18氟-氟代脱氧葡萄糖PET／CT检查判断结直肠癌术后预后的临床价值  

Clinical value of Fluorine-18-fluorodeoxyglucose PET/CT examination to predict the prognosis of patients after colorectal cancer operation

作　　者：丁重阳[1] 李天女[1] 郭喆[1] 孙晋[1] 倪燕[1] 

机构地区：[1]南京医科大学第一附属医院核医学科,210029

出　　处：《中华消化外科杂志》2016年第10期1018-1025,共8页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金（80202032、81472634）

摘　　要：目的：探讨 18氟氟代脱氧葡萄糖（ 18F-FDG）PET/CT检查判断结直肠癌术后预后的临床价值。 方法：采用回顾性横断面研究方法。收集2007年3月至2015年10月南京医科大学第一附属医院收治的80例结直肠癌患者的临床病理资料。80例患者术前均行 18F-FDG PET/CT检查。完善术前相关检查后，遵循患者及家属意愿行手术治疗，依据患者具体情况施行术后辅助化疗。观察指标：（1）术前影像学检查结果。（2）治疗和随访情况。（3）预后因素分析。采用门诊及电话方式进行随访，术后第1年每3个月1次，第2年每半年1次，以后每年1次。随访内容包括肿瘤复发、进展和患者生存情况。无瘤生存时间为术后第1天至首次发现肿瘤复发、进展，患者死亡或随访截止。总生存时间为术后第1天至患者死亡或随访截止。随访时间截至2016年5月。偏态分布的计量资料以M（Qn）和M（范围）表示。以无瘤生存作为阳性事件，采用受试者工作特征（ROC）曲线获得最大标准摄取值（SUV max）、平均标准摄取值（SUV mean）、 代谢体积（MTV）及病灶糖酵解总量（TLG）的最佳界值点，并计算曲线下面积（AUC）值。如果ROC曲线下面积较小，则以中位数为界值点。采用KaplanMeier法进行生存分析。单因素分析采用Logrank 检验，多因素分析采用COX比例风险模型。 结果：（1）术前影像学检查结果： 结直肠癌患者PET/CT检查均表现为肠壁局限性增厚，肠腔狭窄，部分病灶周围脂肪间隙模糊，可见肿大淋巴结， 18F-FDG代谢异常增高。 80例患者结直肠癌原发灶SUV max、SUV mean、MTV、TLG分别为11.83（4.26，35.42）、7.06（2.38，20.92）、20.47 cm3（1.29 cm3，161.50 cm3）、138.58（14.17，857.89）。ROC曲线分析显示：SUV max的AUC=0.453［95%可信区间（CI）：0.307~0.600，P〉0.05］；SUV mean 的AUC=0.448（95%CI：0.303~0.594，P〉0.05）；Objective：To investigate the clinical value of Fluorine18fluorodeoxyglucose （ 18F-FDG） PET/CT examination to predict the prognosis of patients after colorectal cancer operation. Methods：The retrospective crosssectional study was adopted. The clinicopathological data of 80 patients with colorectal cancer who were admitted to the First Hospital of Nanjing Medical University from March 2007 to October 2015 were collected. Eighty patients received first preoperative 18F-FDG PET/CT examination and underwent operations under decisions of patients and their families, and then adjuvant chemotherapy were performed according to the patients′ condition. Observation indicators included： （1） preoperative imaging examination, （2） situations of treatment and followup, （3） analysis of prognostic factors. The patients were followed up by outpatient examination and telephone interview once every 3 months within postoperative 1 year, once every half a year within postoperative 2 years and then once a year up to May 2016. The followup included tumor recurrence or progression and survival of patients. Tumorfree survival time was from postoperative day 1 to tumor recurrence or progression and death or end of followup. Overall survival time was from postoperative day 1 to death or end of followup. Measurement data with skewed distribution were represented as M （Qn） and M （range）. The optimal cutoff point of tumorfree survival of maximum standardized uptake value （SUV max）, mean standardized uptake value （SUV mean）, metabolism of volume （MTV） and total lesion of glycolysis （TLG） were investigated using the ROC curve analysis, and calculating area under the curve （AUC）. The median was used as a cutoff point if there was smaller AUC. The KaplanMeier method and Logrank test were respectively used for survival analysis and univariate analysis, and COX proportional hazards model for multivariate analysis. Results：（1） Results of preoperative imaging examination： results of PET/CT in

关 键 词：结直肠肿瘤 预后 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：R735.34[医药卫生—肿瘤] R730.44[医药卫生—临床医学]