^(18)F-FDG PET/CT在胃癌骨转移中的临床应用  

Clinical application of ^(18)F-FDG PET/CT in bone metastases from gastric cancer

作　　者：熊敏 张伟光[1] 樊卫[1] 林晓平[1] XIONG Min;ZHANG Weiguang;FAN Wei;LIN Xiaoping(Department of Nuclear Medicine,Cancer Prevention and Treatment Centre of Sun Yat-sen University,Guangzhou 510060,China)

机构地区：[1]华南肿瘤学国家重点实验室//中山大学肿瘤防治中心核医学科,广东广州510060

出　　处：《分子影像学杂志》2022年第1期1-7,共7页Journal of Molecular Imaging

基　　金：广东省自然科学基金(2021);广东省科技计划项目(2020A1414010227);广东省食管癌研究所基金(Q202011)。

摘　　要：目的探讨胃癌骨转移患者的临床特征以及^(18)F-FDG PET/CT在胃癌骨转移中的临床应用。方法选择2010年1月~2020年12月在中山大学肿瘤防治中心治疗前行^(18)F-FDG PET/CT检查且原发灶经病理确诊的21例胃癌骨转移患者,其中男性9例、女性12例,中位年龄57.0(28.0,81.0)岁,回顾性分析其临床资料及^(18)F-FDG PET/CT定性、半定量[最大标准化摄取值(SUV_(max))]指标特点。根据原发灶组织分化情况,将患者分为:低分化组13例(65.0%)和中-低分化组7例(35.0%)。根据Lauren分型,将患者分为:肠型组4例(20.0%),混合型组9例(45.0%),弥漫型组7例(35.0%)。根据Soloway分级将骨转移灶数量分为3组(Ⅰ级≤5,Ⅱ级6~20,Ⅲ级>20):Ⅰ级(组)6例,Ⅱ级(组)4例,Ⅲ级(组)11例。根据PET/CT上溶骨性、混合性及成骨性表现将骨转移类型分为3组:纯溶骨性转移6例,混合性(溶骨性/成骨性)11例,成骨性4例。结果本组胃癌患者发生骨转移部位依次为脊柱(19/21),肩胛骨、肋骨、锁骨、胸骨(18/21)及骨盆(17/21),其中3例伴有骨髓浸润。患者同期血清碱性磷酸酶升高11例(57.9%),乳酸脱氢酶升高7例(36.8%)。不同骨转移类型组间乳酸脱氢酶水平存在差异(χ^(2)=6.823,P=0.047),混合性转移乳酸脱氢酶升高更常见。骨转移灶SUV_(max)大小在性别、Lauren分型及Soloway分级的差异有统计学意义(Z=-1.990,H=6.326,H=6.070,P<0.05);女性组中位SUV_(max)为11.6(7.3,32.1),高于男性组的7.2(3.7,17.1);弥漫型[12.2(5.3,32.1)]及混合型组[10.8(7.2,17.2)]高于肠型组[6.7(3.7,7.3)];Soloway分级越高,即骨转移数目越多,骨转移灶的SUV_(max)越高。Soloway分级在性别上存在差异(χ^(2)=6.832,P=0.033),女性患者Soloway分级普遍高于男性。原发灶及骨转移灶SUV_(max)大小与年龄有关,低龄组(<中位年龄57.0岁)骨转移灶SUV_(max)多较高而原发灶SUV_(max)多较低(χ^(2)=5.838、10.831,P<0.05)。结论^(18)F-FDG PET/CT能够全面评估胃癌骨转移情�Objective To explore the clinical characteristics of patients with bone metastases from gastric cancer and the clinical application of ^(18)F-FDG PET/CT in bone metastasis from gastric cancer.Methods From January 2010 to December 2020,21 gastric cancer patients with bone metastases from gastric cancer who had undergone ^(18)F-FDG PET/CT before treatment at the Cancer Prevention and Treatment Centre of Sun Yat-sen University and whose primary foci were pathologically confirmed,including 9 males and 12 females with a median age of 57.0(28.0,81.0)years old.The clinical data and the characteristics of the ^(18)F-FDG PET/CT qualitative and semi-quantitative(maximum standardized uptake value SUV_(max))index were retrospectively analyzed.According to the tissue differentiation of the primary foci,the patients were divided into:13 cases(65.0%)in the hypofractionated group and 7 cases(35.0%)in the intermediate-hypofractionated group.According to the Lauren typing,the patients were divided into:4 cases(20.0%)in the intestinal group,9 cases(45.0%)in the mixed group and 7 cases(35.0%)in the diffuse group.According to Soloway classification,the number of bone metastases was divided into 3 groups(class Ⅰ≤5,class Ⅱ 6-20,class Ⅲ>20),including 6 cases of class(group)Ⅰ,4 cases of class(group)Ⅱ,and 11 cases of class(group)Ⅲ.Bone metastasis types were divided into 3 groups according to the manifestations on PET/CT(osteolytic,mixed,and osteogenic).There were 6 cases of pure osteolytic metastasis,11 cases of mixed(osteolytic/osteogenic),and 4 cases of osteogenic metastasis.Results In this group of patients with gastric cancer,bone metastases occurred in the spine(19/21),scapula,ribs,collarbone,sternum(18/21),and pelvis(17/21),of which 3 cases were accompanied by bone marrow infiltration.The serum alkaline phosphatase and lactate dehydrogenase were elevated in 11 cases(57.9%)and 7 cases(36.8%)during the same period.There were differences in lactate dehydrogenase levels between different types of bone metastasis(χ^(2)=6.8

关 键 词：胃癌 骨转移 PET/CT ^(18)F-FDG 

分 类 号：R735.2[医药卫生—肿瘤] R730.44[医药卫生—临床医学]