18F-FDG PET/CT在评估肢体软组织肉瘤预后中的价值  

18F-FDG PET/CT in Evaluating the Prognosis of Extremity Soft Tissue Sarcoma

作　　者：马欢 杨春梅 周妮娜[1] 张岩[1] 杨志[1] 李囡[1] MA Huan;YANG Chunmei;ZHOU Nina;ZHANG Yan;YANG Zhi;LI Nan(Key Laboratory of Carcinogenesis and Translational Research,Ministry of Education,Department of Nuclear Medicine,Peking University Cancer Hospital&Institute,Beijing 100142,China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所核医学科,恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142 [2]北京密云妇幼保健院病理科,北京101500

出　　处：《中国医学影像学杂志》2020年第8期615-621,共7页Chinese Journal of Medical Imaging

摘　　要：目的评价18F-FDGPET/CT在肢体软组织肉瘤(ESTS)预后中的价值。资料与方法回顾性分析行18F-FDG PET/CT并经病理证实的52例ESTS患者,分析性别、年龄、病变部位、深度、平均径、最大标准化摄取值(SUVmax)、SUVmax/平均径、密度、有无钙化、有无液化坏死、有无周围侵犯、有无淋巴结和(或)远处转移等指标与病理分级的关系,随访3~79个月。采用受试者工作特征(ROC)曲线分析,比较其区分中低级别与高级别ESTS的诊断准确性;采用Cox回归分析探讨影响无疾病进展生存(PFS)和总体生存(OS)的因素。结果52例患者中,高级别组38例,中低级别组14例,两组SUVmax差异无统计学意义(8.71±10.86比9.26±5.60,P>0.05),而病变平均径[(10.28±3.82)cm比(6.48±3.57)cm]、密度、有无液化坏死及有无淋巴结和(或)远处转移方面差异有统计学意义(P<0.05),ROC曲线下面积分别为0.791、0.648、0.714和0.658。41例获得随访,中位随访时间20(14,41)个月,仅SUVmax是OS及PFS的独立危险因素(P<0.05),SUVmax>7.47的患者疾病进展、死亡风险均高于SUVmax≤7.47者[HR分别为3.05(95%CI 1.15~8.11)和12.39(95%CI 1.52~100.65)]。结论高级别ESTS患者病变相对小且实、伴液化坏死、合并淋巴结和(或)远处转移。SUVmax不能明确ESTS的组织学分级,但是影响患者生存的独立预后因素。Purpose To evaluate the value of 18F-FDG PET/CT in the prognosis of extremity soft tissue sarcoma(ESTS).Materials and Methods Fifty-two patients with ESTS who underwent 18F-FDG PET/CT and pathologically confirmed were retrospectively analyzed.The correlations between gender,age,location,depth,mean diameter,maximum standardized uptake value(SUVmax),SUVmax/mean diameter,density,calcification,liquefactive necrosis,peripheral invasion,lymph nodes and/or distant metastases and pathological grade were analyzed.All patients were followed up for 3-79 months.Receiver operating characteristic curve was used to compare the diagnostic accuracy of each index in distinguishing low/intermediate-grade from high-grade ESTS.Cox regression analysis was used to analyze the prognostic factors of progression free survival(PFS)and overall survival(OS).Results Among the 52 patients,38 were in the high-grade group and 14 were in the low-grade group.There was no significant difference in SUVmax between the two groups(8.71±10.86 vs.9.26±5.60,P>0.05),while the average diameter of the lesion was[(10.28±3.82)cm vs.(6.48±3.57)cm],density,presence or absence of liquefaction necrosis,lymph node and/or distant metastasis were statistically significant(P<0.05),the area under the ROC curve was 0.791,0.648,0.714 and 0.658.41 cases were followed up with a median follow-up time of 20(14,41)months.Only SUVmax was an independent risk factor for OS and PFS(P<0.05).Patients with SUVmax>7.47 had a high risk of disease progression and death compared with those with SUVmax≤7.47[HR were 3.05(95%CI 1.15-8.11)and 12.39(95%CI 1.52-100.65)].Conclusion The lesions in patients with high-grade ESTS are relatively small and solid,with liquefaction and necrosis,combined with lymph nodes and/or distant metastases.SUVmax cannot clarify the histological grade of ESTS,but it is an independent prognostic factor that affects patients’survival.

关 键 词：软组织肿瘤 四肢 体层摄影术 X线计算机 正电子发射断层显像术 最大标准化摄取值 氟脱氧葡萄糖F18 预后 

分 类 号：R738[医药卫生—肿瘤] R730.44[医药卫生—临床医学]