^(18)F-FDG PET/CT在探查肝胆恶性肿瘤免疫联合治疗中免疫相关不良反应的应用价值  

Clinical value of 18F-FDG PET/CT imaging for detecting immune related adverse events of the combined immunotherapy in hepatobiliary carcinoma

作　　者：王雪竹 王静楠 胡桂兰 丁洁 任超 杨旭 赵海涛 李方 霍力 Wang Xuezhu;Wang Jingnan;Hu Guilan;Ding Jie;Ren Chao;Yang Xu;Zhao Haitao;Li Fang;Huo Li(Department of Nuclear Medicine,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences Beijing Key Laboratory for Molecular Targeted Diagnosis and Therapy in Nuclear Medicine,Beijing 100730,China;Department of Liver Surgery,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中国医学科学院、北京协和医学院北京协和医院核医学科、核医学分子靶向诊疗北京市重点实验室,北京100730 [2]中国医学科学院、北京协和医学院北京协和医院肝胆外科,北京100730

出　　处：《中华核医学与分子影像杂志》2022年第6期352-356,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：国家自然科学基金(81571713);中国医学科学院医学与健康科技创新工程(2018-I2M-3-001)。

摘　　要：目的:研究^(18)F-FDG PET/CT监测肝胆恶性肿瘤免疫联合治疗疗效和免疫相关不良反应(irAEs)的能力。方法:21例接受免疫联合治疗晚期肝胆恶性肿瘤患者[男14例、女7例,年龄(58.5±10.0)岁]于2018年8月至2019年7月在北京协和医院按常规方法行66次^(18)F-FDG PET/CT检查,回顾性收集患者治疗前后PET/CT影像特点,获得病灶SUV_(max),分析irAEs出现时间、症状等,并采用实体瘤治疗疗效PET评价标准(PERCIST)评价疗效[完全代谢缓解(CMR)、部分代谢缓解(PMR)、代谢稳定(SMD)和代谢进展(PMD)]。结果:(1)临床结果。5例患者未出现irAEs,16例出现22次irAEs,累及6个脏器;其中,甲状腺炎8次、结肠炎5次、肺炎4次、皮疹2次、肝炎2次、肌炎筋膜炎1次,出现的时间分别为治疗后(103.0±58.0)、(141.6±103.5)、34.0(6.0,308.8)、9和117、62和67及87 d。PET/CT检出全部肺炎和肌炎筋膜炎,检出结肠炎4次、甲状腺炎6次,未检出皮疹和肝炎。(2)irAEs PET/CT征象。除甲状腺炎外,irAEs病灶在同机CT上均有渗出样改变,在PET上表现异常浓聚,SUV max分别为9.0(7.9,17.6)(结肠炎)、7.1±3.2(甲状腺炎)、5.3和8.6(肺炎)、4.1(肌炎筋膜炎)。(3)疗效评估。21例患者中,PMR、SMD和PMD分别有7、9和5例;irAEs组对应分别有7、8和1例,无irAEs组对应分别有0、1和4例。结论:晚期肝胆恶性肿瘤患者可从免疫联合治疗方法中获益,^(18)F-FDG PET/CT通过同时观察肿瘤病灶变化及irAEs出现情况评估免疫联合治疗效果,但需结合同机CT以鉴别肿瘤进展与irAEs。Objective To investigate the capability of ^(18)F-FDG PET/CT imaging in monitoring combined immunotherapy response and detecting immune related adverse events(irAEs)in patients with advanced hepatobiliary carcinoma.Methods From August 2018 to July 2019,21 patients(14 males,7 females,age(58.5±10.0)years)with advanced hepatobiliary carcinoma routinely underwent 66^(18)F-FDG PET/CT examinations in Peking Union Medical College Hospital.SUVmax,the occurrence time and symptoms of irAEs were obtained and analyzed.Therapy response(complete metabolic response(CMR),partial metabolic response(PMR),stable metabolic disease(SMD),progressive metabolic disease(PMD))was evaluated according to PET response criteria in solid tumors(PERCIST).Results(1)Clinical results.Twenty-two irAEs occurred in 16 patients,while were not found in 5 patients.Six organs were involved,including thyroiditis(8),colitis(5),pneumonitis(4),rash(2),hepatitis(2),myositis and fasciitis(1).The appearance time of each irAEs were(103.0±58.0),(141.6±103.5),34.0(6.0,308.8),9 and 117,62 and 67,and 87 d after therapy,respectively.PET/CT detected all pneumonitis and myositis and fasciitis,but no rash and hepatitis were found.For colitis and thyroiditis,PET/CT detected 4 and 6 times respectively.(2)PET/CT signs of irAEs.Except thyroiditis,all irAEs lesions exhibited exudative changes in CT and high-avidity in PET.SUV_(max) of the lesions were 9.0(7.9,17.6)(colitis),7.1±3.2(thyroiditis),5.3 and 8.6(pneumonitis),4.1(myositis and fasciitis),respectively.(3)Therapy assessment.Among 21 patients,there were 7 for PMR,9 for SMD,5 for PMD,which were 7,8,1 in patients with irAEs and 0,1,4 in patients without irAEs.Conclusions Patients with advanced hepatobiliary carcinoma can benefit from combined immunotherapy.^(18)F-FDG PET/CT can be used to evaluate the efficacy of immunotherapy by detecting the changes of tumor lesions and the occurrence of irAEs simultaneously.However,it is necessary to use CT to distinguish tumor progression from irAEs.

关 键 词：免疫相关不良反应 免疫疗法 正电子发射断层显像术 体层摄影术 X线计算机 氟脱氧葡萄糖F18 

分 类 号：R735.8[医药卫生—肿瘤] R730.44[医药卫生—临床医学]