^(18)F-FDGPET/CT在评价索拉非尼治疗^(131)I难治性分化型甲状腺癌疗效中的应用  

^(18)F-FDG PET/CT imaging in the monitoring of response to sorafenib in patients with radioiodine-refractory differentiated thyroid cancer

作　　者：刘敏[1] 程凌霄[1] 阮茂美[1] 罗全勇[1] 陈立波[1] 

机构地区：[1]上海交通大学附属第六人民医院核医学科,上海200233

出　　处：《中国癌症杂志》2016年第1期88-96,共9页China Oncology

基　　金：国家自然科学基金(81271609);上海市科技启明星(12QH1401600)

摘　　要：背景与目的:肿瘤的疗效评价是阻碍确定肿瘤治疗最佳策略的因素之一。在淋巴瘤及其他实体肿瘤,基于正电子发射断层显像/电子计算机断层扫描(positron-emission tomography/computed tomography,PET/CT)的疗效评价的价值已经显现,尤其是对于靶向治疗(导致肿瘤活性改变而肿瘤大小可能未变)的疗效评价。通过对比实体瘤反应评价标准(Response Evaluation Criteria in Solid Tumors,RECIST 1.1)和欧洲癌症研究和治疗组织(European Organization for Research and Treatment of Cancer,EORTC)标准,研究18F-FDG PET/CT在评价索拉非尼(sorafenib)治疗^(131)I难治性分化型甲状腺癌(radioiodine-refractory differentiated thyroid cancer,RR-DTC)疗效中的作用。方法:回顾性分析2011年—2014年索拉非尼治疗前和治疗3个月后均行^(18)F-FDG PET/CT检查的14例RRDTC患者(男性6例,女性8例,平均年龄55.6岁)。用Wilcoxon符号秩和检验分析靶病灶直径之和与∑SUVmax变化百分比的差异。用χ~2检验比较两种标准的疗效评分有无差异。用Wilcoxon秩和检验比较按照RECIST 1.1或EORTC标准不同反应组间的无进展生存期(progression-free survival,PFS)有无差异。用Spearman秩相关评估PFS与形态学(RECIST 1.1)或功能学(EORTC criteria)反应分组的相关系数。结果:不同反应组间靶病灶直径之和与∑SUVmax变化百分比差异无统计学意义(Z=-0.408,P=0.683)。根据两种评价标准,14例患者中10例的评价结果是一致的(χ~2=2.345,P=0.424),其余4例中,2例为SD/PMR,2例为SD/PMD。无论是按照RECIST 1.1(χ~2=8.571,P=0.003)还是按照EORTC标准(χ~2=8.781,P=0.003),各反应组间的PFS均有差异。PFS既与形态学评价结果相关(r=0.741,P=0.002),也与代谢学评价结果相关(r=0.816,P=0.000 4)。结论:18F-FDG PET/CT可用于RR-DTC患者索拉非尼治疗后的疗效评价。尽管71.4%的患者RECIST 1.1和EORTC标准结果一致,但是基于PET的代谢学评价标准在预测治疗效果方面更为准Background and purpose： The evaluation of treatment response is one of the most important building blocks in determining the best strategy for the management of malignant tumors. In lymphoma and several solid cancer types, PET/CT-based response evaluation has been shown to be valuable, especially in visualizing the effect of the targeted treatment, which induces tumor activity changes not necessarily followed by tumor shrinkage. This study aimed to evaluate the role of 18F-FDG PET/CT in the monitoring of response to sorafenib treatment in radioiodine-refractory differentiated thyroid cancer （RR-DTC） patients; and to compare the Response Evaluation Criteria in Solid Tumors （RECIST 1.1） with the European Organization for Research and Treatment of Cancer （EORTC） criteria. Methods： This was a single-centerretrospective analysis of 14 patients with RR-DTC treated with sorafenib in the period from Dec. 2011 to Dec. 2014. A Wilcoxon signed-rank sum test was used to assess the differences in percentage changes between the sum of diameter and ∑ SUVmax. These values of responses were statistically compared using the chi-square test （Fisher＇s exact test）. The differences in PFS between response categories according to either RECIST 1.1 or the EORTC criteria were evaluated using the Wilcoxon signed-rank sum test. The Spearman rank correlation coefficient was estimated between PFS and either morphologic （RECIST 1.1） or metabolic response （EORTC criteria） categories. Results： There was an agreement between the RECIST 1.1 and EORTC criteria in 10 of the 14 patients （x2=2.345, P=0.424）. The remaining 4 patients with SD in- cluded 2 patients with PMR and 2 patients with PMD. Differences in PFS among different response categories according to either RECIST 1.1 0（2=8.571, P=0.003） or EORTC criteria （22=8.781, P=0.003） were statistically significant. Correlations were found between PFS and either morphologic （r=0.741, P=0.002） or metabolic （r=0.816, P=0.0004） response criteria. C

关 键 词：18F-FDG PET/CT RECIST 1.1 EORTC 131I难治性分化型甲状腺癌 索拉非尼 

分 类 号：R736.1[医药卫生—肿瘤]