PET／CT代谢体积对进展期肠型胃癌新辅助化疗疗效的价值  

Value of the neoadjuvant chemotherapy with PET/CT metabolic tumor volume （MTV） in advanced gastric cancer of intestinal type

作　　者：何信佳[1] 王康[4] 王静[2] 张碧媛[1] 于丽[1] 王振光[3] 李大成[3] 赵园园[1] 

机构地区：[1]青岛大学医学院附属医院肿瘤科,266003 [2]青岛大学医学院附属医院内分泌科,266003 [3]青岛大学医学院附属医院PET/CT中心,266003 [4]青岛大学医学院临床医学系,266021

出　　处：《中华核医学与分子影像杂志》2014年第3期183-187,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的探讨基于肿瘤^18F-FDG摄取的MTV在肠型胃癌新辅助化疗（NAC）疗效评价中的应用价值。方法回顾性分析NAC前后均行^18F-FDGPET／CT检查的41例肠型胃癌患者（男28例，女13例），根据术后病理分级分为有效组和无效组。对化疗前后的原发灶SUVmax减少率、MTV减少率与病理分级的关系进行Spearman分析，利用ROC曲线分析比较MTV减少率、SUVmax减少率预测病理学反应的效能。同时以术后病理为“金标准”，利用x^2检验比较以传统影像学为基础的实体瘤疗效评价标准（RECIST）1．0与PET／CTMTV减少率预测NAC后病理学反应的准确性。结果41例患者中，有效组20例，无效组21例。化疗前后SUVmax减少率、MTV减少率与病理分级的r分别为0．434和0．763（均P〈0．01），预测病理学反应的AUC分别为0．789和0．943，差异有统计学意义（Z=2．114，P〈0．05）。以MTV减少率49．4％为评价化疗有效的阈值，其预测病理学反应灵敏度为90．0％（18／20），特异性为90．5％（19／21），准确性高于RECIST1．0[90．2％（37／41）和80．5％（33／41）；x^2=7．14，P〈0．05]。结论在FDG摄取的胃癌患者中，^18F-FDGPET／CT可用于NAC治疗反应的评价。MTV可作为评价治疗反应有效性的重要指标。Objective To investigate the feasibility and effectiveness of ^18F-FDG PET/CT in neoadjuvant chemotherapy （NAC） response in the patients with resectable advanced gastric cancer of intestinal type. Methods Forty-one patients （28 males and 13 females） with gastric cancer of intestinal type were recruited in this study. All patients received NAC and radical gastric resection, FDG PET/CT was performed before and after NAC and the histopathologic response were detected by postoperative histopathology. The reduction rates of SUVmax and MTV after NAC at primary tumor were calculated and the correlations with histopathologic grades of regression were analyzed using the Spearman correlation analysis. Prediction of pathologic response by SUVmax and MTV was assessed using ROC analysis. x^2 test and Z test were also used to analyze the accuracy of Response Evaluation Criteria in Solid Tumors （RECIST） 1.0 and reduction rate of SUVmax for predicting the pathologic response after NAC. Results Twenty patients had effective outcomes according to the histopatholgic response and others didn＇t. Both of the two metabolic parameters showed significant correlation with the histopathologic grades of regression, while the correlation factor of tumor MTV reduction rate was higher （r= 0.763, P〈0.01） than that of SUVmax reduction rate （r= 0. 434, P〈0.01）. The AUC for predicting response was 0.789 with SUVmax reduction rate and 0.943 with MTV reduction rate （ Z = 2.114, P〈0.05）. The cutoff value of MTV reduction rate was set to 49.4% for the highest accuracy for prediction of histopathologic response with a sensitivity of 90.0% （18/20） and specificity of 90.5% （ 19/21 ）. The MTV with PET/CT was a better predictor for histopathologic response than that of RECIST 1.0 criteria （accuracy： 90.2%（37/41） vs 80.5%（33/41） ;x^2=7.14, P〈0. 05）. Conclusions lSF-FDG PET/CT MTV can be used as an important indicator for assessment of NAC response in patients with resectable advanced gastric cancer of

关 键 词：胃肿瘤 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：R735.2[医药卫生—肿瘤] R730.44[医药卫生—临床医学]