Cox回归多因素生存分析示,MTV是影响PFS及RFS的独立预后因素,Wald值依次为10.80、10.30,风险比依次为1.13、1.14.结论 CCRT前的MTV是预测非手术食管癌CCRT疗效的独立预后因素.SUVmax2～4对治�Objective To investigate the metabolic changes during the concurrent chemoradiotherapy (CCRT) of non-surgical esophageal squamous cell cancer (ESCC) and to explore the predictive value of sequential 18F-FDG PET/CT scan in CCRT.Methods From May 2009 to October 2011,28 patients with pathologically confirmed ESCC were prospectively enrolled into this study.All patients received definitive treatment with CCRT.18F-FDG PET/CT scans were performed at the following 4 time points:before therapy,at the time when radiation dose reached 50 Gy and 60 Gy,and one month after treatment completion.SUVmax of the 4 time points were recorded as SUVmax1--4.The volume of the area with SUV greater than 40％SUVmax in primary tumor and adjacent lymph node was summed and named as MTV.The starting point of all survival data was from primary disease documentation.All patients had regular follow-up (median time:18.5 months) to record the disease status,including progress free survival (PFS),recurrence free survival (RFS) and overall survival (OS).Patients were divided into different groups according to the following status:progress free or progress,no recurrence or recurrence and death or living.The Mann-Whitney u test was used to compare SUVmax and the rate of △SUVmax in different groups.The AUC of ROC curve was calculated to find the optimal threshold of MTV.Kaplan-Meier and Cox regression were utilized to analyze the differentiation of survival.Results Among the 28 patients,19 showed disease progression,17 showed recurrence and 15 died during follow-up.In the groups of recurrence or no recurrence,there were statistical differences for SUVmax2 and SUVmax3,(SUVmax2:7.4±3.3 vs 4.8±2.5 ; SUVmax3:5.5±2.1 vs 3.8±2.1 ; u =46 and 47,both P＜0.05).As for SUVmax4,statistical differences could be found at every survival group (progress vs progress free:5.3±3.9 vs 2.4± 1.7 ; recurrence vs no recurrence:5.6±4.0 vs 2.4± 1.5 ; death vs living:5.8±4.2 vs 2.6± 1.5; u =31,26 and 29,all P＜0.05).The analysis of the derived parameters of SUVma

关 键 词：食管肿瘤 放射疗法 药物疗法 体层摄影术 发射型计算机 体层摄影术 X线计算机 脱氧葡萄糖 

分 类 号：R735.1[医药卫生—肿瘤]